Friday, January 14, 2011

Preparing for Medicare

Wonderful artwork by Poppy to brighten the page.
In early December I wrote about the fact that I had submitted my application to be noted as eligible for Medicare (see blog). I have been told that this application is being processed.
In preparation for submitting an application, all midwives are required to participate in a Professional Practice Review approved by the Board (NMBA). The review that I undertook is the Midwives in Private Practice Professional Practice Review ('MIPP PPR' for short) which had previously been submitted to the Board for approval. Having worked on the MIPP PPR since its introduction in 2002, I enjoyed updating it to meet the written requirements of the new Board, and then undertaking a practice review, and presenting my findings to an experienced and respected midwife colleague.

The MIPP PPR enables a midwife who practises in primary maternity care settings to demonstrate personal competence to peer reviewers of the full scope of midwifery practice, as defined by the International Confederation of Midwives (ICM 2005), and further developed in current Australian midwifery codes and standards.

The MIPP PPR requires the midwife to make a systematic recording of :
  • quantitative summaries of practice data across the continuum of care
  • reflective accounts of specific situations in which the midwife acted to promote normal birth and ensure safety and wellbeing for mother and/or baby in her care
  • consultation and referral to appropriate specialist care providers when clinically indicated, or at the woman’s request
  • ongoing education, and continuing professional development
  • examples of client feedback
The MIPP PPR enables discussion with well informed peers of implementation of contemporary best practice standards, and application of evidence into a midwife’s practice, and sets down ongoing practice goals and subsequent commitment to professional development.

I have given a lot of thought to the importance of achieving the notation as eligible for Medicare under the new laws, and even though Medicare enables public funding rebates for our clients, for the midwife it's not about the money. A midwife is limited by the number of women we are able to provide primary maternity care for, particularly when practising across the pregnancy-birth-postnatal spectrum. The commitment I make to individual women, to be with them when their time to give birth comes, demands a great deal of emotional as well as physical energy. The number of women a midwife can book at any time is one of the most limiting factors of our professional lives. We can't work like some other health professionals, who can book two patients for every 10-minute segment in a working day.

Achieving Medicare means, for me, that I am striving to achieve the highest level of clinical practice that is recognised in our community. It means that I, as an older midwife, am forging pathways that other midwives who come this way after me will be able to take with confidence. It means that I am using whatever processes our government has set up to enhance my professional status.

Concern continues in midwifery and birthing communities about the new requirements for collaboration with medical practitioners, in order to access Medicare rebates. I acknowledge the points of concern, and am working through the regulations in an attempt to comply with the requirements, while continuing to provide authentic and expert midwifery services to the women in my care, without submitting to medical supervision. I will attempt to keep blog readers informed as time goes by.

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