Saturday, October 9, 2010

Medicare funding from 1 November 2010

The Health Insurance (Midwife and Nurse Practitioner) Determination 2010 has been released. To search for the legislative instruments click here.

We will keep our readers informed as soon as we hear of any progress by midwives in incorporating Medicare into their private practices.

There are widely different opinions held as to what the Medicare-Midwife will look like, what she will be required to do. Here is a section from the piece of regulation, the National Health (Collaborative arrangements for midwives) Determination 2010
5 Collaborative arrangements — general
(1) For the definition of authorised midwife in subsection 84 (1) of the Act, each of the following is a kind of collaborative arrangement for an eligible midwife:
(a) the midwife is employed or engaged by 1 or more obstetric specified medical practitioners, or by an entity that employs or engages 1 or more obstetric specified medical practitioners;
(b) a patient is referred, in writing, to the midwife for midwifery treatment by a specified medical practitioner;
(c) an agreement mentioned in section 6 for the midwife;
(d) an arrangement mentioned in section 7 for the midwife.

(2) For subsection (1), the arrangement must provide for:
(a) consultation between the midwife and an obstetric specified medical practitioner; and
(b) referral of a patient to a specified medical practitioner; and
(c) transfer of a patient’s care to an obstetric specified medical practitioner.


This is legislative language that confuses many.

The Medicare-Midwife (medi-wife) will:

* have a close working relationship with a group of obstetricians (no doctors work 24/7 these days)
* provide prenatal checks in the community, possibly in 'rooms' shared with obstetricians or other doctors (it has been suggested that a new GP Superclinic could include medi-wives)
* attend births in private hospitals where she has visiting access, and where the 'senior' member of the professional team is always the obstetrician
* be able to order basic tests and prescribe basic drugs, such as oxytocics
* provide postnatal services for mothers and babies in hospital, and possibly at home.

It is not yet clear whether public hospitals, which currently provide obstetric backup for the clients of privately practising midwives who plan homebirth, will accept the new medi-wife as a practitioner with visiting access.

Midwives are at present contacting public hospitals and requesting details of the hospitals' processes and time lines in preparation for enabling midwives to practise in the hospitals with visiting access.


Joy Johnston said...

The following comment has been posted online at the Australian Doctor by Dr Harry Hemley, President AMA Victoria.

"The Federal Government's plans for independent midwifery prescribing through the PBS next month will not come to pass in Victoria.
"The Victorian legislation bringing national registration into effect did not contain any provisions for midwifery prescribing. This is a significant win, as it resists significant federal government pressure and means that Australia's most liberal prescribing regime does not see the merits at this point in midwifery prescribing.
"Midwives cannot legally prescribe, which means that the PBS access issue is moot in this state."
Posted by Dr Harry Hemley, President AMA Victoria 12/10/2010 2:37:34 PM

Joy Johnston said...

With reference to the previous comment, that the Victorian legislation "did not contain any provisions for midwifery prescribing." [note that "This is a significant win, ..."!:)]
Advice about the legislative changes, received by midwives is that
"Access to the PBS is JUST access to a rebate for drugs prescribed and it has handled at a Federal level. Whether you have access to PRESCRIBE is handled by the legislation at a state level, by the various drugs and poisons acts.
"Each state has to change their legislation to fit with PBS access. Some states are slower than others. NSW, for example, has already changed and midwives will be able to prescribe and use the PBS."

With only a fortnight before the commencement of Medicare and related changes at 1 November, midwives are still waiting for a process to follow when applying to be eligible.