Tuesday, October 18, 2011

the reshaping of private midwifery practice

Private midwifery practice is undergoing real changes, as midwives who have Medicare provider numbers are able to offer certain midwifery services for which women will receive substantial Medicare rebates. 

There is scheduled fee for each item, from which rebates are calculated [variation in amount payable depends on a person's safety net]. For example:

  • Initial antenatal professional attendance (history) [Item # 82100] $51.35 
  • Short antenatal consultation (less than 40 minutes) [Item # 82105] $31.10 
  • Long antenatal consultation (more than 40 minutes) [Item # 82110] $51.35 
  • Maternity Care Plan meeting after 20 weeks (at least 90 minutes) [Item # 82115] $306.90 
  • Attendance for labour and birth planned hospital birth (when midwife has visiting access) [Item # 82120] $724.75 
  • Short postnatal consultations in your home (less than 40 minutes) [Item # 82130] $51.35 
  • Long postnatal consultations in your home (more than 40 minutes) [Item # 82135] $75.55 
  • 6-7 week postnatal review of mother and baby [Item # 82140] $51.35 
Midwives in private practice have, to a great extent, built our practices on attending women for homebirth.  The 'niche' in the market has grown slowly over the years.  The midwife primary carer is responsible to provide antenatal, birth, and postnatal midwifery care, and to refer appropriately if medical care is indicated.

Homebirth programs with public funding are a fairly recent innovation in Victoria.  Pilot programs offering homebirth out of Casey and Sunshine hospitals, both situated in Melbourne's population growth corridors, are being evaluated before any roll-out of this option within public hospital systems.

Midwives in private practice (MIPPs) who are eligible for Medicare provider numbers, as well as those who have not sought the eligibility notation, are continuing to provide homebirth services.

In considering the reshaping of private midwifery practice, I would encourage the reader to reflect on the complex nature of consumer 'demand', social expectations around birth, and financial considerations in decisions around maternity care.

The government's reforms, enabling Medicare rebate for certain midwifery items, will not, of themselves, result in women flocking to private midwifery care.  The number of eligible midwives is small, and the capacity of each midwife to take client bookings for care across the pre-intra-postnatal continuum is limited.   There are at present no hospitals in Victoria, public or private, where a midwife has authority to attend a labouring/birthing woman, even though many of the Medicare-authorised midwives have purchased the government-supported indemnity insurance that covers intrapartum care. 

One potential growth area for MIPPs is with a new group of women: those who have given birth in hospital, and who wish to access private midwifery care postnatally, in addition to what has been provided by the hospital (private or public) where they gave birth.  The Medicare item numbers and rebates for postnatal care in the 6-7 weeks after birth will make this option more attractive than it has been in the past.

Midwives practising privately could meet a real need, particularly with women who are experiencing difficulties with breast feeding, or other complex needs within the scope of the midwife's practice.  Midwives may choose to bulk bill or charge rebate only in certain situations, but it is likely that in most instances there will be a co-payment.  Electronic payment and rebate options are available for midwives to set up with their bank and Medicare.

There does not seem to be any cap on the number of rebate claims a woman can make in that period of time. Although it doesn’t come anywhere near the ideal of continuity of carer through the whole episode of care, it would give that woman a known midwife to consult with through weeks 1-6.

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