Thursday, August 1, 2013

amended regulation

On July 25th 2013 the Health Insurance Amendment (Midwives) Regulation 2013 was introduced.
The purpose of this regulation is to enable midwives to have collaborative arrangements that provide pathways for consultation, referral and transfer of care to specified medical practitioners employed or engaged by a public or private hospital or other entity such as a health service, through an arrangement with the hospital or entity.

This new regulation adds a new type of collaborative arrangement for an eligible midwife who is credentialed by a hospital, having successfully completed a formal assessment of her or his qualifications, skills, experience and professional standing.  At present processes exist with some public maternity services for midwives to be recognized as shared antenatal care affiliates.  It would seem reasonable to expect that these processes could be extended to meet the requirements for collaborative arrangements during intranatal and postnatal care as well as antenatal. 

Three years ago, in April 2010, the Health Insurance Act (1973) was amended to provide for new arrangements to enhance and expand the role of certain midwives, allowing for a greater role in the provision of quality health services through primary maternity care.  Since the measure was introduced, midwives have reported ongoing difficulties in establishing collaborative arrangements. This has hindered their ability to participate in the Medicare arrangements, and has prevented some women from receiving Medicare rebates.  

Midwives who have achieved endorsement on the AHPRA Register of Midwives as Eligible (for Medicare and Prescribing) have achieved a high standard of clinical practice.  They have gone to considerable financial and personal cost, in complying with the requirements of the Board.  When a midwife is in private practice, with a Medicare provider number and a Prescriber number, that midwife has access to the most advanced model of clinical practise in primary maternity care available to midwives in Australia.

A few midwives participating in Medicare have a collaborative arrangement in the form of a signed agreement with an obstetric medical practitioner: an arrangement that applies to all women in their care.

Most midwives, however, require a separate collaborative arrangement for each woman in their care.  This is the reason many midwives have reported ongoing difficulties in establishing collaborative arrangements. Each collaborative arrangement needs to be requested, and negotiated separately.   

One of the options for collaboration is referral:
5 (1) (b) a patient is referred, in writing, to the midwife for midwifery treatment by a specified medical practitioner;

A general practitioner doctor (GP) who provides obstetric services, such as shared antenatal care, is able to act as a specified medical practitioner who refers a woman to an eligible midwife for midwifery treatment.  

Midwives who have received letters of referral, or other collaborative arrangements, from GPs or obstetricians, recognise that there have been areas of uncertainty and difficulty in establishing meaningful collaboration that meets the legislated requirements and is in the interests of the wellbeing of the mother and her baby.  Some GPs have expressed serious concerns about their liability, should there be an adverse outcome at some time in the future.  No amount of assurance by the midwife that she/he is accountable, and insured (except for homebirth) will satisfy a doctor if their insurer tells them not to take the risk of supporting midwives.

In recognition of the difficulties experienced by midwives in achieving collaborative arrangements, the government agreed to expand the types of collaborative arrangements available to midwives in an attempt to make it easier for midwives to work collaboratively with medical practitioners employed or engaged by hospitals or other health services. This amendment to the regulations potentially takes the pressure off GPs, in that midwives will (theoretically, at least) be more able to establish collaborative agreements with hospitals.  The woman's GP will not be ignored, as there is a continuing requirement for a discharge letter, copies of any test and investigation results, and reports of referrals, to be sent to the GP.

MIPP is engaging in ongoing discussions with public maternity hospitals, in an effort to forge new pathways for credentialing by the hospitals for midwifery care that spans the full episode of care. 

Perhaps this amended regulation will be the impetus for progress in maternity hospitals that have, to date, been resistent to change.  The need for collaborative arrangements to be facilitated through the public maternity hospitals to which we refer women in our care is obvious.  The systems need to be seamless and transparent, protecting the wellbeing and safety of mother and child, as well as offering a reliable and accountable process for members of the midwifery profession, and for the hospital and its employees.

Your comments are appreciated.

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