Change is Occurring
FEDERAL LEGISLATIVE NEWS
Big Picture Shows Positive Movement for Midwifery
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by Patrick Cooney, ACNM Federal Lobbyist
re you still wondering if change will ever come for midwifery? Does it seem like the profession is talking about the same barriers to practice it did a decade ago? You are not alone. Change may be slow, but if you stop to look around, you will see movement in the right directions. Take, for example, reimbursement for midwifery services under Medicare. Prior to January 1, 2011, CNMs were reimbursed under the Medicare program at 65% of what physicians were reimbursed under the Part B fee schedule. The Affordable Care Act included a provision which provided CNMs equity in reimbursement with physicians. But what has really changed during the ensuing 3 years? According to the Center for Medicare and Medicaid Services (CMS), total
CNM reimbursement from Medicare has increased dramatically. In 2010, the year
before the new reimbursement rate, CNM billing under Medicare amounted to $1.5 million. In 2011, total CNM billing under Medicare more than doubled to over $3.1 million. Positive movement has also happened relating to the resources midwives are receiving from the CMS to adopt electronic health records. Midwives became eligible for the program in 2009. As of April 2013,
2189 CNMs have taken advantage of the incentive payment program for a total of payments equaling $42,041,000.
with 1.8 million deliveries in 2008 (46% ternity care providers. In areas with of total births) at a cost of over $11 billion few obstetricians, much of this care to the federal government. The report is delivered by family physicians and anticipates challenges forthcoming with midwives. Fewer family physicians have the expansion of Medicaid, and focuses on been providing maternity care over time. critical issues relating to quality measures The trend is reversed for midwives: in and access to providers. Key highlights from the Two federal bills of critical importance to MACPAC report include: ACNM were recently introduced in Congress. • Access to OBGYNs and Rep. Lucille Roybal-Allard (D-CA) introduced midwives is a significant the “Maximizing Optimal Maternity Services issue in many areas of the for the 21st Century Act of 2013” also country: in 2004, nearly known as the MOMS 21 bill, H.R.2286. The 50% of US counties had legislation would improve maternal health no OBGYNs providing outcomes in the United States by harnessing direct patient care and 85% the best evidence in maternity care delivery. of counties fell below the Learn more at http://bit.ly/17zdgPc. The national ratio. This indicates Quality Care for Moms and Babies Act, S. that, as with primary care 425/HR 896, was also introduced in both physicians, the nationwide houses by Senators Stabenow (D-MI) and ratio is being driven by the Grassley (R-Iowa), and Rep. Eliot Engel metropolitan counties that (D-NY). The bill would provide funding have high concentrations of for inter-professional collaboratives to OBGYNs. Relative to popuimprove care and update quality measures lation, rural counties had used by Medicaid. Learn more at http:// less than half the number of bit.ly/18qOqUN. Please encourage your OBGYNs that metropolitan legislators to co-sponsor these bills! counties did (1.4 versus 3.3 per 10,000, respectively).
Ninety-three percent of counties that had no OBGYNs also had no CNMs in 2003.
• The number of hospitals offering
While barriers to practice remain, these are positive signs of movement for midwives that will aid the growth of practices across the nation. Work continues as ACNM seeks to improve access to midwifery care.
obstetric services has also been declining over time, particularly in rural counties that may already have a shortage of OBGYNs. Forty-four percent of
rural counties lacked hospital-based obstetric services in 2002, compared with 24% in 1985. In the mid-1980s,
2010, midwives attended 8.4% of all US births, up from 7.8% in 2000. • Barriers to midwifery practice remain, including l ??\?YYX?ZY ^[Y[? ? ?[]]?H ???S??[?X[?H ?]\????][ ?]?[Y?[?? ?X?Y\? ?Y?\?[?? ??Y\?? ?? ?X?X?H[?[?]Y[? ?] [????[? ?]H ???H? ?X?X?H]??HH?[[??\? ?Y? ]X[] H ??Y[??&\?X[ ?\?H ?\??X?\? ?[???H ?? ?Y?\??Y? ??[Y[X?\? ] ???\??\??Z[??XYK[? ]]\? \ ? \? ??Y\ H?[YH?\??[?????\?\? ?Y??\? ] ?[ ?Y X?H?\??Y\?? ?ZY ?Y?\?H ?X?X?K?? ?] ?X???Y\?[? ???B??PP?P??\???HH ?\?\??YY?H HYYX?ZY[??T^[Y[?[?X??\????[Z\??[?
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