Pay equity for midwives
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Certified nurse midwife Abigail Rizk lets Summer Arrigo-Nelson listen to her child's heartbeat during her first exam at The Midwife Center in the Strip District. Because of new changes in coverage, Mrs. Arrigo-Nelson plans to deliver her baby at the center, rather than a hospital. -
Christine Haas is the executive director of the Midwife Center.
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One little-noticed health care change going into effect this month appears in Section 3114 of the Patient Safety and Affordable Care Act.
In short, it says certified nurse midwives will now receive the same Medicare reimbursement as physicians when they provide the same services, from prenatal care to routine deliveries. They had been getting only 65 percent of the physician's fee.
The obvious question: What does a profession that specializes in childbirth have to do with a program for people 65 and older?
It has to do with setting a standard. Where Medicare goes, private insurance usually follows. Anyway, that is the hope of midwives and midwife birth centers everywhere.
This week, Pennsylvania's Department of Public Welfare sent out a questionnaire to the state's five licensed birth centers to gather cost data so it can review Medicaid payment rates -- a sign that reimbursements for birth centers may increase, too.
And, as contracts with private insurers come up for renegotiation in the next few years, the Medicare reimbursement increase is sure to come up in the discussions.
"The new law will help make midwife and birth center services more accessible and viable, which will ultimately lower costs to the health-care system as well as improve outcomes," said Christine Haas, executive director of the Midwife Center for Birth and Women's Health in the Strip District, the only licensed free-standing birth center in Western Pennsylvania. The area's other major program is at Magee-Womens Hospital of UPMC.
The Medicare reimbursement schedule does apply immediately to many military families and those who are Medicare-eligible due to a disability.
The change in the reimbursement formula is coming just as some local hospitals have either moved or closed their obstetrical delivery service. Ms. Haas said the Midwife Center at Penn Avenue near 28th Street, which has had about 240 births annually in recent years, is expecting that to increase to about 290 this year.
"Unlike a lot of businesses," she said with a smile, "we have the ability to project out a good six months."
One reason their numbers are growing, Ms. Haas said, is the nationwide impact of the 2008 documentary film "The Business of Being Born," which looks at different childbirth options and lays out an unflattering portrait of hospital-based obstetrical delivery.
"It raised awareness for alternatives," she said. "I think a lot of women are looking for alternatives because the C-section rate is getting so high in this country."
Another likely factor is cost. According to one statewide survey, the average charge for a midwife delivery at a birth center is $4,600, compared with $7,737 for a vaginal delivery at a hospital and $10,958 for a cesarean delivery.
That becomes more of an issue as employers cut back or drop insurance coverage for their workers and more families shift to high-deductible plans to lower their premiums.
California University of Pennsylvania biology professor Summer Arrigo-Nelson and her husband, John, of Munhall are expecting their first child, and she said she was delighted to find the Midwife Center.
"I just wanted to use a birthing option where people would be more open to it just being a natural process," she said. With a routine, uncomplicated pregnancy, she added, "I just don't see a hospital birth as a necessity."
As much as she prefers the home-like birth center to the clinical atmosphere at a hospital, though, Dr. Arrigo-Nelson said using a midwife probably would not have been an option if their health insurance didn't cover it.
And that's where the increased reimbursements can help.
According to tax records, the Midwife Center ended 2009, the latest figures available, with a reserve of $177,031 following a two-year fundraising campaign; but that follows losses in the two previous years of $49,134 in 2008 and $12,084 in 2007.
"The money that we receive from insurers, either private or public, pretty much covers what we do, and the fundraising helps to subsidize care," said Ms. Haas.
But that doesn't cover capital expenses or the purchase of an electronic health records system -- nor does it necessarily even cover the utility bills. The higher reimbursement, she said, will allow the center to address those needs -- as well as make the service more accessible to expectant mothers -- without depending on perennial fundraising campaigns.
"We'd like not to have to sit down with our donors and say, 'Our heating and ventilation system is out of date. Can you help us?'"
First Published January 11, 2011 12:00 am
