Tuesday, March 30, 2010

A Win for the Little People

by Heather Bradford, CNM, ARNP
Chair, ACNM Government Affairs Committee

Tuesday, March 23, was a big day for many Americans when the President signed major health care reform legislation into law. But Tuesday was an even BIGGER day for midwives. Under this new law, after 19 years of hard work, certified nurse-midwives (CNMs) will be equitably reimbursed for their services under Medicare beginning January 1, 2011.

It would seem like receiving our current rate—65% of what physicians receive from Medicare—wouldn’t be that much of a hardship on a day-to-day basis for most midwives, as we don’t care for many women covered by Medicare. But receiving 100% is a very important change because Medicare often serves as the gold standard of reimbursement rates. For example, I just learned last week that Aetna is reducing its reimbursement rate in Washington State (and many other states) for nurse practitioners, physician assistants, and certified nurse-midwives to 85% of what physicians receive starting June 1. It’s not a coincidence that they did not apply these new rates to certified nurse anesthetists, as they currently receive 100% under Medicare. Other insurers who have a discrepancy in rates include Blue Cross Blue Shield and Regence, and I am sure there are many others. There are also 22 states where Medicaid currently reimburses CNMs less than 100% for their services. What’s their reasoning? That’s the interesting part—they don’t have to give one.

When we midwifery advocates lobbied on this bill, we explained to legislators that a pap smear is a pap smear is a pap smear. Meaning—it doesn’t matter what the letters are after your name; as long as you are qualified and licensed to perform it, you should be equitably reimbursed. But for CNMs, this took a lot of education, phone calls, e-mails, letters, trips to DC, and downright begging to convince legislators to understand. I have been lobbying on this bill since 2001, and there were many midwives that came before me who are celebrating just as loudly as me. So, here’s a toast to us little people who have finally won one in the battle against the giants. Watch out, private insurers and Medicaid states. The new gold standard rate for CNMs is 100%.

Editor’s note: If you have been involved in gaining support for equitable reimbursement for CNMs at any point in time—by contacting your members of Congress, visiting Capitol Hill, or working to mobilize support—help ACNM thank and celebrate you by sending your name, picture, and a sentence or two about your involvement to pr@acnm.org. And, while you’re at it, leave a comment on this post!

From left to right: ACNM Executive Director Lorrie Kline Kaplan; Midwives-PAC President Katy Dawley, CNM, PhD, FACNM; Representative Jim McDermott (D-WA); ACNM Government Affairs Committee Chair Heather Bradford, CNM, ARNP; ACNM President Melissa Avery, CNM, PhD, FACNM, FAAN.

Senator Al Franken and Brielle Stoyke, CNM


crystal said...

Congrats! This is wonderful news for midwives, and women all over the country.

Janey said...

And I love the photos. Those of us who wanted health care reform the 1st time around (year one of the first Clinton presidency) remember Jim McDermott's "Single Payor" option. If only we'd gotten there back in the 1990's :-)

Wendyrful said...

How does this work for CNM's in states like AL. We have the most restrictive laws for CNM's to work under. They can't work independantly, they aren't paid by insurance directly at all. It has been hard on them. There are only 4 CNM's even catching babies in the state.

Heather Bradford, CNM said...

Hi Wendyrful - hopefully with the passage of this bill, your reimbursement rates for Medicaid and private insurers will all increase to 100% of what MDs receive (with some advocacy on your part). Thats our next step. If a CNM is at 100% of what a MD receives, there is no motivation to have the billing be under a MD.