A letter to obstetricians

I have sent letters to obstetricians practising in my area.

Re: Medicare rebates for private midwifery services

Dear Dr XXXX
I am writing to inform you of my current private midwifery practice since obtaining notation as a Medicare ‘eligible’ midwife. 

Examples of the services I am able to provide are:
• a part of the woman’s care such as postnatal only (after discharge from hospital)

• antenatal care that is shared with an obstetrician or hospital,
• primary maternity care for the whole episode of care, whether the woman is planning to give birth at hospital or in the home.
[Note: At present midwives do not have visiting access/clinical privileges in hospitals. However, this is a goal to which public hospitals are working, through the Three Centres group project on ‘Collaborative arrangements with eligible midwives for Victorian public hospitals’. I am a member of the Expert Reference Group for this project, and am keen to see privately practising midwives able to obtain visiting access in hospitals.]

Medicare scheduled fees and rebates for private midwifery services are listed on the attached document Health Insurance (Midwife and Nurse Practitioner) Determination 2010 Health Insurance Act 1973 Part 1 Midwifery services and fees – revised 1 November 2011.

Since becoming eligible for Medicare, I have found that some women appreciate more postnatal visits in their homes, with Medicare rebates making the service more affordable, than was previously the case. Rebates are available for postnatal consultations in the six weeks following the birth, and for a 6-7 week review. I am now able to write referrals to obstetricians and paediatricians, and request tests and investigations related to childbirth. I do not yet have PBS authorisation, and Victorian law is yet to be amended to enable midwives to prescribe.

In order for women to claim Medicare rebate on fees for antenatal and postnatal visits the participating midwife is required to document a collaborative arrangement, by which a specified medical practitioner is identified as the person to whom the woman will be referred if indicated. Referral is one type of collaborative arrangement, described in Section 5(1) that the “patient is referred, in writing, to the midwife for midwifery treatment”, in this case antenatal and/or postnatal services, and that [Section 5 (2)]: “For subsection (1), the arrangement must provide for: (a) consultation between the midwife and an obstetric specified medical practitioner; and (b) referral of a patient to a specified medical practitioner; and (c) transfer of a patient’s care to an obstetric specified medical practitioner.”

That is, the collaborative arrangement to be entered into is that I, the midwife, will provide midwifery services (treatment), with consultation and referral to you when/if indicated. Under such collaborative arrangement, I am required to send you (the named medical practitioner) a Maternity Care Plan (proforma attached), results of any tests and investigations, and referrals.

Also I am required to send a discharge summary to you and the patient’s GP.

I would appreciate your support through referral or other collaborative arrangements. I am happy to make an appointment to meet with you and discuss this with you further if you wish.

There is a small number of midwives in Victoria who now have Medicare provider numbers, and others who are waiting for their applications to be processed. I anticipate gradual expansion of private midwifery services in response to the government’s maternity reforms.

Thankyou for considering this request.
With best regards
Joy Johnston

Attachments: 
Health Insurance (Midwife and Nurse Practitioner) Determination 2010
Maternity Care Plan proforma