Midwives to get Medicare pay equity, thanks to new law

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.

For instance, Pennsylvania's Department of Public Welfare sent out a questionnaire this week 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.

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 Pittsburgh.

The Medicare reimbursement schedule does apply immediately to many military families and those who are Medicare-eligible because of a disability.

Haas said the free-standing Midwife Center, 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, 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 obstetric delivery. "I think a lot of women are looking for alternatives because the C-section rate is getting so high in this country,"she said. (In 2007, 32 percent of all U.S. births were cesarean deliveries, according to federal data.)

Another likely factor is cost. According to one Pennsylvania 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.

With a routine, uncomplicated pregnancy, some patients might prefer a homelike birth center to a hospital, though using a midwife might not be an option if health insurance didn't cover it.

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 higher reimbursement, she said, will allow the center to address capital expenses and make more services available to expectant mothers without having to depend as much on fundraising.

Haas said, "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?'"