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Nov
13
2006

By Mónica Arce

I have found it very interesting that there is a lot of talk about reducing costs, and that our health care system's survival depends on it.  I would like to know what percentage of the expenses of the Oregon Health Plan and federal health programs pay for maternity care, including prenatal care, labor and delivery and postpartum.  The use of nurse-midwives has been shown in several studies to reduce the amount of interventions during labor and delivery.  Midwives have outcomes that are the same or better than Ob/Gyn doctors.  I would like to see more talk about the money-saving advantages of hiring and using more midwives in our hospitals and community health care centers.

Homebirths have also been shown to be as safe as hospital birth and use less interventions in birth, keeping costs down.  Several countries around the world with better mortality/morbidity rates than the United States use midwives as their primary care providers for pregnant women, and only have Ob/Gyn doctors when a pregnancy becomes complicated or high risk.  I would like to see more conversation around this issue.

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Dec 2, 2006 3:25:42 PM
Teresa Goodell,RN,CNS,PhD says

I agree. Many studies have shown that routine care provided by advanced practice nurses is equal or superior to that provided by physicians. Specific procedures, such a screening colonoscopies, are done more cheaply and equally effectively by nurses, but for some reason this option has not even entered the public dialogue. The studies also show that patients find care provided by advanced practice nurses as satisfying or more satisfying than care provided by physicians, so consumer preference is not the reason for excluding this potential solution to some of our health care cost woes.

Can any readers provide an explanation?

Dec 4, 2006 4:22:49 AM
Angela Heider says

In some instances, maybe the problem is the cost to the employer. Many such nurses are employed by physician practices. My former practice did employee midwives and nurse practitioners. However, when the practice was squeezed financially by rising overhead, lower reimbursements, and malpractice costs, the physician extenders were discontinued. Physicians then took over their roles - and probably did not do the job as well, since they already had jobs.

Also, with midwives, at least in my area, the standard of care was to have a physician in the hospital to cover the midwife at all times. Therefore, if the midwife had a patient in labor, I also had to be there. Having two providers attend one birth isn't so cost-effective.

In large hospital settings, the issues may be different. Large hospitals often have residents who can perform similar tasks. However, more training centers are using extenders to help with resident workload.

Those are some of the road-blocks in my area.

Dec 4, 2006 4:24:04 AM
Angela Heider says

In some instances, maybe the problem is the cost to the employer. Many such nurses are employed by physician practices. My former practice did employee midwives and nurse practitioners. However, when the practice was squeezed financially by rising overhead, lower reimbursements, and malpractice costs, the physician extenders were discontinued. Physicians then took over their roles - and probably did not do the job as well, since they already had jobs.

Also, with midwives, at least in my area, the standard of care was to have a physician in the hospital to cover the midwife at all times. Therefore, if the midwife had a patient in labor, I also had to be there. Having two providers attend one birth isn't so cost-effective.

In large hospital settings, the issues may be different. Large hospitals often have residents who can perform similar tasks. However, more training centers are using extenders to help with resident workload.

Those are some of the road-blocks in my area.

Dec 4, 2006 11:51:37 PM
Monica Arce says

This situation varies a lot from state to state. In Oregon nurse practitioners work and manage their patients independently as long as they stay within their scope of practice. They also have independent prescriptive authority as long as they are prescribing drugs they have been trained to use and fall within their scope. Nurse practitioners in Oregon have independent licenses and are not considered physician extenders, they don't practice under the license of a doctor. I believe that Oregon has done a great job in the licensing arena, I just don't see the State utilize this resource as much as it needs to.

Dec 7, 2006 9:24:58 PM
Teresa Goodell,RN CNS,PhD says

I know of a pediatric practice that had to let go of their nurse practitioner because she only got 85% of the reimbursement that their physicians received, and yet the overhead costs of the advanced practice nurse were no lower than that of the physicians. The cost of liability insurance and the salaries of APNs are much lower than those of physicians, but these factors are not entered into the equation as insurance reimbursements and costs of practice are. So perhaps part of the problem is how we do the accounting.

APNs are reimbursed at 85% of the MD rate, and our salaries average about 50%. So why aren't those cost savings realized by consumers? If the insurers are pocketing this money, one would think they would promote the use of APNs for primary care, but nothing could be further from the truth.

It just doesn't make sense.

Dec 10, 2006 3:18:20 AM
sesles says

I work as a midwife in the U.K and it is through good anti natal education the midwives give makes women more relaxed in childbirth and mush more confident that their bodies will not let them down

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