Association Collaborations Advancing Midwifery

Transcription

1 Association Collaborations Advancing Midwifery AABC 05 Annual Conference Ginger Breedlove, PhD, CNM, FACNM October 4, 05 ACNM Lens Provide up-to-date information about legislative work on the federal and state level, highlighting need for collaboration in conversations related to changes brought forth by the ACA, ICM Global Standards, and women s health provider workforce shortage, emphasizing ACNMs goal to advance midwifery and birth options in the US

2 9th Annual AABC Birth Institute 0//05 Federal Initiatives Active on The Hill during ACNM 60th Over 700 midwives stormed offices Historical moment of 3 ACOG Presidents visiting together with ACNM ACNM: Federal Focus Patrick Cooney, Jesse Bushman, ACNM President of The Federal Dir. Advocacy and Govt Group Affairs

3 SHARE!! 3

4 Quality Care for Moms and Babies Act S 466 Senator Grassley June, 05 Sharing best practices is something to encourage in any field, especially in health care, where lives are at stake," Senator Grassley said. "With the federal government paying for 40 percent of births in the United States and the incredible expense and risk of complicated deliveries, improving maternity outcome quality makes sense for moms, babies and taxpayers. Charge for AHRQ and CMS to Develop Quality MCH Measures Would improve maternity care by holding Medicaid and the Children's Health Insurance Program accountable through higher quality standards. Support collaboration that promotes the best care and avoids medical complications to reduce costs. Expand Maternity Care Quality Collaborative s. 4

5 ACNM ACOG National Partnership for Women and Families June 05 Fact Sheet cnm/files/cclibraryfiles/fil ename/ /qc MBFactSheet.pdf Joint Support 5

6 Improving Access to Maternity Care Act S 68/HR 09 Instructs HRSA to identify areas of the country where there there is a shortage of full scope maternity providers. These shortage areas will be known as "maternity care health professionals shortage areas." The definition of these areas takes into account both maternity care professional and medical facilities. Notably, "medical facility" is defined to include birth centers as they are defined in the SS act. Key Points Virtually budget neutral Expand designations beyond Primary Care, Mental health and dental care services Best providers align with mounting need for services, in midst workforce shortage Particular focus on rural and underserved areas 6

7 Maternity Providers Education Act *NEW No Bill # assigned Would require Medicare to make payments to teaching CNMs for services of medical interns/residents and midwifery students under their instruction in the same fashion as Medicare currently pays teaching physicians for the services of medical interns/residents who they oversee. Also permit grants from HRSA currently made to advanced nursing education programs to be used to support clinical education. 7

8 Coalition for Quality Maternity Care, CQMC, 0 Works to establish national strategies to ensure access to affordable, high quality maternity care for all women and infants. GOAL: remove barriers to optimal maternal health practice, promote models of care that are evidence-based, improve maternity care choices for women, and reduce disparities in maternal and newborn health. Steering and Founding Member Associations AABC ACNM Amnesty International USA AWHONN Black Women s Health Imperative Childbirth Connections ICTC MANA NACPM 8

9 Recent Invitation Position on new Institute for Medicaid Innovation s National Advisory Board. Newly formed subsidiary of the Medicaid Health Plans of America, dedicated to generating and disseminating evidence that demonstrates the impact of Medicaid managed care on access to quality care. Belief that Medicaid is not just about providing healthcare and measuring quality outcomes but also understanding how core community services address social issues and inequalities. Agenda to identify what works well in Medicaid and to also identify areas that need improvement, with goal to inform and enhance the Medicaid program. ACNM State Advocacy Cara Kinzelman, PhD Assoc. Dir. State Government Affairs 9

10 State Level Activity: ACNM Key Resources State Fact Sheets Members Only 0

11 State Midwifery Legislative Activity Understanding Your Practice Environment: Making an Informed Decision About Where to Work 05 Cara Kinzelman, PhD, Manager, State Government Affairs Jesse Bushman, Director, Advocacy and Government Affairs

12 CNMs/CMs per 00,000 Population 0 CNMs per 00, Out of 3,4 U.S. Counties,,758 (56%) have no CNM. Source: Area Resource File. Slide originally created on 3//04 by Kate Crawford, Birth by the Numbers ( Obstetrician/Gynecologists per 00,000 Population 0 ACOG estimates that in 0, there were 9.5 million women living in a county without a single OB/GYN. OB/GYNs per 00, Out of 3,4 U.S. Counties,,459 (46%) have no OB/GYN. Source: Area Resource File. Slide originally created on 3//04 by Kate Crawford, Birth by the Numbers ( See also: The Obstetrician Gynecologist Workforce in the United States, Facts, Figures, and Implications, American Congress of Obstetricians and Gynecologists,

13 CNMs/CMs and OB/GYNs per 00,000 Population 0 Out of 3,4 U.S. Counties,,63 (40%) have no CNM or OB. CNMs & OB/GYNs per 00, Source: Area Resource File. Slide originally created on 3//04 by Kate Crawford, Birth by the Numbers ( Total Number of Birth Centers per State (Accredited and Non-Accredited) - 05 Accreditation by Commission for the Accreditation of Birth Centers (CABC); Does Not Include Pending Accreditations WA 9 OR 3 NV CA 34 AK 0 MT 7 ID 9 WY UT 0 CO 3 AZ NM 9 5 HI ND SD NE KS 3 OK TX 65 MN 7 IA MO 3 AR LA WI 7 IL MS IN 3 MI TN: 4 AL KY There were a total of 98 birth centers as of May OH 5 GA WV SC 4 FL 3 PA 6 VA 8 NC 3 NY VT MA: RI NJ CT: DE: ME MD: DC: NH: 4 No Birth Centers Under 5 Birth Centers 5-9 Birth Centers 0 or More Birth Centers Source: American Association of Birth Centers 3

14 Number of Accredited Birth Centers Per State - 05 Accreditation by Commission for the Accreditation of Birth Centers (CABC); Does Not Include Pending Accreditations CA 3 AK 5 OR WA NV ID AZ 3 UT HI MT WY NM CO 3 ND SD NE KS OK TX 7 MN 3 IA MO AR LA WI IL MS IN TN: 3 AL MI KY There were 8 accredited birth centers as of May 05 OH GA WV SC FL PA 5 VA NC 3 NY VT NH MA: RI NJ CT: DE: MD: DC: ME No Accredited Centers Under 5 Birth Centers 5-9 Birth Centers Source: Commission for Accreditation of Birth Centers Percent of Births Occurring Out of Hospital - 03 WA 3.6% OR 3.67% CA 0.88% AK 6.36% ID 3.33% NV.6% UT.97% AZ.33% MT 4.5% HI.67% WY.8% CO.94% NM.90% ND.08% SD 0.94% NE 0.74% KS.% TX.8% Source: CDC/NCHS, National Vital Statistics System. Birth certificate data is known to contain errors and misattribution and should be understood to be less than 00% accurate. OK 0.84% MN.4% IA.4% MO.84% AR.3% WI.8% LA 0.40% IL 0.55% MI 0.96% IN.3% KY.8% TN.4% AL MS 0.3% 0.3% OH.5% GA 0.63% Nationwide,.35% of all births occurred out of hospital. The distribution among states: Min: 0.3% (AL, MS) Median:.4% (TN) Max: 6.36% (AK) PA.99% WV 0.68% VA.0% NC 0.99% SC.38% FL.6% VT.9% NY.00% ME.0% MA 0.9% RI 0.45% CT 0.85% NJ 0.36% DE.04% MD.05% DC 0.93% NH.06% 0% 0.99% of births.00%.49% of births.50% -.99% of births.00% -.49% of births.50% % of births 4

15 Regulatory Structure for Certified Nurse-Midwives and Certified Midwives Data Current as of June 04 WA OR ID MT WY ND SD MN WI MI ME VT NH NY MA CT RI CA NV UT CO NE KS IA MO IL IN KY OH WV VA PA NJ DE MD DC AK AZ HI NM TX OK AR LA TN MS AL GA SC FL NC Supervision Required (6 States) Written Collaborative Agreement (4 States) Written Collaborative Agreement --- Rx Only (6 States) Independent Practice (5 States) Source: ACNM analysis of state laws and regulations. States that License Direct Entry Midwives Data current as of May 05 WA CA OR NV ID UT MT WY CO ND SD NE KS MN IA MO WI IL MI OH IN KY WV VA PA NY VT DE MD NH NJ DC ME RI CT MA AZ NM OK AR TN SC NC TX LA MS AL GA No licensure available Licensure available FL AK HI Source: ACNM analysis of state laws and regulations. Evaluation excluded ME, MO and NY because they do not have explicit licensure mechanisms currently in place for direct entry midwives. 5

16 Which States License/Regulate Birth Centers - 05 WA OR ID MT WY ND SD MN WI MI ME VT NH NY MA CT RI CA NV UT CO NE KS IA MO IL IN KY OH WV VA PA NJ DE MD DC AZ NM OK AR TN MS AL GA SC NC No Regulation TX LA FL Under Other Regulations Birth Center Specific Regulations AK HI Medicaid coverage for birth center services is only available if the state regulates or licenses them. Source: American Association of Birth Centers. Data current as of May 05. Bottom Line: Serious Workforce Challenges ACOG has projected a shortage of between 5,73,73 OB/GYNs by 050 Static Entries into OB/GYN Specialty Changes in Provider Demographics Increasing Patient Needs The US is in critical need of both more OB/GYNs and CNMs/CMs. Source: William F. Rayburn, MD, MBA, FACOG, The Obstetrician Gynecologist Workforce in the United States: Facts, Figures, and Implications, American Congress of Obstetricians and Gynecologists, 0. 6

17 Pregnancy and Risk Stratification Higher Risk Pregnancies Normal Pregnancies There is no uniformly utilized definition of a high risk pregnancy. CDC estimates that in 03, 83% of first time mothers were at low risk for a cesarean birth. The NIH lists several high risk factors affecting - 0% of pregnancies. The World Health Organization estimates that properly trained midwives can care for 87% of maternity care patient needs. 3 It is reasonable to assume that the majority of women are able to have a normal pregnancy and delivery and could be attended by CNMs/CMs. Percentage derived from number of low risk women, shown in Table I of the technical notes here: and from the total number of first time mothers, derived from See: 3 State of the World s Midwifery, available at: Maximizing Midwifery: What is Possible 00% 90% 80% 70% 60% 50% 40% 30% 0% 0% 0% 78% 77% 75% 7% 7% Finland Iceland Sweden Denmark France Percent of Births Attended by Midwives Source: J.K. Emons, M.I.J. Luiten, Midwifery in Europe: An inventory in fifteen EU-member states, The European Midwives Liaison Committee, study by Deloitte & Touche, 00. Available at: Note that his source reports a range of 70% - 75% midwife attended births in both Denmark and France. The graph above takes a midpoint from that range. Data on Iceland provided in private communication from Hildur Kristjánsdóttir, Chief midwifery officer, Division of supervision and quality, Directorate of Health 7

18 Positive Indications of Progress Maternal Levels of Care document (05) US MERA Delphi Study (05) ACOG endorsement of ICM Standards and definition of midwifery (05) Lancet Series and SOWMY Report (04) What s Next? Challenging discussions with difficult conversations --- but together we CAN do this! Tipping Point to advance midwifery has never been closer 8

19 Series of Questions - Discussion. Accreditation vs. Licensure vs. both for all birth centers as promoted standard of care?. Medicaid reimbursement only for licensed and accredited birth centers? 3. Provider type and oversight of birthing centers? 4. Uniform definition of free standing birthing center? 5. Legislative advancement of CNM, CM and CPM promoting licensure at fullest scope of education and training 6. Starting conversations with multistakeholders, whose responsibility? 9

20 9th Annual AABC Birth Institute 0//05 Your Role in Our Future 0