This bill is up infront of congress. It calls for equal Medicare payments for CNMs and CMs (right now CNMs get 65% of the pay, and I'm not sure that CMs can even bill the system). We all know that the vast majority of CNMs provide *better* care than OBs for most women; they do more education, they spend more time with the clients, and they have better outcomes, thereby SAVING the system thousands of dollars per birth.
Following is a letter that ACOG wrote opposing this bill. Please write your congressmen in support of this bill. Please mention how much money midwives save the system. If you have personal experience that you want to add, please do so.
State insurances will often follow the federal lead. Right now our state insurance also pays about $400 for a CNM attended birth as opposed to a MD; on top of the fact that state insurance reimburses less overall for the birth than private insurance does.
Thank you for your support!!!
June 14, 2005
The American College of Obstetricians and Gynecologists, representing
47,000 physicians dedicated to women's health, has concerns with
S.911, a bill to increase Medicare payment rates for certified
nurse-midwives (CNMs) and certified midwives (CMs). ACOG believes in
the value of collaborative practice between ob-gyns and certified
nurse-midwives, but this proposal has very significant problems and
must not move forward in Congress.
ACOG has long recognized that, as part of a multidisciplinary team,
CNMs may provide perinatal care for low-risk women, manage normal
newborns and provide gynecologic services in accordance with state
laws or regulations.
S.911 would increase Medicare reimbursement rates for CNMs from their
current level of 65% of physician levels to 100% of the rate Medicare
pays physicians, well beyond the 85% level recommended by the Medicare
Payment Advisory Commission (MedPAC) in its June 2002 report. The
legislation would also, for the first time, allow CMs to directly bill
This proposal comes at a time when Congress is struggling to find
offsets needed to prevent the Medicare physician payment cliff. The
first of five payment cuts, totaling nearly 30%, begins on January 1,
The Alliance of Specialty Medicine, of which ACOG is Vice Chair,
strongly supports S.1081, legislation introduced by Senators Kyl and
Stabenow, the Preserving Patient Access to Physicians Act. This bill
would provide a 2.7% update to Medicare physician payments in 2006 and
a 2.6% update in 2007, giving Congress time to negotiate a permanent
repeal of the Sustainable Growth Rate (SGR) formula that is at the
heart of Medicare physician payment problems. This legislation is
badly needed and could cost as much as $32 billion over five years.
Clearly, in light of the tremendous need for Congressional
intervention to prevent the Medicare physician payment cliff, we urge
Congress to focus its efforts and any available Medicare funding
toward this urgently needed physician payment fix. Only once that fix
is complete could we support Congressional efforts to increase
payments to other Medicare providers.
ACOG also vehemently objects to the findings in S.911, which would
have Congress legislate that delivery care provided by nurse-midwives
is far superior to delivery care by ob-gyns. Ob-gyns provide needed,
high quality, compassionate care in the delivery of thousands of
babies every day. We absolutely object to any suggestion that ob-gyn
care is inferior to care provided by nurse-midwives or other
A third element of concern is broad language in the bill that would
allow certified nurse-midwives and certified midwives to supervise
ob-gyn interns and residents. Supervision of interns and residents by
midwives must only be allowed with a physician's direct inclusion and
At a time when Congress is struggling to fix the Sustainable Growth
Rate and prevent the 2006 physician payment cliff, we strongly object
to efforts to divert Medicare funds to increasing Medicare
nurse-midwife payment rates to the rates paid to physicians, and it is
certainly bad and unacceptable policy for Congress to impugn the care
delivered by ob-gyns or to give nurse-midwives blanket authority over
We urge you to carefully and fully consider the important issues we
raise and to take no action on S.911.
Thank you for your interest and consideration. For further
information, please contact Tara Straw in ACOG's Government Relations
Department at (202) 863-2512 or [email protected]
Michael T. Mennuti, MD, FACOG