Dear all
I know i have put this request out to you before, but am in need of more
specific information, and there may be some of you who have got further
down the track than we have.
I have put forward (with the help of some colleagues) a protocol for
midwives ordering routine tests for the pregnant and birthing women they
have all but sole care of. Teh medical men and admin are in agreement that
this is a sensible thing to hasten slowly on. We have hit a stumbling
block, however with our director of pathology services who says we cant get
paid for tests that midwives order. All forms must have a doctor's
signature on them. I find this difficult to believe, as many of these
doctors only can order tests within the hospital environment anyway, so
cannot have full provider numbers necessary for such re-imbursement. As
this is covered by the medicare act (in my understanding) and this is a
federal rather than state law, and as other hospitals are doing this sort
of thing (and thanks to KEMH and Alice Springs for info so far) I know it
can be done. It is unlikely these places are doing it for nothing!!!
So, my request is for the actual mechanics of the process. I need to know
how you are re-imbursed for tests ordered by midwives (and nurses if
applicable), what protocols allow this, eg standing orders, using your
pathologists provider number just like interns do, etc. It is my
understanding that this responsibility can be delegated, it is just a
matter of will on the part of those 'at the top'.
On another matter, i sat in a meeting hte other day where it was said the
hospital needed to put a friendlier face on for women who had chosen
homebirth, but who were also booking in to hospital 'jsut in case'. I
suggested allowing full visiting rights for their midiwves as the
professional responsible. Teh answer was that it was looked at some time
ago, but could not occur as other than a support role becuase of
medico-legal reasons. Now I know this is probably a furphy. But I would
love to have evidence from other centres that this is the case, that
midwives can have visiting/admission priveleges without posing a
medico-legal risk to hospitals or obstetricians. So, if you are willing to
share, I would like copies of policies, pro forma contracts, etc, so I can
get moving on this (AGAIN) down here. I think the wind is in the right
direction for a change, and I want to ride it.
Cheers, Trish
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