privately practising midwives and the insurance that underpins collaboration

Privately Practising Midwives and Insurance

that Underpins Collaboration

Thursday 21 June 2012

4th Annual Obstetric Malpractice Conference

Monday, 25 June 20122

Agenda

MIGA

– Our services and experience

■ Midwives Insurance Scheme framework

Overview of the cover available to midwives

Key conditions of the cover

Effective collaboration between obstetricians and midwives

Questions.


MIGA

Specialist niche insurer – in business more than 100 years

Core business Medical and Professional indemnity for

– Doctors, medical students, midwives and corporate entities

Extensive experience & knowledge of medical & legal system including obstetrics

More than an insurer - Support services

– Medico-legal support and advice

– Risk management

– Practitioners‟ Support Service

Head office – Adelaide

– Branches in Sydney, Melbourne and Brisbane.

Federal Government Scheme


Federal Government Scheme

MIGA is the sole provider under the Scheme

We must work within a legislative framework

We must comply with Federal Government requirements for the:

– Cover we can provide

– Conditions we work within

– Cost of cover.


Do midwives have to insure?

■ Yes - it‟s the law!

Requirement under National Registration and Accreditation Scheme (NRAS)

– From 1 July 2010 privately practising midwives must have appropriate insurance

Exemption from insuring for provision of intrapartum care for planned homebirths

All other midwifery practice must be covered by appropriate insurance

Cover available under Federal Government Scheme for Eligible Midwives.


Who is an eligible midwife?

■ Licensed, registered or authorised to practise midwifery – with no restrictions on practice

■ Completed at least 3 years of post-registration practice (across the continuum of midwifery care) within previous 5 years

■ Completed an approved professional review program for midwives (across continuum of midwifery care)

■ Completed 20 additional hours of continuing professional development (across continuum of midwifery care)

■ Completed (or undertakes to Board to complete within an agreed timeframe):

– Accredited and approved program to develop knowledge and skills in prescribing, or

– Program substantially equivalent, as determined by the NMBA.

Cover available to midwives


What does MIGA provide?

MIGA provides 3 layers of support

■ Cover for:

– Claims for compensation and legal costs

– Expenses and support in the event of enquiries

■ 24 hour emergency advice and support

■ Package of risk management resources

– Free risk management education program (premium discount on completion)

– CPD points

– Risk Resources – on-line risk management tools, fact sheets and resources.


Two options for cover

Option A

– Midwives who provide intrapartum care in their

private practice

– In addition to antenatal and postnatal care

■ Option B

– Midwives who only provide antenatal and

postnatal care

– Provide no intrapartum care in their private

practice.


Limit of the cover

Cover provided jointly by

MIGA and the Commonwealth

MIGA's policy limit is $2m per claim

– Commonwealth contribution

– 80% of claims between $100,000 and $2m

Midwives covered for claims > $2m by Federal Government

Claim managed by MIGA irrespective of amount

Eligible Midwives are effectively covered for an unlimited

sum.


Cost of the cover

Fixed by agreement with the Federal Government

Maximum “full time” cost

Reductions for „part time” cost

Per year Intrapartum Care

Option A

No Intrapartum Care

Option B

Full time i.e. 40 women or

more

$7,500 $3,400

30 to 39 women $6,500 $3,000

15 to 29 women

women

$5,000 $2,250

Fewer than 15 women $3,375 $1,530

Key conditions of the cover


Key conditions of cover

Only available to eligible (registered) privately practising midwives

Cover is only for care provided to:

– Private patients

– In Australia

There is no cover for:

– Care provided to public patients

– Intrapartum care for planned home births

– Care before 1 July 2010 (or date of inception if later)

– Midwifery services provided in course of employment (other than in certain situations).


Key conditions of cover cont

Care must be provided as part of a

– Collaborative Arrangement or,

– Care Plan communicated to a Public Hospital providing obstetric services

■ In relation to cover Option B (cover for antenatal care

and postnatal care only)

– No cover for intrapartum care

– If at any time you provide intrapartum care as part of your private practice

– Except in an unforeseen emergency situation


Key conditions of cover cont

Comply with ACM‟s National Midwifery

Guidelines for Consultation and Referral or

– If working in collaboration either ACM or RANZCOG guidelines

– Particularly in relation to discussion, consultation and referral

Suitably qualified and authorised (as determined

by the NMBA) for prescribing.


What if midwife is employed?

They can still be covered provided

They are employed (full or part-time) by a company that is:

Owned solely by them, or

Owned solely by practising midwives including them

– and where the only directors of that company are

them and other practising midwives


Important access to run-off cover

Cover provided is on a “Claims Made” basis

Only covers claims made and reported during policy period

No cover after policy ceases

Run-off covers midwife for claims made in future which relate to incidents that occurred in their prior practice

Need to maintain run-off cover after they cease practice to be protected against claims that may arise in the future

Note: The National Law requires run-off cover is maintained after the midwife ceases practise.


Benefits of ROCS

Only MIGA‟s policy provides access to Federal Government Run-Off scheme

– Called “ROCS”

Scheme is funded via a levy of 10% on premiums

Access to Scheme following:

– Permanent retirement after age 65

– Death or permanent disability

– If ceasing practice before age 65 – will cover from 3

years after they cease

– Maternity leave - temporarily or permanently.

Effective collaboration between

obstetricians and midwives


Barriers

To practicing as an eligible midwife, being able to offer full range of midwifery services and accessing the Govt

insurance scheme

Requirement for collaboration and care plans – these have proven difficult to achieve

Lack of access agreements for midwives to provide intrapartum care in public hospitals

Cost of the product.

Lack of insurance for home births.


Making collaboration work

■ We insure obstetricians and midwives

■ We support effective collaboration

– There is no issue in terms of insurance cover

– We see this form of collaboration as no different to any others we insure

■ We have provided guidance to our clients on how to underpin this with an agreement

■ Will soon have on our website a draft Collaborative agreement that any doctor or midwife can use.


Some practical tips

■ Consider having collaborative arrangement in writing

■ Make sure you have addressed in advance

– Communication protocols

– Clinical settings where the services will be provided

– Roles of each party

– Protocols for consultation, referral and transfer including in an

emergency situation

– Arrangements for initiating pathology and diagnostic imaging tests

– Arrangements for sharing information from patient‟s medical record

– Prescribing arrangements and protocols

– What will happen in the event of absences

– The basis for charging and recoupment of out of pocket expenses.

Questions

privately practising midwives and the insurance that underpins collaboration

Health & Medicine