Maternity Care Issues Take Center Stage

Ongoing collaboration between the AAFP and the American College of Obstetricians and Gynecologists, or ACOG, on issues of mutual interest has paid off recently -- especially for AAFP members who deliver babies and offer maternity care to patients.

Specifically, some developments during the summer have led to

Daniel Ostergaard, M.D., AAFP vice president for international and interprofessional activities serves on the ACOG-AAFP liaison work group, and he credits its ongoing work for the recent actions. Other AAFP members serving on that work group are James Dearing, D.O., of Phoenix; Beth Choby, M.D., of Baytown, Texas; and Virgilio Licona, M.D., of Fort Lupton, Colo.

"We have an ongoing respectful, collaborative relationship," said Ostergaard of the members on the work group. "We've weathered some storms and cultivated that relationship. This summer, we were able to come to an agreement on some issues."

Stanley Zinberg, M.D., ACOG deputy EVP and VP of practice activities, also serves on the work group and expressed a similar sentiment. "The ACOG-AAFP liaison work group has met regularly over the past several years to successfully address areas of mutual concern," said Zinberg. The group's overall goal is to "further the collegial working relationships between obstetrician-gynecologists and family physicians on a local and national level," he added.

Perhaps more importantly, said Ostergaard, is the groundwork that was laid during the past few years. "Because of that groundwork," he said, "the work group is able to react and respond quickly when a situation demands quick attention and resolution."

The maternity care payment situation that recently arose in Arizona highlights the group's ability to address pressing issues. Ostergaard said that in the space of 48 hours, AAFP and ACOG drafted a joint letter to Mercy Care, a managed care organization that is affiliated with Arizona's Medicaid program. The letter voiced opposition to the insurer's decision to pay only obstetricians -- to the exclusion of family physicians -- for the provision of maternity care services in urban Arizona.

The Aug. 16 letter was signed by AAFP Board Chair Larry Fields, M.D., of Flatwoods, Ky., and ACOG EVP Ralph Hale, M.D.

"We urge Mercy Care to reconsider what appears to be an arbitrary decision to exclude family physicians from payment for maternity care services in urban areas and to adopt a policy in alignment with the AAFP-ACOG Joint Statement," said the letter, in reference to the AAFP-ACOG Joint Statement on Cooperative Practices and Hospital Privileges, a copy of which was included with the letter.

The letter chided the insurer for imposing such a payment policy on urban areas of the state. Fields and Hale said the insurer's decision was "contrary to policies of both AAFP and ACOG, which hold that privileges and payment should be based on the training, experience, and demonstrated current competence of the physician, and not on the physician's specialty." Mercy Care has not yet responded to the letter.

ACOG's invitation to the Academy to provide representation on its Committee on Obstetric Practice and its Committee on Practice Bulletins -- committees that, according to Zinberg "address and develop the obstetric issues and clinical policies for ACOG" -- also resulted from task force discussions, said Ostergaard. Appointments to those committees are in process.

Give and take within the task force also helped bring about a change on the ACOG antepartum record, form A. Specifically, the phrase "Newborn's Physician" now appears near the top of the form where space is designated for the name of the doctor that will care for the newborn. Previously, the form read "Newborn's Pediatrician."

Ostergaard said that this change is important to FPs because when a woman in labor and under the care of an obstetrician shows up at the hospital, labor and delivery nurses are responsible for making sure that someone is going to take care of that baby. "Oftentimes that physician is unassigned," said Ostergaard, and previously, nurses would pick from a list of available pediatricians.

"The new wording on the form will encourage obstetricians and labor and delivery nurses to consider the names of family physicians along with those of pediatricians when assigning the baby's physician," he said.