Chair’s report: Special issues sessions

Dr. Richard W. HendersonRichard W. Henderson, MD

The District Advisory Council (DAC) met in early October in Philadelphia. It hosted three guests who shared important information on topics that have been focuses of discussion on the ACOG Executive Board: workforce issues, the Affordable Care Act (ACA), and continued collaboration with the American College of Nurse Midwives (ACNM).

Workforce issues
William F. Rayburn, MD, MBA, has done a lot of work with ACOG to identify current and future workforce concerns that are and will continue to affect our specialty and the patients for which we care. Dr. Rayburn shared information with the DAC specific to District III and our US sections. I encourage you to read the article he submitted for this newsletter, “District III workforce update.”

For a more in-depth dive into the workforce issues facing ACOG, I highly recommend the monograph that was authored by Dr. Rayburn and ACOG, “The Obstetrician-Gynecologist Workforce in the United States: Facts, Figures, and Implications—2011.”

From Dr. Rayburn’s work and his presentation, it is clear that workforce issues are real and must be addressed. These issues will affect how care is delivered to our patients and the type of practices we will have in the future. Needless to say, it is imperative that we, as ob-gyns, the recognized leaders in women’s health, be engaged in the changes in our workforce and lead the conversation about how these changes will affect our patients and our specialty.

Affordable Care Act
Lucia DiVenere, senior director, ACOG Government Affairs, discussed the impact of the ACA on ACOG with the DAC. She explained that ACOG “reluctantly opposed” the ACA because it did not adequately address tort reform, meaningful changes in the calculation of the sustainable growth rate, or a repeal of the Independent Payment Advisory Board. However, ACOG continued to work with the administration and others as a partner to make sure many other things important to women and ob-gyns were included in the ACA.

Ms. DiVenere discussed the rationale behind the Supreme Court’s recent decision to uphold the constitutionality of the ACA and reviewed the pros and cons of the ACA from ACOG’s perspective. The pros include, but are not limited to:

  • Mandated coverage of maternity and women’s preventive care, including all contraceptives approved by the US Food and Drug Administration
  • Direct access for women to see ob-gyns that is not linked to having a primary care designation
  • Insurance reforms, such as the elimination of preexisting condition exclusions
  • Reimbursement for smoking cessation counseling
  • Improved family planning coverage by Medicaid
  • Standardization of health information technology requirements
  • More research into postpartum depression
  • Ob-gyn participation in medical homes for women
  • The rescue of ob-gyn–performed ultrasounds from cuts in reimbursement
  • The defeat of efforts to limit obstetricians to attending only high-risk deliveries

The cons are fewer and include:

  • Probable increased integration, hospital employment, and larger group practices
  • The increased inclusion of lay midwives in free-standing birth centers
  • Abortion coverage restrictions in state exchanges that begin in 2014, including a continuation of federal prohibitions on the use of either federal subsidies or premium dollars to purchase coverage for abortions. The ACA also makes no changes to any existing state abortion laws regarding parental notification

By the time this newsletter goes to print, the presidential election may determine if the ACA survives as we know it now or is repealed by executive order.

ACNM collaboration
Kate McHugh, CNM, MSN, ACNM region II representative, spoke to the DAC about the relationship between ACOG and ACNM. Ms. McHugh is the equivalent of an ACOG district chair for region II of ACNM, which includes Delaware, New Jersey, New York, Pennsylvania, and Puerto Rico. She was invited to attend the DAC meeting as part of a commitment at the national levels of ACOG and ACNM to build on efforts to improve communication and working relationships between our organizations. This commitment began as part of the presidential initiative of Richard N. Waldman, MD, on collaborative practice.

Ms. McHugh described the organizational structure of ACNM and highlighted the organization’s focus on the higher educational and training requirements that must be met and maintained to be a member of ACNM. She made a clear distinction between the educational and training requirements of other types of midwives who are not part of and are not represented by ACNM. Ms. McHugh also discussed possible opportunities for collaboration at the district and regional levels of ACOG and ACNM.

This session was an excellent introduction for our organizations and should provide a sound foundation on which to build moving forward. With regard to both women’s health and workforce issues, increasing our efforts and energies at collaboration with ACNM would be of benefit to both of our organizations and the women we serve.   

American Congress of Obstetricians and Gynecologists
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