Delivering continuity of midwifery care to Queensland women

Considerations when implementing caseload (group practice) model
It is essential that if this model is under consideration it can be demonstrated:
• there is a critical mass of midwives willing (or who are able to be supported) to work
within such a model of care
• the model is self-sustaining in the face of resignations and departures from the facility
(succession planning is integral)
• there is support and collaboration with relevant medical colleagues such as obstetricians,
general practitioners and obstetric registrars (may be off-site support)
• National Midwifery Guidelines for Consultation and Referral (ACM 2008) is understood by
all practitioners
• the clinical governance structures around the model meets the best practise requirements.
Revenue for caseload (Group Practice) based on six FTE midwives
—240 births per year
This generalised model was constructed using inlier payments for DRGs and clinic
attendances (Queensland Health 2010a) and supports the premise that a caseload
midwifery model of care can be a financially viable proposition within the existing structure
of a Queensland Health maternity service.
Antenatal (AN):
The average number of antenatal appointments a woman currently attends and is supported
in the Queensland Health Personal Health Record documentation is 10. The funding
available per antenatal visit is $165.
Birth or Intrapartum (IP):
10 AN visits x 240 woman x $165 = $396 000.00
DRG (Phase 14) Peer Group DRG Payment
per case
060Z - Vaginal Delivery M1 $ 4 299.94
M2 $ 4 063.39
L3 $ 3 887.85
P $ 3 754.16
CSO $ 2 946.67
With current activity across QH Facilities the CSO cost of $ 2 946.67 DRG payment per case,
for women in a caseload (MGP) model.
240 woman x $ 2 946.67 per birth = $ 707 201
Postnatal (PN)
Caseload models of care include postnatal care to six weeks postnatally. On average the
woman and her baby are visited or telephoned seven to ten times during the six week period.
Visits are variable due to discharge timing and in response to the woman and baby’s needs.
Additionally babies will receive newborn care and physical assessments during this period.
8.5 PN visits x 240 woman x $165 per visit = $336 600
8.5 PN visits x 200 babies x $165 per visit = $280 500
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Delivering continuity of midwifery care to Queensland women