Midwifery in New York

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1 Midwifery in New York Barbara Hughes, CNM, MS, MBA, FACNM Wilson Hughes Consulting, LLC The culture of midwifery: It s all about listening to women, caring for women, empowering women, and doing the right thing for our future and the future of our children. 1

2 DEFINITION OF A CERTIFIED NURSE-MIDWIFE A certified nurse-midwife (CNM) is an individual educated in the two disciplines of nursing and midwifery, who possesses evidence of certification according to the requirements of the American Midwifery Certification Board, Inc. (AMCB). ACNM Position Statement: May 2011 DEFINITION OF A CERTIFIED MIDWIFE A certified midwife (CM) is an individual educated in the discipline of midwifery, who possesses evidence of certification according to the requirements of the American Midwifery Certification Board, Inc. (AMCB). ACNM Position Statement: May

3 DEFINITION OF A LICENSED MIDWIFE In New York, Licensed Midwives (LMs) are defined as healthcare practitioners that can provide care for pre-adolescent, adolescent, and adult women throughout their life span. DEFINITION OF MIDWIFERY PRACTICE The practice of the profession of midwifery is defined as the management of normal pregnancies, child birth and postpartum care as well as primary preventive reproductive health care of essentially healthy women, and shall include newborn evaluation, resuscitation and referral for infants. 3

4 DEFINITION OF MIDWIFERY PRACTICE The CNM and CM practice within a health care system that provides for consultation, collaborative management or referral as indicated by the health status of the client. CNMs and CMs practice in accord with the Standards for the Practice of Midwifery, as defined by the American College of Nurse-Midwives (ACNM). ACNM Position Statement: May 2011 JOINT STATEMENT OF PRACTICE RELATIONS BETWEEN OBSTETRICIAN/GYNECOLOGISTS AND CERTIFIED NURSE-MIDWIVES (2011) The American College of Obstetricians and Gynecologists (the College) and the American College of Nurse-Midwives (ACNM) affirm our shared goal of safe women s health care in the United States through the promotion of evidence-based models provided by obstetrician gynecologists (ob-gyns), certified nursemidwives (CNMs) and certified midwives (CMs). 4

5 The College and ACNM believe health care is most effective when it occurs in a system that facilitates communication across care settings and among providers. Ob-gyns and CNMs are experts in their respective fields of practice and are educated, trained, and licensed, independent providers who may collaborate with each other based on the needs of their patients. 5

6 OBSTETRICS & GYNECOLOGY September 2011 Editorial: Collaborative Practice Between Obstetricians and Midwives Richard N. Waldman, MD & Holly Powell Kennedy, CNM, PhD In our estimation, collaborative practice will be very important to the future of maternity care. Integrated practice models can reflect many forms and financial intricacies Collaborative practice is a deep and thoughtful process and when it works well it is very rewarding. Midwifery in New York Certified Nurse-Midwives have been practicing in NY since 1930 CMs, most credentialed in NY, have been legal since the Midwifery Practice Act passed in 1992 NY was the 1 st state to credential CNMs & CMs by the same law & regulation 6

7 Midwifery in New York Over 1000 midwives licensed Over 400 midwifery practice sites Over 9% of births attended by LMs Practice is regulated by the State Board of Midwifery 7

8 Midwifery Education in NY Four Programs in the State SUNY Downstate Medical Center New York University Stony Brook University Columbia University Distance learning programs also serve NY students 8

9 NYSALM Our Mission To promote the health and well-being of women and infants through midwifery care To facilitate the professional practice of licensed midwives in the State of New York To encourage and maintain collegial relationships with healthcare providers, institutions, and organizations 9

10 NYSALM Objectives To improve statewide communications among LMs To remove barriers to midwifery practice and to improve consumer access to midwifery care To affect state-wide legislation and regulation To promote midwifery education, clinical practice and research To promote quality midwifery care throughout the state To enhance public relations for LM practice To provide consultation and advice for association members To convene an annual meeting of all midwives in the State of New York for the purpose of political activity, education and support Models of Midwifery Care Hospital Based Community Based Physician Owned Practice Midwifery Private Practice Faculty Practice Birth Center Home Birth 10

11 Hospital Based Midwifery Practice Employed & funded by a hospital Number of FTEs varies with volume LMs may provide antenatal, intrapartum and well woman care Physician consultation can be provided by existing MD/Dos Various financial models may be developed with community or academic partners Advantages of Hospital Based Practice Folded into an existing infrastructure Having LMs may present the hospital with a competitive advantage LMs can bill for services provided No or minimal additional liability insurance cost May be able to draw upon grant or other MCH funds Hospital receives inpatient facility fee & downstream revenue from any new business 11

12 Disadvantages of Hospital Based Practice Potential physician perception of competition Cost of salary & benefits may be greater than revenue, especially during start-up period Increased overhead by the addition of outpatient clinic space, support staff Depending on hospital capacity, additional volume may require additional inpatient space & staff Implementation Strategies Identify hospitals in the hot spots who might consider integrating midwives into their setting and initiate conversations with the leadership team Continue the dialogue with community physicians to identify potential consultants for LMs Explore community partnerships for referrals Health Departments Planned Parenthood Pregnancy Support Centers 12

13 Physician Owned Practice Employed & funded by a physician owned practice Existing community physicians may consider the addition of LMs to their practice Initial planning grant funding can help spark excitement from existing practices or assist with the recruitment of additional physicians Advantages of Physician Owned Midwifery Practice Folded into an existing infrastructure Physicians may view the addition of LMs an asset, providing their practice with a competitive advantage and workload relief A practice who is considering recruitment of an addition physician may prefer to add LMs who typically have lower compensation than physicians LMs can refer complicated OB and GYN cases to physicians, increasing their revenue generating potential 13

14 Disadvantages of Physician Owned Midwifery Practice Potential physician perception of competition In order to offer a true midwifery practice model more than one LM is needed Cost of salary & benefits may be greater than revenue, especially during start-up period Increased overhead by the addition of outpatient clinic space, support staff Cost of liability insurance greater than in a hospital or community based practice Recruitment of LMs to more rural areas may be difficult Implementation Strategies for Physician Owned Midwifery Practice Identify existing physician practices who might consider integrating midwives into their organization & initiate conversations with their leadership team Continue the dialogue with community hospitals to explore delivery capacity and potential for shared risk Explore community partnerships for referrals Develop a business plan 14

15 Midwifery Private Practice Midwife owned and operated practice NY law passed in 2010 allows for independent midwifery practice without physician supervision Most existing LM owned practices provide birth center or home birth services A midwife owned practice can contract with existing physicians for consultation Advantages of Midwifery Private Practice Independent practice would allow development of a small start-up model with minimal overhead Utilizing a LM already practicing in the community could build upon existing relationships with patients, referral sources, physician consultants and hospitals A small start-up practice may be eligible for loans & other support from the SBA 15

16 Disadvantages of Midwifery Private Practice Potential physician perception of competition Potential barriers with hospitals who do not currently credential midwives Overhead cost, including liability insurance may too high for the model to break even Recruitment of LMs to more rural areas may be difficult Implementation Strategies for Midwifery Private Practice Identify midwives with the targeted areas who may be interested in starting a private practice that offers hospital deliveries Identify members of the community who would commit to being educated and licensed as a midwife and offer scholarship support in exchange for future services Identify existing physician practices who might consider integrating midwives into their organization & initiate conversations with their leadership team Continue the dialogue with community hospitals to explore delivery capacity and potential for shared risk 16

17 Questions? Now, to the exciting part 17

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