Practice Model Description Advantages Disadvantages Implementation Strategies

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1 Potential Models of Midwifery Practice for CHFWCNY Project* *For the purposes of this overview, midwives referred to are Licensed Midwives (LMs) in the State of New York Practice Model Description Advantages Disadvantages Implementation Strategies Hospital Based Employed & funded by a Folded into an existing hospital infrastructure Number of FTEs varies with volume LMs may provide antenatal and intrapartum care Physician consultation can be provided by existing MD/DOs Having LMs may present the hospital with a competitive advantage LMs can bill for services provided No or minimal additional liability insurance cost Cost of salary & benefits may be greater than revenue, especially during startup period Increased overhead by the addition of outpatient clinic space, support staff Identify hospitals in the region that might consider integrating midwives into their setting and initiate conversations with the leadership team physicians to identify potential consultants for LMs Explore community partnerships for referrals o County Health Departments May be able to draw upon grant or other MCH funds Hospital receives inpatient facility fee from any new business Depending on hospital capacity, additional volume may require additional inpatient space & staff that addresses key variables and projections o Community competitive environment o Availability of physician consultation Existing s New recruits o Volume of deliveries o Revenue including downstream revenue for the hospital o Other potential funding sources MCH funds State grants o Identify outpatient clinic space o Outreach & marketing plan o Recruitment of LMs Consider integrating other value added services from LMs including triage of all OB patients and 1 st assist at cesarean section Wilson Hughes Consulting, LLC Page 1

2 Community Based Employed & funded by a public health department or community health center or Family Planning Clinic May only offer antental care and refer to a hospital or may also offer intrapartum care The organization may have an existing relationship with physicians to provide consultation services The community hospital may already be providing support to the county health department or clinic Folded into an existing infrastructure Collaboration with other support services is more streamlined Organization is familiar with the patient population Increases access to care in the community Generally, no increase in liability insurance Outpatient visits may be reimbursed at a level higher than in a private setting (as per FQHC criteria) Community an existing clinic setting may not be as positive as for a private setting Primary care providers may not readily embrace a specialty model such as midwifery Provider compensation in many public health settings is less than in a private organization Identify existing community based organizations who might consider integrating midwives into their organization & initiate conversations with their leadership team physicians to identify potential consultants for LMs Identify outpatient clinic space (likely to utilize existing space) Explore existing funding sources for potential expansion dollars Wilson Hughes Consulting, LLC Page 2

3 Physician Owned Practice Employed & funded by a physician owned Existing community physicians may consider the addition of LMs to their Initial planning grant funding can help spark excitement from existing s or assist with the recruitment of additional physicians Folded into an existing infrastructure Physicians may view the addition of LMs as an asset, providing their with a competitive advantage and workload relief A that is considering recruitment of an additional physician may prefer to add LMs, who typically have lower compensation than physicians In order to offer a true midwifery model more than one LM is needed from the onset 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 Identify existing physician s who might consider integrating midwives into their organization & initiate conversations with their leadership team hospitals to explore delivery capacity and potential for shared risk Explore community partnerships for referrals o Health Departments LMs can refer complicated OB and GYN cases to physicians, increasing their revenue generating potential Cost of liability insurance greater than in a hospital or community based Wilson Hughes Consulting, LLC Page 3

4 Midwifery Private Practice Midwife owned and operated NY law passed in 2010 allows for independent midwifery without physician supervision Most existing LM owned s provide birth center or home birth services A midwife owned can contract with existing physicians for consultation Independent 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 may be eligible for loans & other support from the SBA Potential barriers with hospitals who do not currently credential midwives Overhead cost, including liability insurance may too high for the model to break even Identify midwives with the targeted areas who may be interested in starting a private 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 s who might consider integrating midwives into their organization & initiate conversations with their leadership team hospitals to explore delivery capacity and potential for shared risk Explore community partnerships for referrals o Health Departments HMO Based If existing HMOs in the target areas have a clinical, expansion with midwifery is an option Medicaid HMOs may be open to this discussion as many of the patients targeted by this project are insured by Medicaid HMO s often have an existing infrastructure with vast resources to support midwifery patients (i.e.: multispecialty referral base, social workers, educators) Many HMOs are focusing on the bottom line and are not prepared to add new services in a timely fashion Physicians employed by or contracted with an HMO may perceive midwifery as a competitive threat Identify existing HMOs in the target areas and initiate dialogue with their leadership team If an HMO has a clinical base, explore the possibility of adding midwifery services If no HMOs in the target area have an active clinical, explore the opportunity to partner with interested HMOs and start a midwifery Wilson Hughes Consulting, LLC Page 4

5 Faculty Practice Faculty of existing midwifery education programs can expand to provide care in the defined areas Midwifery Education Programs in NY include: 1. SUNY Downstate Medical Center 2. New York University 3. Stony Brook University 4. Columbia University Many midwifery programs are searching for faculty options as a source of revenue and clinical education sites for students Local LMs may collaborate with the midwifery programs to serve as faculty Midwifery schools are struggling to find qualified faculty to teach core courses. It may be challenging to find (and fund) additional FTEs for faculty sites in the target communities The financing for a start-up site may not be available through the Universities Identify directors or other key decision makers of midwifery education programs in NY and programs that offer distance learning with clinical experiences in NY Schedule an initial discussion with interested parties to explore the possibility of faculty expansion to the target areas Broaden the discussion to potential hospital partners and physician consultants in the community to assess interest and potential barriers Identify individuals who currently live in the target areas and who desire midwifery as a career. They may be able to go to school if clinical experiences are available in their home community Wilson Hughes Consulting, LLC Page 5