Summary of Organizing Committee Policy, Fiscal, Physical Plant and Administrative Positions Regarding the Operating of the Birthing Center
The Harlem Birthing Center Organizing Committee organized by the Northern Manhattan Perinatal Partnership, Inc. and several midwives, doulas and community members is excited about our meeting this morning to discuss the opening of a birthing center and establishing a process to hire midwives with Harlem Hospital. We have met over the last six weeks to prepare the enclosed document that outlines our negotiating positions and communicates our operating philosophy and policies to build and manage a birthing center.
The Harlem Hospital Holistic Birthing Center is a joint project of Harlem Hospital Center and the Northern Manhattan Perinatal Partnership, Inc. Both entities have allocated key staff and resources to move the organizing process to this current stage. Both entities should be prepared to invest financial and human capital to guarantee the success of this project. We are prepared to move quickly after the meeting today to hire midwives, secure an architect, finalize space requirement, develop an outline for a marketing plan and slowly build mind share and eventually market share for Harlem Hospital when it comes to the number of births per year.
BIRTHING CENTER PHILOSOPHY:
The goal of the Harlem Hospital Holistic Birthing Center is to provide safe and satisfying family-centered healthcare for women before, during and after normal pregnancy, labor and birth. Central to the philosophy of this Birthing Center is the belief that women who utilize the services provided might need self-empowering modalities with an emphasis on social support services during this time. These modalities might emphasize self and parental actualization, which will promote self and parental responsible health behavior through education, information and service.
* We believe that the birth of a child is such a sacred event that upholds the right of the mother to give birth in a setting that is respectful of her cultural mores and norms and is as free of medical intervention as possible.
* We believe that birth is a natural and normal process and that the role of the provider is to support and promote this health process while recognizing and addressing any deviations from normal, which may occur.
* We believe each woman becomes more confident and trustful of the capabilities of her body if she is in an environment that is non-threatening, warm and supportive, and surrounded by support persons of her choice.
* We believe that birth is a statement of achievement and success. This success will be facilitated and realized through the active input and participation of the community at large.
The Birthing Center will be housed within the Midwifery Service. The Director of the Midwifery Service and the Director of OB/GYN will review the qualifications of prospective midwifery candidates. Qualified candidates will, in addition, interface with the Chief of Obstetrics and the current midwifery staff whose input and recommendation regarding their appropriateness for employment will be solicited.
Midwives will be held to the Standards for the Practice of Midwifery as outlined by the American College of Nurse-Midwives. Consequently, midwives will report directly to the Director of the Midwifery Service.
The Midwifery Service is an integral component and division of the Department of OB/GYN. It is recognized that safe and satisfying obstetrical care can only be rendered by members of an allied health care team composed of midwives and obstetricians who are in concert with and support of the concept, philosophy and practices within a birth center. As a result, midwives at Harlem Hospital must have input in the hiring process of prospective obstetricians in the future.
It is imperative not only to attract but also retain the best midwifery talent available. To this end, salaries must be competitive and remain competitive to reward and motivate midwives not only for current performance but to motivate to contribute for future growth and development for the profit of the organization. Based on our review of the NYC labor market, the entry-level midwifery salary is $75,000. There will be regularly scheduled meetings between the collaborating obstetrician and the Birth Center midwives.
The Organizing Committee proposes that a Director/Chief Midwife be hired to lead the practice. If Harlem Hospital does not have a management and line structure for this budding practice one should be built immediately! Based on our review of the NYC labor market the Director/Chief Midwife’s salary should start at $85,000.
The Director/Chief Midwife will be responsible for the overall clinical and administrative operation of the Birth Center, quality improvement activities, development of a policy and procedure manual, complete performance evaluations of all midwives, provide guidance on clinical practice, supervises and schedules the midwifery staff and ensures that the clinical, business and marketing plans are realized.
Midwives will participate in the orientation of new midwives and obstetricians who will be collaborating with the Birth Center. Both the midwives and the obstetricians will conduct continuing medical education.
A part-time Marketing/Outreach Coordinator position should be built into the initial staffing up plan and expanded as needed. The proportion of clinic versus administrative hours should depend on patient numbers, initially. A yet to be determined set of criteria should trigger the above position becoming full-time.
Registered Nurse(s) will be hired to compliment the other staff within the Birthing Center. The Organizing Committee proposes the hiring of two certified doulas to assist with childbirth education classes, complete home visits and carry out a regimen of established postpartum care for women served within the Birthing Center.
The Birthing Center billing will be separate from the hospital billing. The Birthing Center should be viewed as an independent subsidiary (business unit) with profit center responsibilities for the hospital. If the Organizing Committee is to realize this objective, it must completely understand it’s day-to-day operating costs and weekly/monthly income generated by the practice.
The birthing center should have access to all financial reports that will help the management team lead the practice. Financial reports should be generated and made available to Birthing Center staff to match short and long term marketing/delivery goals to monthly results. The strategy and tactics to building a midwifery practice should be collectively agreed to by the Organizing Committee members and senior staff at Harlem Hospital and Dr. Chu’s office.
The Organizing Committee decided to place the $1,000 incentive payment per birth in a separate account. The practice will collectively decide on how these funds will be used to build the Birthing Center or reward high performing staff. The Organizing Committee decided against compensating individual midwives. These funds will not be used to replace operating budget personnel or OTPS expense items.
Birthing Center Reimbursement Financials:
Delivery@$990 to $1,500
Harlem Area Facility Fee@$5,818.95 for normal vaginal delivery with no complications.
The PCAP reimbursement facility fee could be double for c-sections and other surgery interventions. It depends on Harlem Hospital’s negotiated Diagnostic Rate Group fee with each managed care plan it has a contract with. Reimbursement rates were secured from the NYS Department of Health. These are Harlem Hospital’s unit of care reimbursement rates.
Initial Visits @$251.07
Return Visits @$129.11
Post Partum @$108.74
Home Visits @$53.03
GYN-Family Planning @$95.00
HIV Counsel w/o test @$90.00
HIV Counsel with test @$95.40
Physical Plant Requirement:
Our primary concerns regarding the floor plan of the proposed Birthing Center including the size and use of allocated space, the number of birthing rooms, the location of public and private space within the Birthing Center and the resulting traffic patterns.
Third Birthing Center Room/Convertible Room:
The initial floor plan shown to NMPP contains two birthing rooms. In our opinion, two birthing rooms would be insufficient to meet service demands. Both the accommodations as well as the reputation of the Birthing Center would be strained whenever three women simultaneously in labor required concurrent birthing services.
On the one hand, we recognize the hospital’s desire to avoid underutilized space, particularly during the Birthing Center’s initial phase of operation. However, a new Birthing Center unable to accommodate clientele or provide essential services at the outset would be subject to negative publicity, thus hindering the center’s growth.
We believe a minimum of three birthing rooms is required to efficiently sustain services. If three rooms are not now available, we propose the hospital establish a convertible post-partum/birthing room to be used in either capacity as needed.
The room would be built in accordance with the specifications of a birthing room, specifically with regard to plumbing and bathtub installation. The room could be designated as a post-partum room and, if unoccupied at the time a third birthing room is needed, would then become a birthing room for the duration of the delivery and recovery period.
The birthing rooms should be located apart from the training room, library and any other space or facility designed to accommodate the general public. Where possible, traffic patterns should allow the public to assemble away from the birthing rooms so that women in labor will be afforded some level of privacy. We propose that the training and library areas be moved to the entrance of the suite of rooms designated for the Birthing Center and the birthing and family rooms be located to the rear of the suite.
Clinical Practice Policies:
Obstetricians will be on call to the Birthing Center for consults and transfers. Midwives will not be scheduled for more than 40 hours/week (we suggest two12 hour shifts and two 8 hour shifts).
The Birthing Center will be adequately staffed. A midwife, initially, will not be required or permitted to attend to more than two patients at a time. When a specific, yet to be determined patient threshold is reached, that ratio should become one-to-one in the Birthing Center at all times. Even if a midwife agrees to work on the L&D Unit, they will not work outside the designated ratio when working with midwifery clients.
The staffing ratio in the outpatient clinics should be two midwives to one obstetrician.
When a patient is transferred, the midwife will co-manage her and continue to provide all care possible within her scope of practice. If it becomes possible for the patient to be returned to full midwifery care, that should be the rule.
Midwives will perform full scope women’s health care throughout the life cycle, which encompasses well woman gynecological and primary care, preconception, antepartum,
intrapartum, postpartum, family planning and post-menopausal care. Patients will be retained under midwifery care throughout the life cycle.
Birthing Center clients will receive childbirth education that incorporates the BC/Midwifery Philosophy and prepares women to take charge of certain decisions, labor coping strategies, and readiness for early discharge.
Midwives will begin to build a working relationship with all staff to inform and educate them about the purpose and philosophy of the Birthing Center. It will be the responsibility of midwives to develop an internal marketing program within the hospital to educate all staff and departments about the history, philosophy and purpose of the Birthing Center.
The birthing center should provide ancillary services for its clients and link to real, useful social service referrals. The Birthing Center should have beautiful and adequate space that grows responsibly to the growth of the practice. There must be a clear delineation of ‘public’ and ‘private’ areas of the Birthing Center and all hospital staff must be trained to respect the private areas. We require a child-friendly family area and space for staff to break in private (separate from work areas).
1. How will the policies and procedures of Columbia College of Physicians & Surgeons impact the development of the Birthing Center?
2. What are the set of clinical and business conditions that will drive the expansion of the Birthing Center?
3. Will there be a policy committee made up of senior Harlem Hospital, HHC, NMPP and Columbia leadership? How will the above entities share power?
4. Who will pay for the midwives malpractice insurance?
5. When will a midwife practice organizational structure be formed?
6. Has Harlem Hospital decided on which space on the fourth floor the Birthing Center will reside?
7. When will a Senior Midwife be hired to lead the practice?
8. What date should we set to start the interview process?
9. Has any midwives been interviewed or hired?
Many hospital systems in NYC are opening birthing centers to differentiate their service offerings to expand delivery market share. Jacobi Medical Center has just opened a family-friendly labor and delivery suite. Woodhull Hospital will be opening a birthing center in the next two quarters. It is time for NMPP and Harlem Hospital to take our turn at making history today. Lets get to work!