Midwife Center Business Plan

STRATEGIC PLAN for The Midwife Center for Birth & Women’s Health 2007. Updated 2012.

Midwife Center Mission

The Midwife Center provides exceptional woman-centered pregnancy, birth, and well-woman care in southwestern Pennsylvania’s only independent birth center.

Midwife Center Vision

The Midwife Center (TMC) will provide exceptional, personalized, woman-centered care to a large, diverse clientele while also conducting extensive advocacy and education. Recognized for providing the highest quality care, TMC will participate in research, provide midwifery education to future providers, and advocate for improved midwifery regulations and reimbursements. These activities will further the field of midwifery and meet the growing demand for midwifery services.

Operating Model and Philosophy

Women and families are active participants in their care at The Midwife Center (TMC). Midwifery care maximizes birth’s potential as a peak experience for the family by stressing education and personal responsibility of all family members.
Our staff recognizes that pregnancy, childbirth, and maturation are normal life processes, in which a provider should not intervene without evidence of a problem.
TMC maintains licensure, accreditation, and a program of quality assurance for our practice and facility. Our practice is based on the most current medical knowledge and our model of care fosters continual improvement to our clients’ care.
TMC’s midwives provide care in accordance with the American College of Nurse Midwives Standards and Code of Ethics.
TMC recognizes that birth is a powerful and life-changing experience. We provide a trusting, private, and respectful environment for our clients to be empowered and celebrated.
TMC provides postpartum support with emphasis on establishing successful breastfeeding.
The highest standard of care is achieved when certified nurse-midwives are first line care providers in collaboration with excellent physicians and other area service providers.
We provide care and education to women of all ages, races, sexual orientations, religions, and socioeconomic status.
We believe that birth centers are part of the solution to the nation’s crisis in rising rates of unnecessary c-sections and increased infant mortality.
Each exchange with the health care system should leave the consumer more knowledgeable about maintaining and maximizing one’s health. To that end, TMC offers education during appointments and classes at the center and in the community.
Excellent care is best achieved with a financially secure center and a stable, high-quality staff. To this end, TMC combines careful business practices with fundraising to implement new programs, keep services available to all, and to improve our facility to best serve our clients.
TMC educates the broader community and maintains a dialogue with policy-makers about the unique benefits of midwifery and birth center care in order to maintain and increase accessibility to midwifery and birth center services.
TMC educates future CNM’s and RN’s in the birth center model of care, and participates in research, as appropriate, to further the field of midwifery and ensure access to birth center care in the future.

Midwife Center Strategic Priorities

Long-Term (10 years)

Continue to serve a culturally and economically diverse clientele, while maintaining the agency’s financial well-being
Continue to improve the quality of care, including both adequate staffing and educational resources to ensure the retention of high-quality staff, as well as operational improvements with technology and the physical facility
Position The Midwife Center as a first-choice women’s health care facility that is both highly-regarded and respected by local providers , policy-makers and the public at large
Develop alliances with major Pittsburgh hospitals to provide or supplement their midwifery services and encourage collaboration with TMC instead of investing in additional midwife facilities
Changed as of January 2012 Board Retreat to: Continue to partner with hospitals, family practice residency and nursing school programs to teach upcoming health professionals about the benefits of midwifery and birth center care and while providing training opportunities at TMC and advocating for more educational programs for midwifery.

Phase I (2008 - 2011) Completed as of 2011

Building and Technology
Staffing Model and Compensation

Advocacy and Awareness

Phase II (2012 – 2015?)

Staffing model to accommodate growth
Building expansion to accommodate growth
Plan for long-term financial stability for TMC
Fundraising plan for the above

Midwife Center Business Plan:

The Midwife Center (TMC) has outlined five services lines that currently comprise its business model:

Childbirth services, and more specifically birth center births, are the key economic driver to TMC’s business model. These services provide the largest profit for the organization, as well as providing for mission delivery though women-centered pregnancy and birth care. Attracting more clients for birth center births, as well as encouraging more clients to choose a BC birth is of primary importance for the sustainability and growth of TMC. In order to accomplish this, comprehensive market research and a marketing plan need to be developed and enacted, including developing methods for midwives to promote the BC birth option to tentative clients.

Well-Woman services are needed services to grow TMC client base as well as to serve the organization’s mission; and are most cost effective when provided by a Nurse Practitioner. It is important to always have a clear analysis of both insured and uninsured/underinsured clients to determine the cost of serving each type of clientfor financial and staffing planning.

Client education servicesare taught by TMC professional staff, with an emphasis on offering classes that increase the likelihood of clients having births in the birth center. Additionally, planning for this service line will include market expansion beyond TMC clients, as well as infrastructure needs.

While professional education offerings are needed and necessary to fulfill the mission and vision of TMC, there is currently no direct financial benefit to providing such programs, although there has been a demonstrated benefit for attracting staff to TMC. Professional education will be focused on providing lectures at area hospitals, serving as a site for student nurses, midwives and other health professionals. The Ruth Stifel Fellowship will serve as our primary professional education program as it is a cost effective way to staff for growth and also contributes to the future of our birth center and others across the country.

Advocacy efforts will be pursued as long as there is funding available and outcomes realized from these efforts, with a focus on joining our sister state and national organizations to improve regulations and legislation for midwives and birth centers. A fundamental part of TMC’s vision, advocacy is necessary for the continued functioning of both the birth center and the practice. Funds for these efforts must be strategically placed and traction in pursuit of our outcomes regularly monitored.

Three goals have been identified to achieve the three strategic priorities of the Phase II Business Plan:

Plan for staffing and facility needs to accommodate growth
Develop, fund and implement relevant staffing and compensation model to accommodate growth up to 500 births a year
Develop a plan for space needs to accommodate growth up to 500 births a year
Ensure long term financial stability of TMC
Create plan for clearly identifying financial impact of each service line (Carried over from last Business Plan):
Include revenues and expenses generated from each operation
Create regular financial reports outlining position of each unit
Analyze costs and reimbursements from Bubbe Hannah programs including Adagio and identify current funding gaps

c. Maximize reimbursements for all service lines

Fundraising
Develop a fundraising strategy to financethe following:
Marketing Plan
Programs of the Bubbe Hannah Fund
Fellowship and other Professional Education activities
Expansion

The following summarizes the specific objectives of each of the threegoals above and how they will be achieved.

Goal 1a: Develop, fund and implement relevant staffing and compensation model to accommodate growth up to 500 births a year.

Objective

Data Elements

Responsible Persons

Process

Timeline

Outcomes

Decisions

Evaluation

Increase salaried nursing staff to give more tasks to increase client contact, satisfaction and organizational efficiency

List of possible tasks from staff and potential reimbursements

Ann, Cheryl, Christine

Tasks identified

approval for hiring
Implementation /

March Board meeting

By Summer 2012 /

Done

August

Continue to increase compensation to be competitive

2008 business plan

“2013 Goals to Reach”
Birth Center and United Way Wage and Benefits Surveys /

Christine, Ann, Chris

Complete goal for CNMs

ED, OM, and RNs

Compare TMC salaries and compensation to other birth centers and United Way Wage and Benefits Survey

By 2013 budget

By 2016 budget
Ongoing
Cultivate diverse recruitment strategy reach number goals and to meet mission / Operations Committee /

Q3 or before next hire

Staffing Plan up to 420 births – see below*

Midwife time studies

AABC and ACNM staffing guidelines /

Ann

Develop staffing models using the fellowship and increasing PT CNMs before hiring another permanent midwife

July

Staffing Plan up to 500 births – see below**

Same as above

Develop plan for Centering Pregnancy for long-term staffing /service strategy

Ann

2013

Continue to ensure adequate funds for professional development for entire staff

Bayer Center and other resources for admin.

ACNM, AABC, and others for clinical staff /

Christine, Ann, Chris

Ensure adequate funding in budget every year

Requirements for staff to take advantage of trainings /

Ongoing

* Current FTE with TS doing .1 administrative = 4.2 FTE

1. Capacity based on 7 births per month per midwife and 4.2 Clinical FTE midwives = 353 births yr

2. With fellow for 9 months: 4.2 FTE + .75 FTE = 4.95 FTE = 416

3. With fellow & 3 mos. w/ fellow appts, increase PT CNM, decrease CNM GYN, & RN or NP do PP visit =5.2 FTE = 437

**Increased CNM with current FTE 7 births per month per midwife configuration

Capacity based on 7 births per month per midwife and 5.2 (increase PT CNMS to FT) clinical midwives= 436.8
With fellow for 9 months: 5.2 FTE + .75 FTE = 5.95 FTE = 499.8
3. With fellow & 3 mos. w/ fellow appts, increase PT CNM, decrease CNM GYN, & RN or NP do PP visit =6.2 FTE = 520.8

** Increased CNMwith lower births per FTE to accommodate more births IF percentage of call worked goes above current FTE configuration

Capacity based on 6.5 births per month per midwife and 6 (increase some PT CNMs plus hire 1 FTE) clinical FTE CNMs= 468 births/yr
With fellow for 9 months: 6 FTE + .75 FTE = 6.75 FTE = 526.5
With fellow & 3 months w/ fellow appts, decrease CNM GYN, & have RN or NP do PP visit = 7 FTE = 546

Add 1 FTE Billing/Client Service Assistant (when more appointments are added to the schedule outside of current hours)

(Anticipated income for births over #1 with each scenario would go towards funding the fellow. Ideally, births should cover about 50% of the cost of the fellow, with fundraising to cover the remaining).

Goal 2b: Identify space needs to accommodate growth up to 500 births a year

Objective

Data Elements

Responsible Persons

Process

Timeline

Outcomes

Decisions

Evaluation

ID Needs /

Survey staff and other birth centers

Christine and Chris

Done – Q1 2012

Short term for classes /

Contact facilities in area for possibilities

Christine

Done – 4.12

PBT for most of CBE, BF, and possibly some Refresher

Plan for exam rooms before expansion is complete /

Appt. schedule

Staff availability /

Ann, Christine

Survey providers and front office staff for who could work outside currently scheduled hours

When we need to increase clinical FTE beyond current

Long term considerations for expansion /

Staff survey

Other birth centers /

Ann, Christine, Chris

Cost estimates /

Student plans

Current avg. $ per sq foot /

Jason

Facility needs for 420 and 500 births /

Consider additional services; otherwise plan should be sufficient for 500

Acquire Lot /

Research comps in area

Campaign readiness survey /

Christine, Chris, Board

Determine financial and fundraising capabilities

Goal 2: Ensure long-term financial stability of TMC

Goal 2a. Implement financial strategies for responsible growth

Objective

Data Elements

Responsible Persons

Process

Timeline

Outcomes

Decisions

Evaluation

Maintain a cash reserve of at least 1 ½ times one month of operating expenses /

Chris

Q1 and ongoing

Done

Reduce construction debt loans /

Chris

$20K by end of 2012

All of 2nd loan by end of 2013

$10K paid down in Q1 2012

Identify financial impact of each service line - Include revenues and expenses generated from each service line /

Chris

Analyze costs and reimbursements from Bubbe Hannah programs including Adagio and identify current funding gaps /

Chris and Christine

Create regular financial reports outlining position of each unit /

Chris

Ongoing after Q2

Consider impact of insurance and hospital environment

TMC client roster

Chris and Christine

Analysis of TMC client insurance and Pgh market

Ongoing

Continue to improve insurance contracts

Chris

Ongoing

Goal2b: Develop a fundraising strategy to finance the following

Objective

Data Elements

Responsible Persons

Process

Timeline

Outcomes

Decisions

Evaluation

Expansion /

See above

Fundraising Committee

Fellowship

“

Professional Education

“

Programs of Bubbe Hannah Fund

“

Marketing Campaign

“

Determine Campaign readiness

Organizational Assessments

Plan to increase “treasure” and diversity of board

Past effect on FR operating

Readiness Survey /

Christine and Board Devel. Committee

Christine
Fundraising Committee /

Review to ID weaknesses

Analysis of donations during Beg. Camp.
Q2 /

Q2 /

Weaknesses assigned to committees to address

Plan for next capital campaign

Costs of above

Fundraising Committee