Objectives Determine the amount of revenue needed to support salaries and overhead in a birth center setting 1
9th Annual AABC Birth Institute 10/1/2015 How we work: Family-centered maternity care by CNM 24/7 Primary care by WHCNP/FNP Lactation Consultants Safe and nurturing care in a homelike setting without unnecessary intervention Four private, fully-equipped birth rooms Tubs for laboring or water births, if desired Early discharge after birth Postpartum home visits Practice privileges at UNC & back up by Dept of Family Medicine if transfer required or consultation needed. Clinical Providers: Allison Koch, CNM Sarah Akers, CNM Cherese Infinito, CNM Jessica Albrecht, CNM Elke Bachmann, CNM Rachel VanBree, WHCNP, FNP Deborah Adler, WHCNP, IBCLC Nancy Albrecht, RN, BSN, IBCLC Maureen Darcey, CNM Executive Director Emily Joubert, CNM Carey Jefferson, CNM Patty Brown, CNM Ellen Chetwynd, RN, BSN, MPH, IBCLC Rebecca Costello, RN, BSN, MPH, IBCLC Mariah Velazquez, CNM Elley Schopler, RN, BSN, MPH, IBCLC 2
Total Births: 600 500 400 300 200 100 0 92 1996 1997 140 186 168 194 206 210 250 1998 1999 2000 2001 2002 2003 180 209 261 2004 2005 2006 2007 2008 2009 2010 291 339 361 413 447 452 2011 2012 2013 2014 Expected in 2015 484 491 503 Statistics: As of 9/24/15 4,279 babies were born at the birth center. Total births 5,722. 75% Delivered at birth center. Average C/S rate 7.7%. IP Transfer C/S rate= 4.5% Hospital transfer rate 13%. (IP Transfer rate) Postpartum Transfers 2% Newborn Transfers 2.7% 3
Payer Type: Medicaid: 25% Private Insurance, PPO & HMO: 69% Self-pay: 6% Calculating Utilization 4
Calculating Revenue 5-6 Births Per Month Per Midwife (after attrition). Accept 7-8 births per month per midwife. If you bill $7K per birth and are reimbursed 60% of your billed charges your avg. income will be $3,500 per birth $17,500-21,000 may be generated per month, per midwife. 50-60% of generated birth income can be calculated to cover overhead (i.e. rent, support staff, general liability, etc.) Calculating Revenue & Overhead $17,500-21,000 may be generated per month, per midwife. 50-60% of generated birth income can be calculated to cover overhead (i.e. rent, support staff, malpractice, etc.) 5
Calculating Revenue & Overhead $17,500-21,000 may be generated per month, per midwife. $17,500X12=$210,000 $21,000X12=$252,000 Salary Range Based on Volume and Overhead $210,000X40%=$84,000 $252,000X40%=$126,000 *$84K-$126K is the total compensation available in this example Include a 10% contingency Salary Range Based including 10% contingency $210,000X40%=$84,000-8400=$75,600 $252,000X40%=$126,000-12600=$113,400 *$75,600-$113,400 is the total compensation available in this example 6
Example Total Compensation Package: New Midwife $86,150 $250, 0% $2,000, 2% $1,800, 2% $4,500, 6% $7,600, 10% $5,000, 6% $65,000, 74% Salary Health Insurance Retirement Continuing Education Bonus Malpractice Moving Allowance Example Personnel Budget 7
Benefits Overview Health, Vision & Dental Insurance coverage & HSA Short/long term Disability Insurance & Life Insurance Vacation, sick & parenting leave Retirement contribution through 403b plan Malpractice Insurance/Tail Insurance Continuing Education Bonuses Employee pricing for boutique products Free breakfast and lunch at monthly staff meetings an employee birthday parties & catered gatherings. Employer paid taxes (SS & Medicare employer match & unemployment tax= ~7.65%) Benefit Costs Health Insurance: Annual costs for health, vision and dental coverage through Blue Cross Blue Shield are $4,918.44. $409.87/month/FTE Health Savings Account (HAS): Annual Benefit is $980. $80/mth + $20 enrollment Life & Disability Insurances $10K of Life Insurance - $24.00 annually; Short-term Disability based upon salary Average is $304.00/yr. Long-term Disability Average is $474.00/yr. 8
Benefits & What to Negotiate ~1st year benefits for a full-time provider costs WBWC $15,317.84. Malpractice: Premium varies based on years in practice. Get projections from carrier & as you grow consider Full-time equivalent policies to avoid costs of tail premium. Consider approved alternates if you aren t ready to bring on a full-time provider. Price Shop Health, Vision & Dental Insurance Retirement contribution: Research all options Benefits Dues and Licensure DEA certificate. $731 RN Licensure. $92 CNM Licensure. $100 NRP Certification. $150 CPR Certification. $45 ACNM Dues for both state and national. $350 national+$200 state 9
Dashboard Example Budgeting for time it takes for Credentialing Hospital-may take 1-3 months Insurance-NPI (National Provider Identification), CAQH (uniform insurance credentialing) DEA 10
Budgeting for time it takes for Credentialing Don t bite off too much too soon in salary Consider a lower starting salary & a 3-mth or 6-mth increase. Paying for a fully equipped midwife prior to them being able to take full call may not be financially prudent. Considerations As you grow you have increased negotiating power with insurers-although a large centers are still much smaller than hospitals. As you grow you may be able to offer increased benefits As you grow many times overhead increases as more support staff is required You will need to carefully track your patients due date list (EDC Spreadsheet) 11
Budgetary Considerations Allow senior providers to determine the number of patients they feel comfortable on their caseload. For most large birth centers this is 7 births/month/midwife. (There will be attrition) If your patient population is growing consistently then you need to hire additional providers to cover the caseload. Is your caseload consistent and growing? Expense Considerations Annual Insurance/Payer Contract Review Biannual Vendor Expense Review/Comparison. Beware of long-term agreements with annual increases. Contingency plans Keeping a min. of 3-mths worth of expenses in savings 12
Questions? 13