Breastfeeding and Newborn Clinic

Jennifer Dixon, Jayda Rupp, and Ann Swanson-Hill

Executive Summary

Expansion of services at Lawrence Memorial Hospital for new parents and families is the purpose of this proposal. Two overall program enhancements are planned. First, the expansion of services that support and promote breastfeeding. Second, a first check up program to assure that newborns are healthy following early hospital discharge.

The establishment of an advanced practice nurse-managed newborn follow-up clinic facilitates a healthier transition for newborns and their families. The ability to offset existing expenses by utilizing staff that can generate revenue as well as provide a higher level of care is a benefit to the organization and to the community.

Problem Definition

The American Academy of Pediatrics recommends that most newborns require follow-up within 48 hours of dismissal.

Not all physicians follow this recommendation, including some in the Lawrence area.

Many normal newborns are discharged from LMH at 24-36 hours of age putting these infants at risk for undetected health issues.

In 2006, it was identified that 1 in 6 newborns did not have a follow-up visit by 14 days of age. (Madlon-Kay and Asche, 2006)

Most at risk not to follow-up: mothers with a low education level, lack of insurance, non-white, those with 2 or more children.

Problem Definition

The American Academy of Pediatrics recommendation of a follow-up visit within 48 hours of dismissal is timed so newborns are examined when: The bilirubin peaks (at 3-5 days of life) Lactation is just being established Congenital heart disease becomes detectable due to

physiologic changes Gastrointestinal and metabolic problems begin to

manifest

Goals and Objectives

The ability to add services to meet these vulnerabilities that can be missed by early discharge and lack of a 48 hour follow-up is the main goal for our newborns.

The object of the ARNP managed breastfeeding clinic is to provide treatment and services that help make the transition from hospital care to home easier and safer for mothers and newborns.

This service adds to the existing maternity services provided by LMH

Proposal

Continue daily rounds to all new mothers conducted by ARNP with lactation certification or RN with lactation certification

Increase educational opportunities for bottle feeding parents

Monitor infants for feeding effectiveness, adequate weight gain, hyperbilirubinemia, and other physiologic changes that can impede a healthy transition

Proposal

Develop a billable follow-up clinic, managed by an ARNP, for all newborns, where a plan of care is created and implemented to address identified problems with transition

Reduce readmissions to the hospital for hyperbilirubinemia, dehydration, or other neonatal conditions

Close the gap that exists due to early discharge and subsequent physician follow-up at two weeks of age

Provide these services in a confidential, family-focused location

Proposal

Services supporting and promoting breastfeeding are directed at achieving: Access to breastfeeding supplies that facilitate the

infant’s early success when challenges occur and support continued breastfeeding

Excellence in the follow-up care provided to newborns and their families

Performance Criteria

Outcomes that will be measured to determine effectiveness include:

Financial- We intend for this business to eventually be profitable. With the initial costs of supplies and salaries, it may take up to a year to see a profit. We will keep financial records to determine if this business is profitable.

Performance Criteria

Customer Satisfaction- By enhancing the services available to new parents, we believe that customer satisfaction will be enhanced at LMH. Customer service will be measured by survey prior to and after the establishment of the clinic. This will also provide an opportunity to make changes to our program as indicated by customers.

Assumptions

All employees of the clinic will be either RN’s or ARNP’s that are also lactation consultants. Appropriate referrals to care providers in the community will be made as needed. Because this clinic is overseen by an ARNP, the services provided at the clinic are billable, a cost center will be established to observe our expenses and revenues.

Constraints

Biggest barriers to providing services: Allocation of space Costs

Physician competition may be a risk, we will defer follow-up appointments for those physicians not wishing their patients to utilize the follow-up clinic

Services provided as potential lost revenue

Milestones

Remodel/Advertisement of new services

Open House/Grand Opening

Performance of cost-benefit analysis at 6 and 12 months

Program Costs

ARNP Salary

Yearly raise following 1st year (if annual goals met)

Total

$80,000.00

1% of Annual =$800/year divided over 26 pay periods=$30.77 per pay period

1st year $80,000 2nd year $80,800

Program Costs

Marketing/Advertising of new ARNP:

Information provided at OB appt

Information in monthly hospital publication

Newspaper ad per week

1 newspaper ad weekly for 1st 6 months

Total

$0

$0

$62.00

$1,488

$1,488

Program Costs

Office Set up:

Billing Service

Desk/Chair

Desktop computer

Tablet computer for mobile documentation

Total

Grand Total Costs (1st year)

Utilize existing

Utilize existing

$900

$600

$1,500

$82,988.00

Program Revenue Avg. monthly dyad visits

Avg. yearly visits

Approx. 80% of visits covered by private insurance monthly

Approx. visits covered yearly

Median billable amount per visit

Median billable amount reimbursed at 80%

Avg. monthly clinic reimbursement by private insurance

Total Average yearly clinic reimbursement

300

3,600

240

2,800

$100

$80

$19,200

$230,400

Cost Benefit Analysis

Grand Total Revenue

Grand Total Costs

Difference

$230,400.00

$82,988.00

+$147,412.00

Support for Hiring ARNP

By hiring an ARNP to provide billable services the clinic can continue offering services that are currently not profitable.

Based on the cost benefit analysis, hiring a Nurse Practitioner will result in a first year profit of approximately $147,412.00

References

Ask.com. http://www.ask.com/web?q=Advertising+Costs&qsrc=6&o=15527&l=

dis&prt=360&chn=retail&geo=US&ver=5

Campbell KP, editor. Investing in Maternal and Child Health: An Employer’s Toolkit.

Washington, DC: Center for Prevention and Health Services, National

Business Group on Health; 2007.

Gutowski JL, Walker M, Chetwynd E. “Containing Health Care Costs Help in Plain

Sight. International Board Certified Lactation Consultants: Allied Healthcare Providers Contribute to the Solution.” Morrisville, NC. United States Lactation Consultant Association, 2010.

Salary.com. http://swz.salary.com/SalaryWizard/Nurse-Practitioner-Salary-Details-66604.aspx

The Topeka Capital-Journal website. (2011). http://sales.cjonline.com/files/mediakit/rates-local-06.pdf

References

American Academy of Pediatrics. (2011). http://practice.aap.org/content.aspx?aid=2577

Madlon-Kay, D., & Asche, S. (2006, May-June, 2006). Factors That Influence the Receipt of Well Baby Care in the First 2 Weeks of Life. Journal of the American Board of Family Medicine, 19(3), 258-264. doi: 10.3122/jabfm.19.3.258