Practice Management

  • 1.  MFM Community Need?

    Posted 11-03-2022 17:28
    Hi All,

    Apologies if this is not the correct forum for my question, I'm happy to remove this post if so. 

    I'm a strategist at a large non-profit health system and am evaluating maternal fetal care programs.

    A common measure is a specialty-specific ratio - number of specialists per 100K in service-area population - as a starting point in evaluating community need.  For example, if 12.6 is the ratio used for OB/GYN Generalists,  a community of 400,000 would need (12.6)(4) = 50.4 OB/GYNs.  

    My challenge is that I cannot find a value for MFMs specifically.  I'm wondering if anyone here has seen such a measure specific to Maternal Fetal Medicine.  And/or could recommend other measures to justify community need.

    Amy Moore

  • 2.  RE: MFM Community Need?

    Posted 11-08-2022 11:11
    To my knowledge, there is no national standard. I asked some of my colleagues in the SMFM Practice Management Division and looked at my own experience and that of other colleagues. A reasonable ratio suggests one MFM for every 4-8 OBs depending on whether the MFM does imaging on all patients or just high risk patients. If in-house call is also routinely taken by the MFM (i.e. off the next day), then you would likely need an additional 2-3 MFMs in the group to cover the in-house call schedule too.

    Fadi BSAT, MD, FAIUM
    Chair, SMFM Practice Management Committee
    Immediate past Chair, SMFM Coding Committee

  • 3.  RE: MFM Community Need?

    Posted 11-14-2022 13:40
    Can anyone provide guidance on how practices are billing for NP services  in conjunction with an MFM visit.?  Is there a legitimate way to add time like would be possible if two mfm saw the patient on the same day for the same practice?  
    We did  add time for inpatient services but not sure about MFM outpatient services.  .

    Also, how are practices optimizing use of NP in an outpatient setting?  Our practice does a lot of comanagement and some assume care.


    Debra Guinn MD, FACOG

    Professor of Obstetrics and Gynecology

    Maternal Fetal Medicine Division Director

    Obstetrical Services Medical Director

    Dept. of Obstetrics, Gynecology and Women's Health
    University of Missouri School of Medicine

    500 N Keene Ave, Suite

    Suite 406

    Columbia, MO 65203

    Phone:  573-817-3306

    New email:


  • 4.  RE: MFM Community Need?

    Posted 11-15-2022 08:20
    In response to Amy's Question, there is information on this in the practice management textbook and as a strategist, this may be helpful for you to purchase from the society.  However, this is based on the original numbers by Rayburn and a probable underestimate of approximately 15-20% in his study but the following should help:

    1 MFM for every 2600 deliveries
    1 MFM for every 37,600 reproductive age women
    1 MFM for every 100-120K population

    Brian Iriye

  • 5.  RE: MFM Community Need?

    Posted 11-15-2022 09:31
    Hi Debra,
    I checked on your question with the SMFM Coding Committee expert Brad Hart. This is his answer to your question:

    It's perfectly acceptable for them to add together the cumulative time for a doctor and an NP (or PA, or CNM), if it all occurs on the same day.  It's just a form of "incident to."  What's not acceptable is to add the time of a physician and someone who does not have the ability to bill the payer on their own, or otherwise bill "incident to" (e.g. RN, genetic counselor, CDE, etc.).
    Best Regards,

    Fadi BSAT, MD, FAIUM
    Chair, SMFM Practice Management Committee
    Immediate past Chair, SMFM Coding Committee

  • 6.  RE: MFM Community Need?

    Posted 11-15-2022 10:03
    That is a great question, we always include this information in our coding course because lots of MFMs have the same question about incorporation of NPs into practice.  They can be a big help infact, but billing can be complicated.  You have to consider the state, credentialing, payer and what procedure (E/M outpatient codes) are being performed. 
    I would refer you to three resources:

    1) The SMFM Coding Course - the April one is available as a Webinar, last week's course (Fall Coding) will be up soon
    SMFM Learning: Coding Course for MFMs - Spring 2022
    We do the incident to/NP billings and the slide sets will probably be useful

    2) A white paper we have put together which is under Coding resources:

    White paper: Non-Physician Providers in Maternal Fetal Medicine

    3) SMFM Coding manual (you may already have this) Shop | - The Society for Maternal-Fetal Medicine

    Sorry I don't have a more clear answer for you - but hope this helps
    I'm sure others will chime in with how they utilize NPs in their practice. 

    Vanita Jain, MD
    Chair, SMFM Coding Committee

  • 7.  RE: MFM Community Need?

    Posted 02-05-2024 09:32

    Your question is entirely appropriate for this forum, and I appreciate your engagement. Evaluating maternal-fetal care programs is crucial for ensuring the well-being of both mothers and infants. While I don't have specific data on the ratio of Maternal Fetal Medicine (MFM) specialists per 100,000 in the service-area population, I can suggest some alternative measures and approaches that may help you in your evaluation:

    1. Collaboration with Professional Organizations: Reach out to professional organizations related to maternal-fetal medicine, such as the Society for Maternal-Fetal Medicine (SMFM). These organizations often conduct research and may have data or recommendations on appropriate staffing ratios or community needs.

    2. Consultation with Healthcare Institutions: Connect with healthcare institutions or academic medical centers that have established maternal-fetal care programs. They may be able to provide insights into their staffing models, patient volumes, and the factors they consider in determining the appropriate number of MFMs.

    3. Review of Existing Literature: Conduct a literature review to identify any published studies or articles that discuss staffing ratios or community needs for maternal-fetal care programs. Academic journals, healthcare publications, or research databases could be valuable resources.

    4. Collaboration with Public Health Departments: Consult with local or regional public health departments. They might have data on birth rates, high-risk pregnancies, and maternal outcomes that could inform the need for maternal-fetal care specialists.

    5. Adaptation of General Ratios: While not specific to MFM, you might adapt general ratios for OB/GYN specialists to estimate a starting point. Collaborate with experts in the field to refine these estimates based on the unique needs and challenges associated with maternal-fetal care.

    6. Expert Consultation: Engage with experts in maternal-fetal medicine, either within your health system or through external consultations. Their insights and experience can provide valuable perspectives on staffing needs.

    Remember that the specific needs of a community can vary based on demographic factors, prevalence of high-risk pregnancies, and other regional considerations. Combining multiple data sources and expert opinions can contribute to a more comprehensive evaluation.

    I hope these suggestions help guide your evaluation, and I wish you success in your work to enhance maternal-fetal care programs.

    Tom fox