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Birth Center Survives Close Financial Call

Insurance Spike Nearly Closes Doors

By Susan Levine
Washington Post Staff Writer
Thursday, February 3, 2005; Page DZ03

The District's only independent birthing center, part of a highly lauded collaboration that serves women and children in one of the poorer neighborhoods in the city, nearly shut its doors last week because of a perfect storm of financial troubles.

The four-year-old DC Birth Center, on 17th Street NE, faced a 30 percent increase in malpractice premiums, on top of continued low reimbursement rates from insurance programs and thousands of dollars in unpaid bills for services. The $22,000 premium down payment was met only after founder Ruth Watson Lubic and some of the center's many advocates pressed District and managed-care officials for payment -- and a major supporter advanced additional funds.

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The crisis left Lubic shaken. As clinic president and CEO of the birth center, she knows that "we're not out of the woods."

A host of people were instrumental in opening the nonprofit facility in October 2000 and uniting it with two partner programs that concentrate on early childhood health and development. But it is Lubic, a nurse-midwife now in her late 70s, whose vision and dogged determination are commonly credited with making it all a reality.

The birth center, housed in a former supermarket across the street from Hechinger Mall, offers gynecological and obstetrical services and parenting guidance to women and general care to their children. Its goal is to provide care before and after birth that will help lower the city's infant mortality rate -- more than 50 percent above the national average -- and set children on a healthy path in life.

Early evidence suggests that the center is making a difference: Its incidences of low-birth-weight babies and preterm babies, who face greater risk of medical complications, are well below city and national averages.

"We are really making a difference," said Lubic, "but you don't do that in a 10-minute visit."

The growth in the number of maternity patients has been slow but steady as the center has earned the community's trust. Though its nurse-midwives handled most of their clients' 136 deliveries last year at Washington Hospital Center, the number of women who chose to have their babies in one of the birth center's quiet, homey rooms more than doubled from 2003, to 24.

No matter where the babies are born, Lubic said, nearly all mothers come back to the clinic for their postpartum visit -- a stellar response given the socioeconomics of the population being served. Many keep returning because they bring their children to the day-care or family support programs run there by the other partners that make up the DC Developing Families Center.

The recent financial crunch was precipitated in part because Medicaid managed-care plans reimburse only about half the center's charges, Lubic said. Another factor was $38,000 in overdue reimbursements. But the final blow was the sharp spike, despite no legal claims, in the cost of malpractice coverage in 2005. If the premium due this week hadn't been paid, the midwives and nurse-practitioners wouldn't have been able to see patients, much less deliver babies.

"Here you have this little clinic that is making enormous strides," said Sharon Baskerville, executive director of the District of Columbia Primary Care Association. "And it can't raise $90,000 for malpractice insurance."

The immediate crisis is past. But Lubic and her board now are faced with raising half of the center's $1 million budget from foundations and other supporters.

Not long ago, a secretary at the center explained the staff's single-minded commitment.

"These people need us," she told Lubic. "We can't go away."


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