Running Your Surrogacy/Egg Donation Agency: Your Phone System

So you have your intake forms ready for people who find your number on your web site....and they call you....on what phone? Your home phone? Your cell phone with that catchy little hip hop beat? or are you installing a separate line or using an answering service? Let me start out by stating you had better NOT be using your home phone number! NO NO NO! Hard to get any more unprofessional then having your 5 year old run to the phone when it rings and yell MOOOOOOMMMMM all through the house to get your attention. Ahhh NO!

The cell? I personally like the business cell phone method. You can carry your 'office' phone in your pocket and won't have to miss a call. You may start to refer to it as your ball and chain but that is how things are when you start up your own company anyway! You are always tied to it! Back to the phone. IF you are going to use the cell....or a second line for that matter, I assume you will have voice mail. Do not have anything on that voice mail recording but YOUR pleasant and professional voice giving out directions on how to leave you a message so you can get back to them ASAP! Voice Mail is the perfect place to make a short and sweet plug for your business as well: "Thank you for calling ABC Surrogacy Services, A full service matching and relationship management company! We are sorry that we can't take your call right now but if you will please leave your name, message, number and a good time to return your call, we WILL get back with you as soon as possible." (here you can leave a notice if you have one) "Please note that we are closed this Monday for Memorial Day." (or whatever) Simple and effective. With unlimited plans out there, this is a very cost effective way to work.

Why not try a professional answering service. This service would be real people picking up your calls and then forwarding them onto you...they act like they work in your office for you and gives that big business feel. I am not sure that I would recommend the expense for a start up but if you have no partner this might be helpful.

Any of these ideas are a home office/Tax write off...which is something you need to take into consideration when you are setting up your business.

ETHICS in Owning an Agency by Guest Blogger Brooke Kimbrough of 4 Sisters Surrogacy Agency

This past weekend I spent two days in sunny southern California with 150 of some of the most educated, respected and experienced professionals in the world of surrogacy.  The conference was put on by S.E.E.D.S (Society of Ethics for Egg Donation and Surrogacy) and covered topics from legal practices to medical risks and everything in between.  Throughout the two day conference, a consistent theme was the ethics involved in surrogacy and egg donation and the responsibility of all players to uphold these ethics. 

With the media focused on the failures within our profession, often times these anomalies within the community overshadow the enormous amount of reputable agencies, attorneys, medical doctors and metal health professionals in the field.  With over 200 agencies within the U.S. alone, how would one not well versed within the community be able to determine the agency's ability to provide quality services?  How would an intended mother be able to insist on using an ART(assisted reproductive technology) mental health professional when she was unsure that such a thing existed? The answer came to me as I sat listening to a review of a sensationalized case currently prevalent in the media regarding a non-compliant surrogate and a now father of triplets. 

Ethics or moral philosophy is the branch of philosophy that involves systematizing, defending, and recommending concepts of right and wrong conduct. (wikipedia.com). Within the surrogacy community, the idea of "right" and "wrong" often fall within a gray area open to interpretation and personal moral beliefs.  So how, as an agency owner for example, do I best practice ethics and serve my community in the most professional and morally positive way?  What are the moral guidelines I should follow when I enter into a gray area?  How do I lead by example for fellow agencies to follow with ethical decency? The answer lies within the name itself; E.T.H.I.C.S.

"E" is for Excellence.  ASRM guidelines exist as a baseline for the practices of surrogacy.  These are the bare minimum of standards that should exist within your agency.  These guidelines, while they hold no legal standing, are certainly an excellent jumping off point for standards that should upheld within your agency.  However, do you want your agency to do the bare minimum? The answer is "no". Your clients and colleagues expect that you are serving your community with excellence.  So, when there is a question of whether a surrogate is qualified or if an intended parent's criminal record should preclude them from using your agency, refer back to "excellence" as your standard practice.  Live above the basic guidelines of ASRM and serve your clients and community with excellence. 

"T" is for Transparency.  As an agency, transparency is key to providing excellent service to your clients.  Did your surrogate fail a MMPI test several years ago but has since made some life changes and passed her most current screening?  Do your intended parents have multiple surrogates? You need to be transparent about all information so that both your surrogates, as well as your intended parents can make informed decisions.  Being transparent allows for each party to be able to clearly see their path and to feel informed and supported throughout the process.

"H" is for honesty.  As a new agency owner, honesty is an essential part of my profession.  Be upfront and honest when you interview IPs and Surrogates.  Be clear about your surrogate availability, provide accurate timelines and be clear about fees and potential additional costs.  By leading by example, you can in return expect honesty from your clients as well. Let your clients know that dishonesty in any aspect of the process will be grounds for breech of contract and elimination from the agency.  Being honest as an agency owner makes for journeys that have clear and appropriate expectations and end with satisfied clients. 

"I" is for Instinct:  Instinct is a feeling that is often disregarded because it can lack physical evidence.  However, instinct is at the core of our ethical and moral compass and should not be overwritten.  If you have a "bad feeling" about a particular set of intended parents, there is no harm in explaining that the agency is unable to handle their case.  You can feel free to refer them to another agency who may be better equipped to handle their particular circumstance or personality.  In the end, this is a service based industry with long term clients.  You have to spend a lot of time and emotional energy on each case and it is completely acceptable to not utilize that energy on a case you do not feel 100% committed to.

"C" is for Connectivity:  Being a small canoe in a very large ocean can be lonely, overwhelming and frustrating.  Connecting to your clients and their needs is the first step in providing quality service.  However, it does not stop there.  Connecting to peers and professionals within your community helps protect you as well as your clients.  Understanding that while you may have vetted your surrogate, the mental health professionals that you work with are another qualified set of eyes who may be able to spot potential issues.  Your attorneys are there to provide quality contracts and to follow through with legal deadlines and requirements.  Connecting yourself with qualified colleagues can help your agency stay on course through the uncertain seas of surrogacy. 

"S" is for Stewardship:  Stewardship is the careful and responsible management of something entrusted to one's care (Merriam-Websters).  Just as your surrogates are to act as stewards for their IPs unborn child, you as an agency owner, are equally responsible for carefully and ethically managing the complete surrogacy journey. Set up systems that keep detailed calendars and records.  Be organized and proactive in managing and overseeing the process and journey.  It is your job as an agency owner to keep everyone involved walking in the same direction, down the same path, towards a happy, healthy baby.  

In trying to manage an agency that is above board and morally sound,  E.T.H.I.C.S is a sure fire way to make sure you are always on the "right" side of any gray area.  By being ethical and moral leaders within our profession, we can be sure that our clients are receiving the best possible care. Additionally, we can ensure that our growing fellowship is being led by a group of honest and trustworthy professionals who can guarantee a more positive and ethical representation of our amazing community.

Brooke Kimbrough is the owner of 4 Sisters Surrogacy Agency in Roseville, CA.  They work with exclusively with California surrogates and domestic intended parents in personalized surrogacy journeys.  She can be reached at brooke@4sisterssurrogacy.com or on their website www.4sisterssurrogacy.com.

The Best Things In Life Come With Patience!

Start NOW! What Are you Waiting For? Start Where You Are, With What You Have.

How Surrogacy and Egg Donation Agency Owners Fail: 8 Tips to Avoid Isolating Yourself

What does this ‘isolating yourself’ possibly mean? We have the Internet and phone(s) what else is there? Believe me I get this reaction all the time when I‘m consulting would-be surrogacy and egg donation agency owners. It’s understandable that the Internet, which reaches almost every corner of our world, seems to be more than enough to run a business especially coupled with our cell phone! Not so my friends. In the world of surrogacy and donation being a one man alone show will not work. Soon you will find yourself lost in the ever shifting field of infertility, uneducated and uninformed. (Behind the times!) 

I am not saying that you can’t run an agency by yourself. That is being done at this very moment by several reputable agencies a crossed the USA. What I am saying is that you need to connect with other agency owners, physicians, clinical staff, reproductive attorneys and mental health professionals. Being an island all unto yourself will not work in the long run. 

I know that getting out of your home office is may cost you money and time. Visit clinics? Talk with attorneys? Attend a conference? Why do you need to do that when you can use the phone and internet? The answer is because people tend to trust those whom they meet in person and I don’t mean just once but over and over. It’s human nature. Plus the things you pick up about others when you meet THEM in person is invaluable!

Here are 8 tips to get you out of the isolation rut:

1) Making a few clinic/office visits a couple of times a year in your area will really help your business grow. (You don’t need to bring lunch…brochures and cards are just fine…cookies are good too!)

2) Attending a conference, seminar or workshop at least twice a year and networking while there (My suggestions: START ART, SEEDS and ASRM)

3) Meet with your clients, donors and surrogates in person whenever possible

4) Meet with hospital staff whenever there is a birth local to you

5) Bring brochures and business cards with you to your own personal appointments

6) Practice your ‘elevator speech’ for the next time someone asks you “What do YOU do?” Get use to talking about YOU!

7) Join a business group like the Rotary Club or Ladies Who Launch, (I belong to STARS: Seattle Tacoma Area Reproductive Society, which is local to me) and attend meetings frequently (Even though some of these clubs are not within the infertility field you can network with other business owners and pick up some general marketing tips and make unexpected connections)

8) Join online listservs, Linked IN and Facebook groups and then attend the face to face get together 

You will find that once people see you out and about and connect with your charming personality your network and contacts will continue to grow. Someone who can’t help their client out might just send them to you. Others may want to work with you on a project or invite you to join a board. The more involved you become the more exposure you will get. Trust me…it’s all good! 

How Surrogacy and Egg Donation Agency Owners Fail: Unethical Behaviors

If you go down the wrong path you will lose clients, your reputation, your staff and finally your business. If that’s not stating the obvious then I don’t know what is! But lets remember that I am talking about Surrogacy/ Egg donation Agency owners/staff who are dealing with clients who come to them already vulnerable and needing a guiding hand through this family building process. Add to that hopeful women who are excited to help your clients become the parents they have always dreamed of being. The temptation to engage in behaviors listed below can be quite strong. But you must RESIST!

What does unethical behavior look like? Below is a snap shot:

*Anything illegal (This is a no brainer but it has to be on the list and I believe we can think of a recent case or two of baby selling/human trafficking....)

*My personal current pet peeve, using state or federal insurance for a surrogate pregnancy (this is illegal in some states and a huge gray area in others and it seems that most people do not want their tax dollars going toward a surrogacy pregnancy)

*Misleading Intended Parents (“Yes, we have several surrogates waiting to be matched” when you really have 2 and you have 5 IP’s in line)

*Misleading donors and surrogates about how many recipients or IP’s are waiting to be matched

*Misleading donors or surrogates about how long the wait may be to be matched and how long it will be before they get any sort of payment

*Telling donors that the agency have bought insurance for them when really they have not

*Misinforming surrogates or donors about the potential risks or procedures (Shots anyone? Bloating? Weight gain? No sex? Hmmmm)

*Telling Intended Parents that the surrogate has maternity insurance when the reality is there is a surrogacy exclusion on her policy and you are just praying that no one finds out

*”Fixing up” donor profiles by removing family history of cancer, alcoholism, drug abuse, higher IQ, etc. (No one will know! It’s ‘anonymous’ right?)

*Padding the bill

*Holding escrow when you are not licensed or bonded to do so

*Encouraging a surrogate to waive the right to an attorney in order "to save" the IP's money

*Telling Surrogate that selective reduction seldom happens and so just agree to it and other demands that IPs may want her to do

*Not contacting the donor with an IPs further questions…instead just guess at the answer

I could go on. I don’t want to you to think I am totally innocent from all of the above! I held escrow…once! Back in 2003 and it just turned out to be a bigger pain then it was worth. We quickly found a local attorney to hold all of our escrows for us. (Instant relief!) I, myself, have waived the right to an attorney for my second surrogacy (2004-2005)…shame on me because I could have really used some advice about half way through…but that’s called the classroom of life. The other issues that are listed are being done by someone, somewhere, right now. Maybe just one or two unethical practices but still…more then one "someone’s" as a matter of fact. And most are changing their ways…it’s hard to change when you want your business to flourish but if you continue along this unethical path you soon will have zero clients to worry about!

How Surrogacy and Egg Donation Agency Owners Fail: Lack of Continuing Education

There is no School of Surrogacy and Egg Donation. (or of any donation for that matter) There are no ‘how to run an agency’ classes out there, unless you hire LaMothe Services, LLC, but that is beside the point. You won’t find any courses offered at your local University or Community College on how to start an agency, run a donation program or serve your Intended Parents. We are just not that mainstreamed yet…sorry to say it. So when I talk about continuing your education I am talking about reaching out, taking the initiative and attending seminars and conferences that will allow you to become more knowledgeable in your field. The field of Third Party Family Building.


A great example is START ART which is an annual REI Nursing Congress. START ART stands for Scientific & Therapeutic Approaches to Assisted Reproductive Technology. (Every August) I found this great seminar about 15 years ago (when it was called SMART ART). It offers CNE’s (Continuing Nursing Education Certification.) Although I don’t need the nursing credits I know that this is a great learning experience for me and my peers.  The networking opportunities are wonderful as well! This is a two and a half day seminar in Las Vegas. Is it worth the time and money! Yes! Do *I* come back to my office with useful information and energized by those I interacted with? Again, Yes! Am I getting paid to promote START ART? NO! But you should attend next year! (I will announce it on my blog. Subscribe so you won’t miss it!)

Another not to be missed conference is the American Society of Reproductive Medicine’s annual meeting in October this year. The ASRM holds an annual meeting every year and as an agency owner you should already be a member. The program is jam-packed with useful sessions and this year it’s being held in Salt Lake City October 15-19th. Because thousands of people from all over the world attend, this is a great learning and networking opportunity! (again, I am not being paid to promote the ASRM annual meeting however I will be attending as usual.)

               

Personally I tend to lean toward the mental health portion of this meeting. I also belong to the Mental Health Professional Group and will be attending their usual Saturday evening welcoming dinner. (Again, meeting people in person where, for most of the year, we might only interact via the Internet). I don’t want to forget to mention Postgraduate Courses on both Saturday and Sunday before the conference.In 2011 I was a part of the faculty focusing on The Psychology and Ethics of Marketing a Mental Health Practice in Infertility with the chair being William Petock, Ph.D. and Jeffery Barnett, Psy.D. It was a very rewarding undertaking!

Another, newer conference is also available via The Society for Ethics for Egg Donation and Surrogacy (SEEDS). This is a nonprofit group created for all U.S. agencies to have a voice in defining a set of ethical standards for egg donation and surrogacy programs. The registration is now open February 26 and 27, 2016 in Long Beach CA. CEs for professionals. Debate, controversy, esteemed speakers, discussion, networking, professional development, shmoozing, fun, food, and more. Go to seedsethics.org, then click on EVENTS to register.

Ok…so is your business going to FAIL if you don’t attend these (or other) conferences? No…you can get by without traveling a half a continent away. Learning about what’s happening in the legal arena, the clinics, and in the ART world of mental health is always educational. But attending these and other seminars and workshops will reassure your clients that you invest in yourself and your agency and are knowledgeable about what is going on ‘out there’ in the field of Infertility today! (Plus you get out of the office! See the world! And meet new people! A win-win situation!)

How Surrogacy and Egg Donation Agency Owners Fail: Sticking to the No Refund Policy

I know how this sounds…refunding money is never something you want to do but there are times when you have to even if it states quite clearly in your agency retainer agreement that there are NO REFUNDS. We had a no refund clause in our retainer agreement when my partner and I owned Surrogacy Consultants of Florida. However we found out quickly that our policy could not be set in stone.

Before I talk about refunds here I want to make a mention about your income. Intended Parents pay your bills. You are counting on their money to run your program all in the name of helping them reach their dream of parenthood. This is a good and needed service. However, if you mismanage your money, your income, it will come back to haunt you. I work with both large and small agencies and I have found that some live ‘hand to mouth’. Not a good idea. What I am about to suggest maybe hard for some especially if you are counting on living on the income that your agency is providing you. Do not spend any retainer money that comes through your office until your IP’s are matched with their donor or surrogate AND their contracts are signed. Not one penny. Bank it. This money may need to be refunded and if you spend it then where will you be?

Here is my refund ‘what if’ list:

*What if the surrogate/donor doesn’t want to work with the IPs that chose them? (and the IP’s don’t see any others they want and would like a refund)

*What if the surrogate/donor doesn’t pass the medical evaluation? (and the IP’s don’t see any others they want and would like a refund)

*What if the clinic rejects the donor or surrogate for failure to follow medical protocol or other reasons? (and the IP’s don’t see any others they want, don’t trust your pool of GS or Donors any longer and would like a refund)

*What if the Intended Parents have a medical or financial issue of their own and need to back out of your program? (After just a few weeks and they are not matched so they would like a refund)

*What if you find out the IP’s are delusional and YOU want to give them a refund after a few weeks of trying to please them and you see that it’s an impossible mission!?

*What if the donor/surrogate is not mentally able to perform their commitment and back out before contracts are signed? (and the IP’s don’t see any others they want and would like a refund)

There are quite a few scenarios but you get the picture. A refund maybe in order. If you can’t rematch, have a difficult client, someone is threatening to sue unless you do refund, or the surrogate/donor has been disqualified, someone may be asking for some sort of refund. (full or partial) If you don’t have any money in your account then this is the place where your reputation is put on the line. I can assure you that your clients will go on message boards to complain about you and your services, they will call their RE and attorney and they may even bring you to small claims court. Having their retainer money on hand could resolve a lot of problems.

If you manage your income and have a ‘cushion’ in your account equal to at least 3 retainer payments you will rest easier. Remember refunding is a hallmark of great customer service and if you have truly done all you can to make your client happy and a refund is the last resort then just give them the money! You will learn from this encounter and find that refunds are few and far between but less painful when you have the money set aside ‘just in case”.

How Surrogacy and Egg Donation Agency Owners Fail: Poor Customer Service

You give them everything and they still want more! Well…that’s the attitude that will put you strait on the road to failure, especially in the surrogacy and donor agency business! Clients are paying out of pocket for your specialized services and they expect the best once they commit!

One thing that you need to do first and foremost is charge a fair amount for your services. If you are not getting paid enough to cover your expenses and your payroll then you will end up cutting corners. Corners that your clients WILL notice! I realize that there is a lot of competition out there (more in some states then in others) however charging far below the minimum of your closest competitor is not the way to go. My suggestion is to first figure out how much your competitors are charging and for what services. Next look at what you are offering and your overhead costs. Remember that it takes time to build a great reputation and a lot of hard work before an agency starts to make a real profit. Quick example: In the case of the effort spent on behalf of the surrogacy agency, it may take 3 IVF cycles and 2 surrogates for some IPs to reach the goal of having a baby. This could take 2 years of your agency’s time and commitment.

What is great customer service? You don’t have to look far to find out the answer…you only need to ask yourself what you would expect if you were in the same shoes as your clients. I know I may be preaching to the choir here because quite a few agencies are owned by past Intended Parents, Donors or Surrogates. Below is my short list for exceptional customer service:

*Phone calls or messages answered or returned promptly

*Clear communication

*Easy Accessibility to you or your staff (24 hour hot line available to clients who have retained your services)

*Taking responsibility for problems that may arise with you or your staff

*Going above and beyond when necessary

*Don’t avoid ‘difficult’ clients

*Never let more than 2 weeks go by without a phone call or e-mail to all parties involved (especially when things are going well)

*Refund when warranted (Read the post on Refunding)

*Offering up-to-date educational information to all clients. This means attending conferences and workshops within the infertility field so that YOU are educated and well informed!

So what if one or two of these little points are not on Your list? That doesn’t matter…because these items ARE on your potential client’s list along with many others. As I stated above, all you need to do is ask yourself how you would like to be treated, how you would feel "IF" and go from there. The way to build a great reputation is to offer the very best of you all in the name of customer service!

How Surrogacy and Egg Donation Agency Owners Fail: Lack of Communication

It doesn’t matter how large of a business you own, if there is little or lack of communication either between you and your employees or between staff and clients you will fail unless this problem is corrected. In the field of surrogacy and egg/sperm donation there really is a lot of room for miscommunication.

First is the non-verbal cues that are given when your telephone is not answered during business hours or messages are not returned within a reasonable amount of time. What this says about your business is that you have no interest in who is calling or why or that you are too busy to take or return the call. This leaves potential clients, donors or surrogates wondering about the quality of services provided by you and your staff. (If they ever do hire you. This is where you might lose a great GS or IP.)

A second common problem with miscommunication is when a client has been given different information by different people in your office. This can happen when staff has not been updated regarding new or existing donors or available surrogates, when the client is quoted different pricing for services, or regarding case management and program protocol.

Speaking of available donors or surrogates, remember to keep your data base updated. When you have unavailable profiles listed in your data base it sends the signal that you are misinforming the public and are sharing more donor or surrogate profiles then you really have available. It also raises hopes if someone is really interested in a profile only to find that the candidate is not available. Always remove a profile once she is talking with other IP’s. If it doesn’t work out you can simply return the profile to your data base. Adding available profiles as soon as you can is a great indication that you have full control of your data base and know exactly who is on there plus all the details.

My third point is continued communication throughout the donation/surrogacy process. Often times once the match is made and the surrogate becomes pregnant, agency owners assume all is well and may not contact the IPs, donor, or surrogate for weeks or maybe even months. If you are advertising ‘full service agency’ that should include checking in on all parties and making sure that procedures have gone smoothly, if the relationship is going well amongst all parties and if anything extra is needed, In the case of the donation it is important to make sure the donor has recovered from her procedure and it’s always nice to see if a pregnancy resulted.

My forth and final point is the communication with other professionals in your field. I am taking about the clinic and nursing staff, attorneys involved, escrow agency and the mental health professional. It is so important that every one know exactly what is going on with your clients. Even if you are not the one directly communicating with these other professionals it is a good idea to remind your clients to make contact at certain points of a match. For instance the attorney should know when the birth is expected to take place and whether it is a singleton or multiples so the proper paperwork will be ready, it’s also a good idea to remind a surrogate to make arrangements for a hospital tour with her IPs, you should tell the clinic if a miscarriage takes place or a twin is lost and the mental health professional might like to know how the match is going and if there is a need for follow up.

Failure to communicate with all parties involved such as your agency staff, clients, and other professionals can give you and your agency a poor reputation. These are all issues can be worked on and eventually fixed. Your future as an agency owner depends on great communication!