Nikki Lee wrote about working for an agency . I work for an
agency too. It's a great way to earn a steady income, but I
agree you can't meet your quota in 8 hours. If I see my full
quota of patients and they don't live close together, my day
is at least 10-12 hours long. I coordinate the Lactation
Program and also have administrative responsibilities. My day
is that long and more because I refuse to cut visits
short.The nurses I work with also work long hours. Getting
insurance authorizations for visits can take hours. I'm not
aware that HIPPA had anything to do with coding changes. A
few years ago most Insurance companies stopped paying for
Lactation Consults, visits are re-imbused as Skilled nursing
visits. This means the LC must do a complete nursing
assessment of mother and baby in addition to an LC consult. A
few insurance companies still pay for LC visits and do pay a
little more than a skilled nursing visit but not nearly as
much as for a bilirubin test and a Wallaby in the home or any
high Tech visit.I do understand the difficulty of managing a
budget, Having tried to keep the Lactation program solvent
and ongoing has been incredibly difficult.           We are
the only home care agency in our area that offers LC
services. I don't know whaaat the answer is, but after 12
years I exhausted, within a month I will be per diem. I will
do what I love, see only 2 patients a day with no
administrative responsibility and pray the program will
continue. Understand your frustration Nikki best wishes!
Chris Erland
RN IBCLC

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