Thanks for all your posts and suggestions!  I have a few moms who contact
me prior to delivery (mostly first timers)  and I have been providing a
prenatal home visit for a small additional fee, to help prepare them for
what to expect in the first few days.  ( I also still teach a
breastfeeding class at the hospital that is an option for moms
prenatally, but have to be very careful about keeping my hospital class
and home business very separate).  Then I have been following up very
soon after discharge to check on them.

I feel odd having to explain to the moms that I cannot see them in the
hospital as a LC, as if there is some reason other than the cost of the
application fee (which I don't want to have to bring up anyway). I agree
with Pamela's remarks that I want to visit as a professional and because
the staff all know me and why I left the hospital, I would feel funny
arriving as a *visitor*.

The fee is charged to other allied health care providers, but most of
them are advanced practice or office nurses and their fee is paid by the
physician they work for.     The reviewing committee is the hospital
administrator, quality assurance director and 5 physicians from various
disciplines.  When I requested a reduction of the fee, they countered
with why should we make is easier for you to have privileges when we have
a similar service in house.

The unfortunate part is that none of them know that the *service* has
been pared down to 18 hours/week and is only meeting the needs of a very
small number of patients.  Also, the LC is only seeing inpatient's and
there is no rental program or ability to see outpatients other than a
weight or bili check.  (Now you are beginning to hear *the rest of the
story*, why I left).

For right now, the fee is not an option as I have other expenses that are
more important, but will probably end up paying it if I find that I have
several patients who want my help in the hospital or if I see a lot of
moms with problems stemming from poor initial management.

Thanks again for your ideas and abundance of responses (for a Sunday
afternoon no less!)

Beth McHugh
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