Everything Alla says here is gospel. I used to work with contract negotiation with insurance companies many, many years ago. It is ALL about making a profit for the insurance company who has investors and trades on the stock market. Customer satisfaction (patients or MD's) is not the motive except tangentially.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Alla Gordina MD, IBCLC, FAAP
Sent: Monday, April 21, 2014 7:54 AM
Subject: Re: Industry standard length of consult?
On 4/20/2014 11:35 PM, Melinda Harris-Moulton wrote:
> I foresee that short lactation visits will be the norm until it is done long enough for a study to be done to prove the negative results it causes:
> ie "30 min LC visits led to a decrease of 50% in EBF, while 90 min LC visits resulted in <10% decrease in EBF"
> Evidence-based Medicine is wonderful, but....
Melinda,
While I do agree with you in the "Evidence-based Medicine is wonderful, but...." department, I will have to disagree on everything else and beyond.
Let's start with the evidence based issue. There are several pitfalls here.
1. A lot of the main street (i.e. published in /*Pediatrics*/) breastfeeding-related articles are sponsored by formula companies, i.e.
the infamous 'supplementation' study published last year.
2. Even if the clinic will get moneys to do an independent study and prove that LC visits are beneficial for the dyad and society, that clinic will go belly up the moment the study will be over and the moneys will dry up.
3. The only studies that insurance industry will be looking at would the the ones that will prove that having 30 min lactation visit will improve outcomes to compare with no visits at all.
Unfortunately, history repeats itself, and some times the rule of "first as a tragedy, second time as a farce" is not always right.
We, as physicians, have been there, we do live through this nightmare, so don't disregard what we have learned.
You are making wrong assumptions, counting on insurance's common sense.
They do count cents only to make them into dollars, billions of dollars.
They count on you to provide services in a shorter and shorter visits while accepting smaller and smaller payments.
They are rewarding doctors for pushing artificial milks as they pay the same for the well visit with a breastfeeding mother and a well visit with the mother feeding her kid artificially (even if that artificial formula s labeled as 'organic') Even if they will start noting what doctor is doing what (i.e. their attention to the antibiotic use i conjunction with the "cold" or
"sinusitis") that will be done is such a crazy way, that time benefits of pushing formula (or giving an abx script) will significantly outweigh the benefits of spending the precious time on explaining why unnecessary abx are bad and breastfeeding is good.
And families do count on everything to be "covered" under the "same low price".
Sorry. Medicine is not a Club Med. And "all-inclusive" here means "nothing is covered".
The questions you have to ask right now are (my answers are in brackets):
- How physicians are doing now?
(Poorly, thank you for asking. Private practice is a dying breed and those who are still solo or in small groups are being punished by higher retail prices, lower payments for the same services and increase push for merging into the mill works of mega-groups or selling their soles to the hospitals)
- How physicians are surviving?
(Barely, but those who want to be afloat next year and in the next ten years are learning their ropes, making their work more efficient and adjusting to the new environment, as it will be only changing to the worst)
- Can we count on insurance companies finally understanding the need for longer LC visits?
(Are you kidding?! We are forced to do more in a shorter period of time while spending $$$$$ on EMR's, MU's, MOC's and other worthless things.)
- Isn't *15 visit pays more then *14, and the *14 pays more then *13?
(Not always. In one hour one can do 4-5 *13 visits, 2-3 *14 visits and 1
*15 visit. Forget about 2 hour visit - that would never ever be paid for. BUT. You - or your clinic - will get much more revenue from doing
*13 visits. Even if - and that is a huge IF - one *14 visit would be paid more then one *13, as most insurances are right now paying the same for them - you will be still in a loss. And *15 visit is more for moral satisfaction then for being paid for accordingly, unless some other procedures will be done)
Alla
--
Alla Gordina, MD, IBCLC, FAAP
General Pediatrics
Breastfeeding Medicine
Adoption and Foster Care Medicine
Global Pediatrics and Family Medicine
NJ Breastfeeding Medicine Educational Initiative
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome
|
