I think it would be a great thing if someone making decisions about lactation reimbursement looked at what actually happens at a lactation visit. Certainly, there are some visits that would fall into the category of preventative counseling, but there are others with diagnosis such as failure to thrive babies, recurrent mastitis, etc. that are more "lactation therapy" than "preventative counseling" with all the assessment and interventions etc. required. Perhaps there will come a time when the differences will be recognized. Probably not until after I retire!
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of [log in to unmask]
Sent: Tuesday, July 31, 2012 9:56 AM
Subject: Re: The impact of decreased fees and client base
Judy G writes:
The IBCLCs will be providing "preventive counseling" and a physician assessment of an infant feeding problem would not have anything to do with this billing. I must assume that prosthesis is "ordered" by a physician and there must be some common diagnosis for each of them. Preventive health care is not going to be ordered by the physician.
~~~ See now perhaps we are getting somewhere. I read "preventative counseling" as a pro-active session designed to provide information and some basic problem-solving strategies. That does sound like something that would take less time and require simpler documentation. What I do, and what many IBCLCs do is more like "crisis intervention" and feels a lot like trying to stop a train that has gone in completely the wrong direction or derailed completely, for dyads for whom many things have not been prevented from going off track, even sometimes have gone horribly wrong. Many dyads are "crashing or have crashed" . This is very time-consuming and ultra-detailed consulting. I don't know any other health professional who goes to the home of the affected family and spends that kind of time and energy, which is then also followed by intense and regular phone and/or email contact after the consultation ( the vast majority of which asks for no further fee despite many extra hours). The phrase "preventative counseling" seems to have little to do with how most private practice IBCLCs work. If it is true, I do find it disconcerting that a physician can bill for a 15 minute lactation visit in office and get paid more than a 2 hour home visit by someone who is providing a vastly different level of detailed analysis, individual relevance in one's own home, the ability t0 take time to see the effect/outcome of many of the suggestions and strategies and much deeper and broader follow-up care. Both of these may be important links in the family's service chain, but they are not at all the same.
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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