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
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