Judy G writes:
Lactation evaluation and management by a qualified lactation consultant,
home health visit, initial, 60- 120 minutes
...
Lactation evaluation and management by a qualified lactation consultant,
home health visit, follow-up, 40-90 minutes
These are pretty close to realistic, if we could tweak the #s up a bit.
Most IBCLCs in private practice where I am spend a minimum of 90 minutes for
an initial, and in very complex "train wreck" situations, stay over 3
hours. Of course part of that is counseling the mother through her anger, her
tears, and her grief. That can take quite a bit of time. It is something only
we do, there is no time or safety in an office or group setting, according
to the moms.
Most follow-up visits are shorter, lasting about 60-90 minutes, but can
also be longer. We had this same problem as PTs where we were limited by
numbers on the forms and had to figure out how to work with them ( when they
were written by people who didn't seem to understand what we did and how we
did it) . Laurie's suggestion was one that woke me up this morning: having
to start to break visits up over time to be able to do what we can now do (
and not charge any extra for, we absorb that cost) when we spend the
90-120+ minutes we usually spend. (btw: Moms do not pay us more for 3 hour visits
than for 2 hour ones. The consult is "a visit.") I feel like that would
break down the continuity of what I get to see though. Especially when that
involves going to each person's home each time, it is something that might
be hard to make work. The other thing I thought of is that most of us are
paid one fee, and then give hours of time on the phone or over email,
usually both, over many months with no extra charge. I just spent an hour
helping a mom I saw whose baby is now 14 months old, and we haven't worked
together since the baby was an infant. I did not charge her anything. Frankly, I
don't want to. Maybe that makes me dumb. It is probably hard to imagine
that fees that feel so high to some, functionally feel like something like a
combination of community service and bare minimum getting by to those of us
in this situation. If we learned nothing else from this, hopefully it's
that IBCLCs work in all kinds of places in all kinds of ways. I really
enjoyed hearing the kinds of ways that people work, as in Laurie and Stephanie's
posts. We are all attempting to help mothers and babies. We are, many of
us, not making a living wage doing something that, to me, seems critically
valuable both as a personal and public health level issue. Having so many
different healthcare providers in my life as friends and colleagues, it feels
like lactation consultants are the lowest valued and most
criticized/politicized group of healthcare providers in existence. Let's not be the most
self-divided as well.
On another topic though: I just watched the Webinar on the 8 new
"preventative services" that will be covered and some of the changes coming in 2014.
It would have been helpful to actually have a list showing what they are,
but I did glean some information. Here is the actual list:
_http://www.healthcare.gov/prevention/index.html_
(http://www.healthcare.gov/prevention/index.html)
There was a brief mention of breast pumps being covered that might "help
working moms", as well as the idea that getting breast milk for "at least a
couple of months " has "long term health benefits." Clicking deeper into
the website didn't clarify whether "breastfeeding supplies" would include
renting a hospital grade pump, but the speaker did acknowledge that some babies
"don't take to breastfeeding right away" and we know that is a rental pump
need not a personal use purchase pump need. If you look at the list of
what they consider preventative services, it is clear that although
"breastfeeding' is simply one of the listed services, it is very different in scope
and timing that anything else on that list. I think that is part of the
issue - what we do is simply not very comparable to any other "preventative
service." We are nothing if not challengers of the system in support of
mothers and babies, so we have that going for us as we move forward...
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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