In my location when a doctor issues a prescription for say an apnea monitor,
the home health agency nurse comes to the hospital with the monitor that is
either provided by the home health agency or another DME, gives a
demonstration, patient teaching, and then the mother can be discharged with
the monitor and a regular schedule of visits from the agency.  There is no
conflict of interest involved.  I do not know how one specific agency is
picked over another agency, I believe that it is only by availability of the
agency to the patient's insurance provider.  I think that this can be applied
in a parallel situation to a lactation visit.  If there is a problem, the LC
would come with the equipment necessary to eliminate the problem, at least
this is what has worked in my practice.  Most of my visits are paid for by the
insurance provider, which means I receive a consent and assignment for
payment.  The doctor issues a statement of medical necessity, and these are
usually very easy to obtain.  Most doctors will write a prescription for a
pump or a scale, a consult or BF supplies.  If the patient is private pay,
they are informed straight before an appointment of the cost of a consult, and
costs of equipment, etc., as extra charges.  It is much easier for me to have
whatever equipment I need with me, rather that to have to refer to a pharmacy
or other place, and not be able to demo etc.  Also I have talked to an
attorney/RN specializing in malpractice who specifically stated that as an RN
if I recommend/lease/sell medical equipment without demonstration, patient
teaching,  & return demonstration, that I have really opened myself for
liability under my RN license.  Therefore, all equipment gets a demo and tried
out before leaving my inventory through consultation (fee and no fee)  I don't
charge a fee, for a simple sale, but they called me, consulted with me and
received my professional advice on equipment available to help them.  I don't
see a conflict of interest on an insurance/private pay consult because I see
the similar situations with the home health agencies or hospitals, we don't
question the suppliers of the supplies or the equipment, but leave it to the
professional preference of the source. The insurance companies that I deal
with have not had a problem with reimbursing for my services or my equipment &
supplies.
Denise Breheny, RN IBCLC
Fayetteville, NC