Regarding the question recently asked about ambulatory diagnosis related
groups - I called the Physician Payment Review Committee in Washington (it
reports to Congress on health care finance issues) and was referred to a
nice fellow at ProPAC (the Prospective Payment Advisory Committee - also to
Congress) who told me that 3M company markets software to calculate
prospective payments for outpatient hospital services - this type of system
is used by several states for Medicaid.  This really looks at the fee to
the hospital, not to the doctors, nurse, or LC.  The fellow at ProPAC was
not aware of any major effort to start prospective payments for ambulatory
care other  than capitation, which is already widespread.  The only way I
thought this interfaced with lactation consulting was if a hospital had an
outpatient clinic for lactation care.  My source suggested contacting 3M.

regarding digestion time for milk - a dear colleague and fellow fp Dr.
Richard Garrison once related his theory on why infants feed more often
when offered human milk - he believes that when a baby if fed processed
artifical liquid food for infants (I'll use this term until the poll
results are in...), a large almost undigestible mass forms in the infant's
stomach, and sits there, and sits there... and the infants thinks "no way
I'm asking for that stuff again," and doesn't request to be fed for awhile.
On the other hand, an infant given human milk likes it, and likes being
fed, and asks for more very soon....

Julie Graves Moy, M.D., M.P.H.
[log in to unmask]
P.O. Box 4768
Austin, Texas  78765
512-440-0480
512-441-1666 fax