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
[log in to unmask]

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome