Questions & comments based on Nikki's post:

> BC/BS kicked the private practice LCs out of network
> when the new HIPPA regulations went into effect, saying that there was no
longer
> a billing code for us.

Can you tell us which codes you were using & where in the HIPAA regulations
we can find the deletion of LC service codes? I thought HIPAA was focused
on privacy? Obviously not.

>      So my income is less, but 0% of a higher number is still zip. So my
> private practice fees are a thing of the past. I am glad I can get work
this way,
> keep my skills up, and make some money.

The vast majority of private practice LCs in Arizona are fee-for-service
and not reimbursed. They provide a letter for the client to attempt to get
their own reimbursement. Occasionally it happens.

>      At orientation today, my preceptor told me that the basic mother-baby
> visit is basically a loss-leader for the insurance companies, who want to
> attract clients. That is why they reimburse so little for them, so the
agency gets
> little and the field nurse gets less.

Another example that medical providers view LCs as a Public Relations
gimmick with no real value or benefit for their patients.

> The money is in the technology:
> wallabies, high-risk antenatal care, high risk infant care, and wound
care. I was told
> that certain visits were the good ones, because they were short and paid
> relatively well.

This is probably why my hospital is doubling the size of our SCN Level II
nursery. They sacrificed our Parenting Room to do it. This was a room where
moms of Level I babies could stay at no charge so they could breastfeed
their baby who was kept under Bili Lights for 1 or 2 additional nights. No
more....  sigh.

>      The implication to me seems that one must be efficient and not spend
too
> much time with a client in order to make a living.
>      The lactation visits pay a little more than mother-baby, some
acknowled
> gement of higher training. I was cautioned not to do "too much
breastfeeding
> teaching" at a mother/baby visit, but to get authorization for a lactation
> visit.

There have been similar comments from others on L'net. The 'bean counters'
at their facilities are asking info on how many patients the LC sees each
day, & some have urged the LC to see more - like there was a daily quota.
It's like, "Hi, I'm here. Sit this way. Position baby this way. He's on a
little bit? Well, that's a start. Keep trying. Gotta run!"

Then if the moms complain, or the clinic complains that mom didn't have
good help, or BFing ends within the week or two after discharge, The
complaint is aimed at the LC!

>      This is modern public health nursing?
>      Gag me with a spoon. I have decided, since I have some other sources
of
> income, to take one case a day and take my time.
>      This is what is happening in the USA now.
>      warmly,
> Nikki Lee RN, MS, Mother of 2, IBCLC, CIMI, CCE, craniosacral therapy
> Adjunct faculty, Union Institute and University, Maternal and Child
Health:
> Lactation Consulting
> Supporting the WHO Code and the Mother Friendly Childbirth Initiative

Phyllis
feeling cynical/discouraged like Nikki


--- Phyllis Adamson, IBCLC, RLC
--- Glendale, AZ, USA
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