Alas,
I foresee that short lactation visits will be the norm until it is done
long enough for a study to be done to prove the negative results it causes:
ie "30 min LC visits led to a decrease of 50% in EBF, while 90 min LC
visits resulted in <10% decrease in EBF"
Evidence-based Medicine is wonderful, but....
Melinda
Breastfeeding Medicine of South Sound
Olympia,WA


On Sun, Apr 20, 2014 at 2:14 PM, Alla Gordina MD, IBCLC, FAAP <
[log in to unmask]> wrote:

> OK, let's get to square one and re-read the original question
>
>  "Does this exist?  I'm currently working in an outpatient setting, most
>> babies seen are less than 2 weeks of age.  Up until now, appointments have
>> been 45minutes (I know, I know).  Management now wants to reduce that time
>> to 30 minutes.  My thinking is, if you want only triage, go ahead; if you
>> want to assess breastfeeding, resolve issues, that's not enough time.
>>  What's the research (if any)?"
>>
>
> Legal disclaimer :-) : I am talking here in GENERAL, so your personal or
> institutional mileage may vary.
>
> Before I will continue, I would like to tell you an old Soviet joke from
> the times when even in Moscow food was available mostly on the TV screens
> and not on the supermarket shelves.
> So, as the story goes, a hungry Muscovite comes to the Zoo and sees a sign
> on the lion’s cage, saying that a lion can eat so much meat, eggs,
> vegetables, etc (in other words - enough to feed a family of 4 for 2-3
> weeks). He asks a zookeeper, if the lion can really eat this entire menu.
> The zookeeper calmly replies, -/“*SURE, HE CAN, BUT WHO WILL GIVE IT TO
> HIM?”*/
>
> Anyhow, what industry standards are we talking here?
> (a) lactation?
> (b) hospital? or
> (c) insurance?
>
> In all honesty - please, get used to the thought that neither (b) nor (c)
> industries do extremely care about the (a) industry standards.
> ACA or not - unless lactation services would be bringing real moneys
> (moneys like MRIs and invasive cardiology) you can not expect any lenience,
> respect, or support.
> And in the most cases ACA lactation services provision is read based on
> the INSURANCE industry standards - pay as little as possible and then -
> take some moneys back. All what ACA does require is for insurances to pay
> for lactation services (15 minutes or 2 hours - thy don't care, thus they
> will gladly pay for 10 minutes) and breast pumps (effective or not
> effective, they don't care either, so they will pay for the pile of plastic
> junk called manual pumps).
>
> Can the industry (a) beat industries (b) and (c) in their own game -
> absolutely a possible thing, at least we have to take this chance.
> No, we can not appeal to their kindness and understanding (neither does
> exist), nor we should succumb to the financial slavery of their horrific
> contracts.
>
> The only way we can survive is by educating ourselves and learning from
> the best examples of the health care industry (even I do hate to think
> about medicine as an industry... :-( ).
> But unfortunately that is not happening simply because of the
> informational disconnect between lactation and medical worlds.
>
> Some time ago I did attend a practice management webinar for lactation
> consultants and I really did not know what to do - either to laugh over the
> idealistic recommendations or to cry, understanding that very little good
> will happen if LC's will be following presenter's advise. I did offer my
> help, but... over 18 months later they still did not contact me.
>
> I am not sure if we do have any research, but from what I am hearing at
> many list serves, is the only way for a clinic to survive is to have a
> physician on board and as such - to bill as incident to services. BTW, do
> you know how Dr. Jack Newman's clinic operates? We are talking Canada, with
> the universal health care. There is no state coverage for lactation
> consultants' services, so that has to be done out of pocket
> https://nbci.ca/appt-request.php. So Canadians have to pay for LC's
> services and Dr. Newman's services are paid by the state. Foreigners have
> to pay for both parts of the visit.
>
> Hope that helps and sorry for spoiling this beautiful holiday afternoon.
>
>
> Alla
>
> --
> Alla Gordina, MD, IBCLC, FAAP
> General Pediatrics
> Breastfeeding Medicine
> Adoption and Foster Care Medicine
>
> Global Pediatrics and Family Medicine
> NJ Breastfeeding Medicine Educational Initiative
>
>
>             ***********************************************
>
> 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
>

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

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