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


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