Re: Access to services LONG.....about WIC

April 30, 2011

I must be getting old because in the past I would have been reluctant to share

my thoughts on this, and now I feel like I cannot 'NOT' share my thoughts on

this!

So, Becky, I don't think your comment is flippant at all. It's an honest

reflection.

And I am going to answer it as I know it to be in MY community. Wont some of you

share what is happening in YOUR community with us please? Because I hope it is

different!

I urge anyone working with breastfeeding families who is using WIC as a referral

resource to please GO TO your WIC agency and check out the quality of services

offered. In the past as I have offered patients in the hospital setting who have

risk factors, or could use support, outpatient follow-up in our breastfeeding

clinic (which DOES bill insurance, including Medicaid), and they would express

their desire to follow with WIC, I would support that and try to describe the

differences. Now I am much more clear about the advantages of seeking qualified

help in our clinic, in addition to WIC.

WIC breastfeeding support in MY community is nowhere near the level of the

standard of care I know mothers and babies deserve. In my community we have a

few IBCLC's, but they are often working as 'certifiers' and they are rarely even

fielding the typical day to day breastfeeding roll call questions....and they

are NEVER performing evaluations, and assessments, or developing a plan of care.

I work for a large healthcare system in Puget Sound, my Mgr. manages the

lactation staff, family ed, children's immunization, maternity support services,

and 2 WIC agencies that collectively serve almost 7000+ clients a month. I

primarily cover the inpatient unit and the level II special care nursery of one

of our hospital birth centers, and I have almost 20 years of experience teaching

MCH. I've also done social program design, development, and implementation as a

Human Services Social Work major. My Mgr recently asked me to assist in the

implementation and training of WIC Breastfeeding Peer Counselors into our clinic

sites. This has obviously associated me with our local WIC agencies. I'm

starting to learn a lot about what WIC does, and doesn't do.

According to our state criteria, staff who have attended a 'lactation

management' intensive are considered 'lactation specialists', and they may be

used as a referral resource for breastfeeding complications. We also have a

breastfeeding promotion coordinator, who desires to be an IBCLC, however has not

performed any lactation consults, ever, and last week I had to explain to her

that no, when using the Lactina the breastmilk does not travel down into the

tubing so she does not need to continue to tell mothers to clean the tubing

after every pumping session (where do they think the milk ends up, in the

piston??).....

I know I cannot speak for every WIC agency, but in my area, after asking at our

local coalition meeting about the WIC IBCLC's in attendance, how many consults

do you perform daily....I quickly realized I should have asked EVER?? I have no

idea how people performing these job functions actually 'earn' the clinical

hours to qualify to sit the IBLCE exam?? There is nothing clinical about putting

together breastfeeding class folders, and teaching a breastfeeding class.

I see the problem at the state and national level. If my state WIC BF Promotion

Director perceives attending (I've seen people sleep at these conferences BTW) a

5 day lactation management seminar as sufficient to throw breastfeeding problems

at, we have a lot of work to do. My mgr. asked at a WIC staff meeting recently

to the staff who according to the state are our agencies go to breastfeeding

specialists...when is the last time you examined a woman's breasts....and they

gasped!

If you have read this far then let me add. I LOVE our WIC staff. They have a

culture ripe for breastfeeding support, and they want to help breastfeeding

families. They simply do NOT have the education, experience, and tools to do

it!! We are trying to change this, and we have recently started placement of our

IBCLC's into our WIC agencies twice a week so the staff can shadow them and

become more familiar with a lactation evaluation and assessment and they will be

coming to our outpatient clinic, and to shadow us in the hospital and the

nursery as part of our quality improvement plan.

In my area there are no breastfeeding evaluations and assessments being

performed at any WIC clinic!

>

> " I understand the reluctance to desire collaboration with insurance

> companies however we cannot overlook the millions of babies and mothers who

> lack access to qualified lactation support because they cannot afford it. "

>

> Don't want to sound flippant, but isn't this what WIC is for? Aren't we all

> paying taxes to support WIC which is supposed to do just this?

>

> Becky , IBCLC

>

> Milky Way

>

> La Plata, MD

>

April 30, 2011

Hello IBCLCs,

I am the chair of the USLCA Licensure and Reimbursement Committee. We are

working very hard to obtain legitimate and adequate reimbursement for IBCLCs

as independent practitioners. Our hope is to have IBCLCs credentialed as are

other appropriately paid allied health professionals, think about OT, PT.

This is not a pittance wage, but would allow an IBCLC to make a living from

her work.

To work in the medical system we must understand it and use it correctly.

This starts with having the NPI number, I will be giving a webinar in May

about this from USLCA. You must then understand how to code a superbill.

CPT codes that typically would be used are 99211-99214 (new and established

patients) or 99241-99244(consultations referred by other providers). Most

IBCLCs who are nurses bill the 99211 code because that is all that nurses

are permitted to bill. This is pittance, in my area it would be about $6 for

a Medicaid patient and maybe around $30-40 for a good private insurer. This

is why we do not want to be grouped with or, as nurses. They are not

independent professionals.

A 99212 would yield roughly $76 in my area ( there is variation in

reimbursement based on CMS guidelines and geography). This would be a low

end visit. Most IBCLC visits are going to be 99213 and payable in the $120

range. The coding is based on Time, complexity and review of systems.

However, as of now, IBCLCs cannot bill this way because we are not licensed

providers. You could contact your local insurance payers and negotiate with

them to become a " credentialed providers " . The private insurers have the

option to hire you and reimburse you this way. You can negotiate your fees

with them as a contractor. You cannot do this with Medicaid because Medicaid

will not reimburse any provider without a license. You can see an

explanatory presentation on this at this web address

http://e-medtools.blogspot.com/2008/10/demystifying-medical-documentation.ht

ml

While I am grateful for the support provided by WIC, there are no agencies I

know except for what describes who actually provide comprehennsivve

clinical IBCLC services. Their IBCLCs mainly serve as administrators. Peer

counselors are not equipped to do lactation consults for breastfeeding

difficulties. They are to provide support for the normal course of

breastfeeding and routine, low complexity problems.

Many women have no access to breastfeeding support because many women do not

qualify for WIC even if I would serve their needs. Many women would benefit

from La Leche League, yet would not go there for support due to lack of

knowledge of their existence or negative ideas about LLL. If IBCLC support

were treated as routine preventive care, by the health care system and the

public, then mothers would have much moer opportunity for access and it

would be legitimized for eveeryone. Many women who do have means can''t even

find and IBCLC and if they find someone who they can pay, they don't know

the differene between as CLC or some other specialist certificate and an

IBCLC.

Please see the document on the USLCA website " Containing Health Care Costs:

Help in Plain Sight " on the website. www.uslcaonnline.org.

Judy

Judith L. Gutowski, BA, IBCLC, RLC

135 McGrath Lane

P Box 1

Hannastown, PA 15635-0001

Cell Phone

Fax

1 of 1 File(s)

winmail.dat

April 30, 2011

Thanks so much for this excellent email, Judy, and the specifics that you

included.

Fay

>

> Hello IBCLCs,

>

> I am the chair of the USLCA Licensure and Reimbursement Committee. We are

> working very hard to obtain legitimate and adequate reimbursement for IBCLCs

> as independent practitioners. Our hope is to have IBCLCs credentialed as are

> other appropriately paid allied health professionals, think about OT, PT.

> This is not a pittance wage, but would allow an IBCLC to make a living from

> her work.

> To work in the medical system we must understand it and use it correctly.

> This starts with having the NPI number, I will be giving a webinar in May

> about this from USLCA. You must then understand how to code a superbill.

> CPT codes that typically would be used are 99211-99214 (new and established

> patients) or 99241-99244(consultations referred by other providers). Most

> IBCLCs who are nurses bill the 99211 code because that is all that nurses

> are permitted to bill. This is pittance, in my area it would be about $6 for

> a Medicaid patient and maybe around $30-40 for a good private insurer. This

> is why we do not want to be grouped with or, as nurses. They are not

> independent professionals.

> A 99212 would yield roughly $76 in my area ( there is variation in

> reimbursement based on CMS guidelines and geography). This would be a low

> end visit. Most IBCLC visits are going to be 99213 and payable in the $120

> range. The coding is based on Time, complexity and review of systems.

> However, as of now, IBCLCs cannot bill this way because we are not licensed

> providers. You could contact your local insurance payers and negotiate with

> them to become a " credentialed providers " . The private insurers have the

> option to hire you and reimburse you this way. You can negotiate your fees

> with them as a contractor. You cannot do this with Medicaid because Medicaid

> will not reimburse any provider without a license. You can see an

> explanatory presentation on this at this web address

> http://e-medtools.blogspot.com/2008/10/demystifying-medical-documentation.ht

> ml

>

> While I am grateful for the support provided by WIC, there are no agencies I

> know except for what describes who actually provide comprehennsivve

> clinical IBCLC services. Their IBCLCs mainly serve as administrators. Peer

> counselors are not equipped to do lactation consults for breastfeeding

> difficulties. They are to provide support for the normal course of

> breastfeeding and routine, low complexity problems.

>

> Many women have no access to breastfeeding support because many women do not

> qualify for WIC even if I would serve their needs. Many women would benefit

> from La Leche League, yet would not go there for support due to lack of

> knowledge of their existence or negative ideas about LLL. If IBCLC support

> were treated as routine preventive care, by the health care system and the

> public, then mothers would have much moer opportunity for access and it

> would be legitimized for eveeryone. Many women who do have means can''t even

> find and IBCLC and if they find someone who they can pay, they don't know

> the differene between as CLC or some other specialist certificate and an

> IBCLC.

>

> Please see the document on the USLCA website " Containing Health Care Costs:

> Help in Plain Sight " on the website. www.uslcaonnline.org.

>

> Judy

> Judith L. Gutowski, BA, IBCLC, RLC

> 135 McGrath Lane

> P Box 1

> Hannastown, PA 15635-0001

> Cell Phone

> Fax

>

April 30, 2011

One thing that made me really upset recently, on the subject of letting moms

know about available resources, was that, through our local breastfeeding

coalition I developed a thorough and helpful leaflet listing all breastfeeding

support resources available in our county. This included offerings by the two

local hospitals. Although we got professional artwork donated, the printing paid

for by the local Health Dept, and have physically taken it to the hospitals to

distribute, they are not doing so.

The one hospital said to an IBCLC who works there, and is on our coalition, that

they wouldn't distribute it because it was " too complicated " . While we could

certainly cut out some of the 'helpful but unnecessary' stuff, I am not

convinced that they would use it even then.

I am concerned that the real reason is because they don't want competition from

non-hospital-based outpatient lactation services. And this means that moms are

NOT getting full options for care, and have a hard time finding resources.

What to do???