Re: Is Lactation Consultation an Essential Health Benefit? (Advocacy)

[Guest guest]

I have a question. How close to correct is my understanding of this situation? If lactation consultations become an Essential Health Benefit, then Medicaid and insurance has to cover it, right? But then *we* can't charge the Medicaid patient, we have to bill Medicaid and wait months for reimbursement, right? It's illegal to charge the mother if she is on Medicaid (I think). And insurance companies never reimburse practitioners an adequate amount, much less the full fee. And that reimbursement can be as small as $18/consultation, based on what Ann Faust has already seen, right?

So it seems to me that we are all just shooting ourselves in the foot, forcing ourselves right out of business, if we tell the government that our consultations are essential.

Dee Kassing

You might like to weigh in on this...

Is Lactation Consultation an Essential Health Benefit? Share your thoughts with the DHHS beginning Nov 1.You are not too 'small' to make a difference! Legislators and policy makers need to hear our concerns and we need to speak for those whose voices may be silent – breastfeeding mothers and babies.

http://www.uslca.org/Advocacy.html

Fay Bosman, IBCLC

Lactation Consultant, www.nwmothernurture.com, Vancouver, WA

[Guest guest]

I can't disagree. It's unfortunate that our model of providing healthcare in the

US is such a strain on private practices such as yours.

In my area, we have no private practice LCs in the immediate vicinity. However

we do have our clinic, which serves everyone regardless of where they deliver.

We also have historically operated at a loss, but we are associated with a not

for profit system that is committed to helping the poor so they have supported

our services. But I can't always count on that either, I do not feel immune from

the recession.

We see @ 250 patients a month in the outpatient clinic. It's going to require a

collaborative effort that will probably involve innovative partnerships and

potentially grant money to accommodate the need.

I would like to see access to comprehensive consults by an IBCLC incorporated

into WIC. That would be a great collaboration.

Being your population also has another 50% outside of Medicaid that could

feasibly be your target market for business. You could determine how many, if

any, Medicaid clients it would be feasible for your business to serve and still

meet your income needs.

I know it would require a shift in how people practice. There are physicians and

specialists who do not work with insurance companies because it is disruptive to

their service style and they find it compromises the quality of the support they

provide and I can't argue with that. I don't see it as a requirement that people

participate. Just an option.

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> Subject: Re: Is Lactation Consultation an Essential Health Benefit?

(Advocacy)

> To:

> Date: Sunday, November 6, 2011, 4:17 PM

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> I see your point Dee. Right now reimbursement from Medicaid for the clients we

see in our outpatient breastfeeding clinic is about 15% of what we bill. Our

clinic does lose money for taking Medicaid. We compensate for it with the other

higher reimbursed rates of other insurance companies.

>

> To me the insurance issue is directly related to the disparities in accessing

care. Right now, despite the generosity of many PP LCs (many in this group),the

absence of insurance reimbursement completely impedes the ability of an

overwhelming majority of women covered under Medicaid to access qualified

lactation support of an IBCLC. And because of that I support this initiative.

>

> Approximately 1/3 of all pregnant women in the US are on Medicaid. The

hospital I work for has a Medicaid rate of @ 52% of our client population in the

birth center.

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>

[Guest guest]

But will this convince the docs? Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.nethttp://breastfeedinghomevisitservices.weebly.com/shop.htmlProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and babyTo: Sent: Sunday, November 6, 2011 7:23 PMSubject: Re: Is Lactation Consultation an Essential Health Benefit? (Advocacy)

That's why the USLCA is working on licensure for IBCLCs!

They are attempting to protect consumers by making sure that the best qualified professional to provide services is licensed as an IBCLC.

>

[Guest guest]

What do you mean by convince the docs?

Thanks,

> >

>

[Guest guest]

Convince the docs that the best Breastfeeding counseling and treatment if needed us from a lactation consultant and not a Breastfeeding nurse or Breastfeeding counselor. I'm not sure they recognize the diffetenceSent from my iPhone

What do you mean by convince the docs?

Thanks,

> >

>

[Guest guest]

Ok now I see where you are coming from. In my area our staff has built such a

reputation we get referrals to our clinics from all over the entire county every

day. The docs call us personally and ask about cases, and occasionally if we can

squeeze in their patient who requires urgent help.

If this is an issue in your area I wonder if it is feasible for you to offer to

do inservices for staff during lunchtime? I would seriously network with them.

They can become your ally.

I know it's hard though and every place has their own unique culture to deal

with as well so some places can be harder to crack than others.

>

> Convince the docs that the best Breastfeeding counseling and treatment if

needed us from a lactation consultant and not a Breastfeeding nurse or

Breastfeeding counselor. I'm not sure they recognize the diffetence

>

> Sent from my iPhone

>

[Guest guest]

I do not deal with insurance now. But if a mother has Medicaid and Medicaid begins to cover LC services, am I obligated to accept her Medicaid or refuse to deal with her? If those are the only two options, neither is acceptable.

Dee

Subject: Re: Is Lactation Consultation an Essential Health Benefit? (Advocacy)To: Date: Sunday, November 6, 2011, 5:22 PM

I can't disagree. It's unfortunate that our model of providing healthcare in the US is such a strain on private practices such as yours.In my area, we have no private practice LCs in the immediate vicinity. However we do have our clinic, which serves everyone regardless of where they deliver. We also have historically operated at a loss, but we are associated with a not for profit system that is committed to helping the poor so they have supported our services. But I can't always count on that either, I do not feel immune from the recession.We see @ 250 patients a month in the outpatient clinic. It's going to require a collaborative effort that will probably involve innovative partnerships and potentially grant money to accommodate the need.I would like to see access to comprehensive consults by an IBCLC incorporated into WIC. That would be a great collaboration.Being your population also has another 50% outside of

Medicaid that could feasibly be your target market for business. You could determine how many, if any, Medicaid clients it would be feasible for your business to serve and still meet your income needs.I know it would require a shift in how people practice. There are physicians and specialists who do not work with insurance companies because it is disruptive to their service style and they find it compromises the quality of the support they provide and I can't argue with that. I don't see it as a requirement that people participate. Just an option.> > > > Subject: Re: Is Lactation Consultation an Essential Health Benefit? (Advocacy)> To: > Date: Sunday, November 6, 2011, 4:17 PM> > > > Â > > > > I see your point Dee. Right now reimbursement from Medicaid for the clients we see in our outpatient breastfeeding clinic is about 15% of what we bill. Our clinic does lose money for taking Medicaid. We compensate for it with the other higher reimbursed rates of other insurance companies.> > To me the insurance issue is directly related to the disparities in accessing care. Right now, despite the generosity of many PP LCs

(many in this group),the absence of insurance reimbursement completely impedes the ability of an overwhelming majority of women covered under Medicaid to access qualified lactation support of an IBCLC. And because of that I support this initiative. > > Approximately 1/3 of all pregnant women in the US are on Medicaid. The hospital I work for has a Medicaid rate of @ 52% of our client population in the birth center. > > >

[Guest guest]

Is being IBCLC financially worth it? Nope. Not where I live. This has been a labor of love and a method for keeping my sanity when my daughter's illness is driving me out of my mind. I have been open since 1995. This is the first year I have made any money. The only reason I could keep the business open was because my husband made enough money to pay the bills. I have never drawn one penny of income from this endeavor. This year, I might be able to pay myself back *some* of the family money I put into it in the early years, before I started to break even.

Dee Kassing

I can't disagree. It's unfortunate that our model of providing healthcare in the US is such a strain on private practices such as yours.In my area, we have no private practice LCs in the immediate vicinity. However we do have our clinic, which serves everyone regardless of where they deliver. We also have historically operated at a loss, but we are associated with a not for profit system that is committed to helping the poor so they have supported our services. But I can't always count on that either, I do not feel immune from the recession.We see @ 250 patients a month in the outpatient clinic. It's going to require a collaborative effort that will probably involve innovative partnerships and potentially grant money to accommodate the need.I would like to see access to comprehensive consults by an IBCLC incorporated into WIC. That would be a great collaboration.Being your population also has another 50% outside of

Medicaid that could feasibly be your target market for business. You could determine how many, if any, Medicaid clients it would be feasible for your business to serve and still meet your income needs.I know it would require a shift in how people practice. There are physicians and specialists who do not work with insurance companies because it is disruptive to their service style and they find it compromises the quality of the support they provide and I can't argue with that. I don't see it as a requirement that people participate. Just an option.> > > > Subject: Re: Is Lactation Consultation an Essential Health Benefit? (Advocacy)> To: > Date: Sunday, November 6, 2011, 4:17 PM> > > > Â > > > > I see your point Dee. Right now reimbursement from Medicaid for the clients we see in our outpatient breastfeeding clinic is about 15% of what we bill. Our clinic does lose money for taking Medicaid. We compensate for it with the other higher reimbursed rates of other insurance companies.> > To me the insurance issue is directly related to the disparities in accessing care. Right now, despite the generosity of many PP LCs

(many in this group),the absence of insurance reimbursement completely impedes the ability of an overwhelming majority of women covered under Medicaid to access qualified lactation support of an IBCLC. And because of that I support this initiative. > > Approximately 1/3 of all pregnant women in the US are on Medicaid. The hospital I work for has a Medicaid rate of @ 52% of our client population in the birth center. > > >

[Guest guest]

Nope, it wouldn't matter how much you bill. They decide what is a usual and customary fee and then they pay a portion of that. They would definitely decide that fee was not usual and customary. I like the idea, though, and wish it could work!

Dee Kassing

We could bill Medicaid $3000 per consult!Feeling cheeky in NYCLeigh Anne

Sent from my Verizon Wireless BlackBerry

[Guest guest]

I can't say for certain but I do believe that you have the right to accept

whatever payment methods you choose so in that event you could decline to take

Medicaid clients if that's your choice.

I think.

I know Dr.s who don't accept or limit the volume of clients they take with

certain under reimbursing insurance including Medicaid.

>

[Guest guest]

I would offer a third option and say ideally she would be referred to an IBCLC

who does work with her insurance.

[Guest guest]

Trouble is, I don't want to turn away a mother who needs help, which is why I've always offered a reduced fee for mothers who can show a WIC appointment card or a Public Aid insurance card. But I won't be able to accept the ridiculously low payment that Medicaid will pay. So it seems if we convince the government to make lactation consultations essential, then I can't accept any Medicaid patients because I would be breaking the law by asking them to pay my fee without turning it in to Medicaid.

Again, this makes LC services to low-income women LESS accessible, not more.

Dee Kassing

Subject: Re: Is Lactation Consultation an Essential Health Benefit? (Advocacy)To: Date: Sunday, November 6, 2011, 9:41 PM

I can't say for certain but I do believe that you have the right to accept whatever payment methods you choose so in that event you could decline to take Medicaid clients if that's your choice.I think.I know Dr.s who don't accept or limit the volume of clients they take with certain under reimbursing insurance including Medicaid.>

[Guest guest]

There are only a few private practice IBCLCs here and none of them accept insurance. The LCs in hospital unfortunately are often less than helpful. I won't send a mother on a wild goose chase by referring her to someone unlikely to be helpful. So your third option does not exist here.

Dee

I would offer a third option and say ideally she would be referred to an IBCLC who does work with her insurance.>> I do not deal with insurance now. But if a mother has Medicaid and Medicaid begins to cover LC services, am I obligated to accept her Medicaid or refuse to deal with her? If those are the only two options, neither is acceptable.>    Dee>

[Guest guest]

I got the air shot out of my balloon as a PP IBCLC today. I printed up "prescription pads" as Jan Ellen Brown suggested and put them together with a flyer for my new mom's group, my Hygeia rental flyers, my business cards and a big professional happy face. I left them in about 25 pediatricians offices. When I called to follow up for questions or to schedule a lunch time appointment, I was told "we are all set". Couldn't even talk to a doc. You'd think I was selling snake oil. I"m number 5 on one of my hospital's referral list and the other hospital uses their own LC for in-home visits.I don't know about you but I may have to quit my day job.

ARG!!! Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.nethttp://breastfeedinghomevisitservices.weebly.com/shop.htmlProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and babyTo: Sent: Sunday, November 6, 2011 10:15 PMSubject: Re: Re: Is Lactation Consultation an Essential Health Benefit? (Advocacy)

Is being IBCLC financially worth it? Nope. Not where I live. This has been a labor of love and a method for keeping my sanity when my daughter's illness is driving me out of my mind. I have been open since 1995. This is the first year I have made any money. The only reason I could keep the business open was because my husband made enough money to pay the bills. I have never drawn one penny of income from this endeavor. This year, I might be able to pay myself back *some* of the family money I put into it in the early years, before I started to break even.

Dee Kassing

I can't disagree. It's unfortunate that our model of providing healthcare in the US is such a strain on private practices such as yours.In my area, we have no private practice LCs in the immediate vicinity. However we do have our clinic, which serves everyone regardless of where they deliver. We also have historically operated at a loss, but we are associated with a not for profit system that is committed to helping the poor so they have supported our services. But I can't always count on that either, I do not feel immune from the recession.We see @ 250 patients a month in the outpatient clinic. It's going to require a collaborative effort that will probably involve innovative partnerships and potentially grant money to accommodate the need.I would like to see access to comprehensive consults by an IBCLC incorporated into WIC. That would be a great collaboration.Being your population also has another 50% outside of

Medicaid that could feasibly be your target market for business. You could determine how many, if any, Medicaid clients it would be feasible for your business to serve and still meet your income needs.I know it would require a shift in how people practice. There are physicians and specialists who do not work with insurance companies because it is disruptive to their service style and they find it compromises the quality of the support they provide and I can't argue with that. I don't see it as a requirement that people participate. Just an option.> > > > Subject: Re: Is Lactation Consultation an Essential Health Benefit? (Advocacy)> To: > Date: Sunday, November 6, 2011, 4:17 PM> > > > Â > > > > I see your point Dee. Right now reimbursement from Medicaid for the clients we see in our outpatient breastfeeding clinic is about 15% of what we bill. Our clinic does lose money for taking Medicaid. We compensate for it with the other higher reimbursed rates of other insurance companies.> > To me the insurance issue is directly related to the disparities in accessing care. Right now, despite the generosity of many PP LCs

(many in this group),the absence of insurance reimbursement completely impedes the ability of an overwhelming majority of women covered under Medicaid to access qualified lactation support of an IBCLC. And because of that I support this initiative. > > Approximately 1/3 of all pregnant women in the US are on Medicaid. The hospital I work for has a Medicaid rate of @ 52% of our client population in the birth center. > > >

[Guest guest]

I am in the same boat. I realize I am new to the Private Practice seen I

unrealistically thought this would be easy. I have had weeks with now phone

calls, emails, and of course actual paying visits. I had planned to just have a

parttime business and only really require 2-3 visits a week. I didn't feel that

was too much. T know I have some more advertising and I made a facebook page

and reduced my rates for the month on Nov. maybe not a smart thing to do but I

just want my name to get out their and also for people to start understanding

how a private practice visit can help so much. I am on a chat and recently

someone posted asking how she could get help with breastfeeding that didn't cost

$50 and hour. I kind of took offense. Other people posted about support group

and other free assistance, but they are not able to give the individual and

personalized support that we can. I know becauase I work at some of those

support groups and max I might get about 10 min with a mom who really needs help

because so many others have questions. One reason I love Private Practice is

that I can give the complete care I can't usually give in the hospital where I

get the baby latched on and I rushing off to the next patient. Hearing some you

more experienced ladies having trouble making money, doesn't give me much hope

so I guess I won't quit my weekend job or my PRN job anytime soon.

Karman Romero

www.babysbreaststart.com