Questions about Dyad (mom and baby) care in Parenting Feb 11, 2019 12:22:32 GMT -5 Tanya Munroe, angietruesdale, and 2 more like this
Post by Cynthia CE Wade on Feb 11, 2019 12:22:32 GMT -5
At a recent workshop I did in Houston with the Spring Branch Whole Life and Hope clinics, one of the pediatricians asked the following questions. I got Lynn Scheidenhelm and Kathy Trotter, our two expert Parenting consultants, to weigh in on this. So below are their answers.
Thought I would start a a thread for all to see and share as well.
I think for the pediatricians, we were wondering if we had to facilitate mom's visit as well (as in checking blood pressure etc...). Is it possible for the pediatricians to only see the infants?
Question 1: Typically pediatricians are very anxious about doing dyad care if they are more old school. The Palo Alto Medical Foundation, one of my CIP sites, will be doing Edinburghs for PP mood screenings at 1,2,4 and 6 month Well Child Care Parenting group visits and generally checking in on areas with Mom that impact her ability to care for the baby. sPeg and I trained 12 pediatricians there last year and they were young, hip and so into dyad care. I think if you are talking about whether they have to do vitals on the Mom, generally I recommend it, if possible, not required. If the vitals are off, like a high blood pressure, they would retake it after a while, if still high refer to the Mom's/Parent's medical provider or send to the hospital (rare). It is not required to take the vitals! I think the most important piece is how the Mom is doing with sleep, nutrition, breastfeeding, support systems, stress management and mood which is why I would recommend all Parenting sites make sure they do the full Edinburgh, not just the two question screens, up to at least 6 months at every parenting group visit. If Mom isn't doing well, baby may be having struggles in one area or another. Remember that they are not just seeing the baby, they are seeing a parent with a baby, a family unit and they need to pay attention to that. They have all the time to do that in the group visit versus the one on one visit where they have less time and focus then primarily on the baby. It would be important for them to have resources ready for referrals if the parent needs to be helped with MH issues, etc.
If there is family medicine involved, the question was how long do you go with the mom visits?
If family practice, generally you can always bill a visit with the Mom and baby up to 4 months, but at least the 2 week, 1 month and 2 month visit as these are the visits that Moms are dealing with medical postpartum issues that can be billed for around recovery from delivery, breastfeeding and birth control. If Mom comes to the visits after that and has issues that providers have to manage medically, they can bill both Mom and baby, but generally the baby is the only one put on the schedule. If Mom has medical issue, they would open up an encounter for her in the group. The Circle Up this week with with Natalie Josephs, pediatrician from Boston Medical Center and she has a Teen and Tot Centering Parenting program she highlighted. I still have to put her powerpoint on CConnects, but she has 8 Moms and 8 babies and she does dyad care as they parents are under 18 so she sees both Mom/parent and baby medically in the groups, so usually 16 encounters per visit. If you want to see a cool webinar and learn more about teen parenting groups, go watch it. Vandana will be putting it up in the next week. Hope this is helpful. Good questions Cynthia!
Kathy -I'll let you weigh in with more stuff from your experience.
This is from Kathy:
hi, I would agree with Lynn except postpartum care for mom is a global fee for six weeks, so not sure you would get paid if you saw her at 2 weeks, 1-2 months. Keeping them focused on mom/dad self care and supporting that is helpful--having a scale there for them to check their weight, BP cuff to check and review if they should go see their provider (just like in the pharmacy where we can check it and pharmacist will say go see someone). The idea of mood check in is in the book, but using the state supported tools has more merit in terms of their site protocols. We can bill for the contraceptive discussion at 4 months too.