As Oklahoma's obesity rate continues to rise, a new clinic for obese children faces challenges of how it will pay for the services it provides.
“These types of clinics do not fund themselves,” said Dr. Ashley Weedn, the clinic's medical director and an OU Children's Physicians pediatrician. “Reimbursement is a real issue in any multidisciplinary clinic.”
In August, the Pediatric Exercising and Eating Responsibly Clinic opened inside The Children's Hospital in Oklahoma City.
When Weedn refers to “multidisciplinary,” she means the clinic provides multiple medical professionals who work with children who are obese.
When a child and family come to the clinic, they meet with a general pediatrician, a dietitian, a pediatric psychologist and a pediatric physical therapist. And although each of these professionals plays an important role in diagnosis and health planning, not all of them are covered by insurance, Weedn said.
Weedn said Medicaid has made improvements in what it will cover in the realm of obesity-related health care, but not all private insurers have caught up. If insurance doesn't cover the services, either the family will be left to pay or the clinic will consider covering the bill.
“We hope the private insurance companies will follow suit,” Weedn said. “We've been working with a couple of the private insurance companies to have that conversation with them, and they realize the importance.”
About 30 percent of Oklahoma's children are overweight or obese, according to the National Survey of Children's Health. Meanwhile, Oklahoma's adult obesity rate has nearly quadrupled since 1988, with more than 30 percent of adults in Oklahoma obese, according to the state Health Department.
The clinic staff anticipates serving about 100 new patients, with 230 visits occurring over the next year. Thus far, six children and their families have sought services at the clinic, an outpatient facility.
The focus is promoting better health among the patient and his or her family members, not who can lose weight the fastest. After family members meet with the medical staff, they together sign a contract that lays out what goals they want to accomplish.
“It's not us saying, ‘You need to stop drinking sugar sweetened beverages,'” Weedn said. “It's figuring out what they can do as a family, not just telling the patient what to do.”
Children ages 2 to 18 with a Body Mass Index greater than the 99th percentile or greater than the 95th percentile with another related disease or condition qualify for the clinic's services.
A child must be referred to the clinic through his or her primary care physician. Families have told clinic staff that getting that referral is not always easy.
“We've had families call for an appointment without a primary care provider referral, and we inform them we need a PCP referral, and they've gone to their PCP, who does not engage in that conversation with them,” Weedn said.
Families have been told their child doesn't have an issue, that their child will “grow out of it,” Weedn said. About 65 percent of 2- through 5-year-olds don't outgrow their weight and will become obese adults, Weedn said.
To help doctors better understand childhood obesity, the American Academy of Pediatrics Oklahoma chapter has created a tool kit that doctors can download from the organization's website.
For the physicians willing to refer patients, there are also barriers. Telling a parent that a child should go to a clinic for obesity-related health issues is not easy.
“It's still such a sensitive topic that we find frequently that primary care providers are reluctant to engage in that conversation,” Weedn said.
The clinic is open only on Thursdays because that's what it has the resources to pay for. It costs about $300,000 to run the clinic for a year. Chesapeake donated the money that helped the pediatric facility open this year.
Most obesity clinics in the U.S. rely on some type of external funding from hospitals, grants or community foundations.
This is because things like the day-to-day functioning of the clinic often aren't covered by insurance, said Stephen Gillaspy, an OU Children's Physicians psychologist who works at the clinic.
“(Weekly) following-up by our program coordinator is an example of what makes the clinic unique but is an example of a service that's not reimbursable,” Gillaspy said.
Gillaspy said there isn't a clear sustainability model that's been found to work for multidisciplinary clinics like the one in Oklahoma City.
“I think our first year is still a testing ground to see how feasible it is,” Gillaspy said. “Everyone would love for us to be able to expand the clinic and offer that service to more people, but the jury's still out because the models across the country, outside of just the insurance reimbursement, they get some kind of additional support through the different funding streams.”