There were times when Dr. Ashley Weedn worried they'd have to close the clinic.
The Oklahoma City pediatrician and a team of doctors have spent the past year taking on one of Oklahoma's hardest challenges: childhood obesity.
In a state battling this epidemic, the medical billing infrastructure is not designed to support the clinic's multidisciplinary approach, which helps children in the most desperate situations.
The clinic operates only on Thursday afternoons and has a three-month waiting list. But longer clinic hours wouldn't solve the demand problem.
“We'd be full,” said Weedn, the clinic's medical co-director. “This clinic cannot serve the needs of our whole state.”
The Pediatric Exercising and Eating Responsibly Clinic, based in The Children's Hospital in Oklahoma City, serves children ages 2 to 18 who are obese or severely obese.
One in four school-age children in Oklahoma are obese, according to data from Schools for Healthy Lifestyles surveys of Oklahoma schools. Meanwhile, one in seven children in preschool are obese.
Since the clinic opened in August, the staff has treated 55 families. Typically, they can see six to eight families in the half day that they're open.
While at the clinic, families see Weedn, a pediatrician, along with a pediatric psychologist, a physical therapist and a dietitian. Studies have shown this model, known as “multidisciplinary,” is effective, but it's the key reason the clinic has trouble getting care reimbursed.
Because of how medical billing codes work, it's hard to find a model that pays for any multidisciplinary clinic, regardless of specialty, said Dr. Stephen Gillaspy, the clinic's co-director.
For example, the clinic's dietitian serves as a care manager, following up with families, a service that isn't reimbursable but is important for planning and accountability.
“Nationally, most multidisciplinary pediatric obesity clinics bill for their services, but they're not able to sustain themselves just off billable service,” he said. “They have to have community support or some type of institutional support.”
For example, last year, Chesapeake Energy provided the clinic with a startup grant. The pediatrics department at OU Physicians has also helped with the clinic.
The Oklahoma Health Care Authority has worked with the staff to better ensure that they could be reimbursed through Medicaid. Private insurance companies have not been as easy to work with, Weedn said.
Weedn said the clinic has found a sustainable model so far and will continue for the next year. The clinic's operating budget for its first year was $102,000, less than the average yearly salary of a pediatrician.
The clinic has created different community partnerships that help with some of the cost. For example, the grocery store company Homeland has a dietitian on its staff that gives the clinic's families tours of its stores, talking with them about nutrition.
“They may not be able to give us a chunk for operational costs at the clinic,” Weedn said. “But they're providing resources that are benefiting our families and the clinic.”