title: Payment for obesity services: examples and recommendations for stage 3 comprehensive multidisciplinary intervention programs for children and adolescents.
abstract: OBJECTIVE
  The Reimbursement and Payment Subcommittee of the National Association of Children's Hospitals and Related Institutions FOCUS on a Fitter Future group sought to guide medical providers, patients, and payers to better serve obese children and adolescents to enable optimum health. Recommendations are provided for the essential components of a stage 3 comprehensive multidisciplinary intervention program as defined by the 2007 Expert Committee recommendations. In addition, suggestions are offered for a stepwise approach to implement these recommendations.
  
  
  METHODS
  In 2009, key informant interviews were conducted with 15 children's hospitals participating in FOCUS on a Fitter Future and 1 nonparticipating hospital. Interview transcripts identified 5 financially sustainable stage 3 programs, each funded differently.
  
  
  RESULTS
  The stage 3 programs interviewed ranged from being nascent to 21 years old (27%, <2 years; 47%, 2-6 years; 27%, >6 years). All of them had multidisciplinary teams that delivered services through 1 of 3 institutional structures: 60% freestanding; 7% specialty; and 33% hospital within a hospital. One-third of them had 1 to 2 funding sources, and 67% had ≥ 3 sources.
  
  
  CONCLUSIONS
  The stage 3 programs in this review shared some common strategies for achieving financial stability. All of them followed key strategies of the chronic care model, the details of which led to the following recommendation: stage 3 programs should include a health care team with a medical provider, registered dietitian, physical activity specialist, mental health specialist, and coordinator who, as a team, provide service to overweight and obese children at no less than moderate intensity (26-75 hours).
authors: Department of Pediatrics, University of California Los Angeles School of Medicine, 2509 Pico Blvd, Los Angeles, CA 90405, USA. wslusser@mednet.ucla.edu
authors: Wendy
authors: W
authors: Slusser
authors: Karan
authors: K
authors: Staten
authors: Karen
authors: K
authors: Stephens
authors: Lenna
authors: L
authors: Liu
authors: Christine
authors: C
authors: Yeh
authors: Sarah
authors: S
authors: Armstrong
authors: Daniel A
authors: DA
authors: DeUgarte
authors: Matthew
authors: M
authors: Haemer
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration; D017281:Cost of Illness; D019468:Disease Management; D006293:Health Promotion; D006776:Hospitals, Pediatric; D006801:Humans; D007349:Insurance, Health, Reimbursement; D017146:Models, Organizational; D009765:Obesity / Q000191:economics* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D014481:United States