CCS Provider Survey Q58 The California Children s Services program (otherwise known as CCS), is an important program serving some of our state s most vulnerable children. Federal requirements stipulate that every 5 years, CCS must conduct a needs assessment to identify priorities for improving services for children with special health care needs. As part of the needs assessment process, the Family Health Outcomes Project at UCSF is conducting this online survey of physicians to get your input. Information gathered in this survey will also be used to inform discussions regarding redesigning the 1115 waiver. Thank you for giving your feedback on how well the program is working and what the priorities should be for the next five years! Q1 Please indicate which of these best describes your role in the CCS program. (Select only one) Cardiologist (1) Endocrinologists (2) Family Medicine Physician (3) Internist (4) Neonatalogist (5) Neurologist (6) Neurosurgeon (7) Ophthalmologist (8) Orthodontist (9) Orthopedic Surgeon (10) Otolaryngologist (11) Oral-Maxillofacial Surgeon (12) Pediatrician (13) Pediatric Allergy Immunologist (14) Pediatric Cardiologist (15) Pediatric Critical Care Physician (16) Pediatric Endocrinologist (17) Pediatric Gastroenterologist (18) Pediatric Hematologist (19) Pediatric Infectious Disease Physician (20) Pediatric Nephrologist (21) Pediatric Neurologist (22) Pediatric Neurosurgeon (23) Pediatric Oncologist (24) Pediatric Pulmonologist (25) Pediatric Surgeon (26) Perinatologist (27) Psychiatrist (28) Other (29)
Q1a If other, please describe. Q2 Are you currently CCS paneled? Yes (1) No (2) Don't know / Not sure (3) Q3 Please select the setting in which you practice: Tertiary Medical Center (Non-Kaiser) (1) Kaiser Tertiary Medical Center (2) Stand alone specialty clinic (3) Primary care practice (private) (4) Primary care practice (public) (5) Federally Qualified Health Center (FQHC) (6) Other (7) Q3a If other setting, please describe.
Q4 Please select the county(s) in which you practice and check all that apply (Hold down 'Control' button to select multiple counties): Alameda (1) Alpine (2) Amador (3) Butte (4) Calaveras (5) Colusa (6) Contra Costa (7) Del Norte (8) El Dorado (9) Fresno (10) Glenn (11) Humboldt (12) Imperial (13) Inyo (14) Kern (15) Kings (16) Lake (17) Lassen (18) Los Angeles (19) Madera (20) Marin (21) Mariposa (22) Mendocino (23) Merced (24) Modoc (25) Mono (26) Monterey (27) Napa (28) Nevada (29) Orange (30) Placer (31) Plumas (32) Riverside (33) Sacramento (34) San Benito (35) San Bernardino (36) San Diego (37) San Francisco, City and County (38) San Joaquin (39) San Luis Obispo (40) San Mateo (41) Santa Barbara (42)
Santa Clara (43) Santa Cruz (44) Shasta (45) Sierra (46) Siskiyou (47) Solano (48) Sonoma (49) Stanislaus (50) Sutter (51) Tehama (52) Trinity (53) Tulare (54) Tuolumne (55) Ventura (56) Yolo (57) Yuba (58) Q5 When seeing CCS clients, what % of your time do you spend providing primary care (if any), and what % of time do you spend providing specialty care (if any)? Primary Care (1) Specialty Care (2) 25-50% (2) 50-75% (3) 75-100% (4) Don't know/not sure (5) Q6 Approximately what percentage of your patients are CCS clients? (1) 25-50% (2) 50-75% (3) 75-100% (4) Don't Know/Not Sure (5)
Q7 Please rate how significant the following potential barriers are to providing high quality care to CCS clients (with 0 as not a barrier and 5 as a very significant barrier). a. Medi-Cal outpatient reimbursement rates for care of conditions NOT covered by CCS (1) b. CCS reimbursement rates for the care of CCS-covered conditions (2) c. Delay in payments for services provided to CCS children (3) d. Amount and difficulty of paper work to complete for reimbursement (4) e. Complexity of care needed by CCS children and amount of time needed to care for them (5) f. Amount of resources needed to coordinate services for CCS children (6) g. Amount of accessible and available resources (e.g. social services, mental health, respite care) for CCS children and families (7) h. Primary care physician s ability to access electronic information from the specialty care providers that are also serving the same CCS children (8) i. Working with managed care plans (e.g., Approval for services/special tests or procedures, reimbursement process) (9) j. State capacity to enforce CCS regulations (10) k. State capacity to conduct facility assessments (11) l. State capacity to quickly process applications to become a CCS paneled providers (12) m. Anything different from the list above that decreases your ability and willingness to participate in the CCS program (please describe): (13) Q7n Please describe other factors that decrease your ability and willingness to participate in CCS program. Q8 What do you, as a physician, need from the system (CCS and/or Medi-Cal) in order to provide the best quality care to CCS clients?
Q9 Please indicate how much you agree or disagree with the following statements: a. Increasing access to primary care for children with CCS conditions will help decreases emergency room visits and hospitalizations. (1) b. Increasing access to specialty care for children with CCS conditions will help decrease emergency room visits and hospitalizations. (2) c. The Medi-Cal provider network of primary and specialty care providers is shrinking and leaving fewer provider choices for families. (3) agree (1) agree (2) Neutral (3) disagree (4) disagree (5) Don't know/not sure (6)
Q10 Please indicate how much you agree with the follow statements about monitoring CCS standards as communicated by regulations and/or numbered letters. a. Regular facility site visits are an important part of monitoring and enforcing regulations/number letters. (1) b. The state CCS program has adequate capacity (i.e. staff, clinical expertise, funding) to conduct periodic facility site visits to monitor and enforce regulations/number letters. (2) c. Facility site visits should be conducted by a multidisciplinary team of state staff and paid consultants who are experts in their fields. (3) agree (1) agree (2) Neutral (3) disagree (4) disagree (5) Don't know/not sure (6)
Q11 Please indicate how much you agree with the follow statements: Dedicated funding for county parent liaisons to help CCS children and their families navigate the health care system should be a CCS program priority. (1) agree (1) agree (2) Disagree (3) Appendix 11 disagree (4) No Opinion (5) Q12 How often do you (or your clinic or practice) communicate with other providers who are also serving your CCS clients? Primary care providers (1) Other specialty care provider, including special care centers (2) Regional centers (3) Regularly communicate (1) Sometimes communicate based on needs (2) Rarely communicate (3) Never communicate (4) Don't know/not sure (5) Schools (4) CCS Medical Therapy Program (MTP) (5) Mental Health Providers (6) Communitybased Organizations (7)
Medical Home Definition: American Academy of Pediatrics: "The medical care of infants, children, and adolescents ideally should be accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. It should be delivered or directed by well-trained physicians who provide primary care and help to manage and facilitate essentially all aspects of pediatric care. The physician should be known to the child and family and should be able to develop a partnership of mutual responsibility and trust with them. Q13 Please indicate how much you agree with the follow statement: a. To reduce fragmentation and improve efficiency and clinical outcomes, CCS should be responsible for ALL the medical care a child needs, including both primary and specialty care (versus the current CCS system which covers care ONLY related to the child s CCSeligible medical condition). (1) b. CCS should develop regulations/number letters outlining staffing and necessary services to be provided to be considered a CCS clientcentered medical home. (2) agree (1) agree (2) Neutral (3) disagree (4) disagree (5) Don't know/not sure (6)
Q14 Do you consider your practice a medical home for your CCS clients? Yes (1) No (2) Don't know/not sure (3) Appendix 11 14a What would your practice need to be the medical home for CCS clients? Additional resources to allow my practice to be the medical home for CCS clients. (1) Nothing, there are other reasons for my not providing a medical home for CCS clients. (2) Nothing, I have everything I need to be the medical home for CCS clients. (3) Don't know/not sure (4) Q14b Please rank, in order of importance, the top 3 additional resource that would enable your practice to be a primary medical home for CCS clients (with 1 being the most important). NOTE: To rank order, drag your first choice to the top of the list, followed by your second and third choices. Electronic medical record system that links with pediatric subspecialty providers (1) Ability to make informal consults and contacts with subspecialty providers (email, phone consultation, and/or telemedicine) (2) Reimburse time for longer visits (3) Support staff for case management/care coordination (4) Readily available treatment guidelines for patients with specific diagnoses/conditions (e.g., neurofibromatosis, seizure disorders) (5) Readily available community level resources (e.g., regional center, Family Voices) for my patients and their families to meet their social/home needs (6) More subspecialty pediatric providers in my network to which I can refer the patient (7) A direct mechanism to communicate and work with the child s school (8) Other (please specify): (9)
Q15 Please indicate how much you agree with the follow statements: a. The State should reexamine CCS medical eligibility to focus on more complex conditions that need longer term, intensive case management and care coordination. (1) b. Variations between county s interpretations of medical eligibility determinations are problematic. (2) c. Medical eligibility determinations should be made at a regional or statewide level instead of by Counties CCS Medical Eligibility consultants. (3) d. The State should convene a statewide medical advisory committee to agree (1) agree (2) Neutral (3) disagree (4) Appendix 11 disagree (5) Don't know/not sure (6)
work on standardizing medical eligibility determinations across counties. (4)
Q16 Please tell us how often, if ever, the following issues related to durable medical equipment (DME) present problems for your patients. a. Too few DME providers willing to work with Medi-Cal due to low reimbursement rates (1) b. DME providers refusing to provide certain kinds of equipment due to low reimbursement rates for that equipment. (2) c. Client discharges being delayed because of delays in getting DME (e.g. ventilators, apnea monitors, wheel chairs). (3) d. Hospitals or families having to purchase DME so that clients can be discharged in a timely manner. (4) e. Clients missing school due to delays in getting or repairing needed DME. Frequently a problem (1) Occasionally a problem (2) Rarely a problem (3) Never a problem (4) Don't Know/Not Sure (5)
(5) f. DME providers refusing to repair or maintain equipment that they weren't authorized to provide. (6) g. Other problems with DME (7) Q16h If other problems, please describe. Q17 Do you know that even if your MediCal managed care plan assigns the youth/young adult to an adult provider, CCS can continue to authorize pediatric primary and specialty care when medically necessary for transition until age 21? Yes (1) No (2) Q18 Should the multidisciplinary team for transition age CCS clients include both pediatrician(s) and internist(s) to help facilitate the transition in to adult care? Yes (1) No (2) Don't know/not sure (3)
Q19 Please indicate how much you agree with the follow statements about transition. Youth/young adults who have aged out of CCS and have MediCal insurance would benefit from having: a. Assistance in finding a new primary care provider. (1) b. Assistance in finding a new specialty care provider. (2) c. Other assistance (3) agree (1) agree (2) disagree (3) disagree (4) Don't know/ Not sure (5) Q19d If other assistance, please describe. Q20 Should eligibility for certain CCS conditions be extended to 65 years at which time MediCare would be available? Yes (1) No (2) Don't Know/Not Sure (3) These next few question are about palliative care. Palliative care is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness whatever the diagnosis. The goal is to improve quality of life for both the patient and their family. Palliative care is provided by a team of doctors, nurses and other specialists who work together with a patient s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment. Q21 Do you have, or have you had any CCS clients that have received palliative care services in the clinic, home, or hospital through the CCS palliative care program? Yes (1) No (2) Don't know/not sure (3)
Q22 Do you currently have any CCS clients that would benefit from but are not receiving palliative care? Yes (1) No (2) Don't know/not sure (3) Q23 Have you encountered any barriers to providing palliative care to CCS clients? (If yes, please briefly describe) Telehealth has been used to provide CCS clients living in rural areas or far away from special care centers with remote access to specialists. Q24 Would you be willing to participate in providing telehealth services to CCS clients? Yes (1) No (2) Don't know/not sure (3) Q25 What, if any barriers are there to your providing telehealth services? Q26 What steps could be taken to reduce barriers to providing telehealth services? Q27 Is there any additional information or data that would help you to improve the services provided to and the outcomes of CCS clients? Q28 What data should be available to improve the CCS program and demonstrate program outcomes? Q29 Research using CCS claims data indicates that for CCS clients with chronic, complex conditions, spending on home care makes up a significant portion of expenditures for these CCS clients. How can home care services be improved while also reducing the cost of these services? Please briefly describe Q30 Please provide what you think should be the top 3 priorities for CCS over the next 5 years. Priority 1 (1) Priority 2 (2) Priority 3 (3) Q31 Please use this space to share any other comments you want to make about the CCS program.