Who Is Responsible for Deciding Necessary Accommodations
There were concerns about physician understanding of who is responsible for deciding what accommodations will be available. Thirteen interviewees reported they were confidant they knew who held responsibility. However, when asked to be specific, the responses included the physician, clinical staff, the patient and/or their caregiver. Some viewed it as a collaborative effort, which is often the most productive approach and generally meets ADA requirements.
Four responding physicians reported having some formal training in ADA requirements during their careers. Twelve denied any training, and another was unsure. Of the four who reported receiving formal training, only one, who graduated after 1990, got their instruction in medical school. The others received instruction during continuing medical education functions or other formats within their clinical setting. Six of the responding doctors had graduated from medical school after the ADA’s enactment.
“In a way, this should not be very surprising,” says Dr. Iezzoni. “There is really very little education about the physician’s responsibilities under the ADA in undergraduate medical school, graduate medical education or even continuing medical education.”
Impact on Patient Care
This lack of knowledge has an impact on patients. The Healthy People (HP) 2010 report published by the Centers for Disease Control & Prevention in 2000 was the first time those with disabilities were identified as a population with health disparities.
“That was continued in HP 2020, and I expect it will continue with HP 2030,” Dr. Iezzoni says. “We now have 20 years of the federal government saying people with disabilities experience significant healthcare disparities. But we haven’t put the same focus on that as seen [on] ethnic and racial minorities.”
3 Major Laws
Three major laws are involved: Section 504 of the Rehabilitation Act of 1973, the ADA as amended in 2008 and Section 1557 of the Affordable Care Act (ACA). All three prohibit entities that receive federal funding, such as Medicare or Medicaid, to have programs or activities that discriminate against people with disabilities. They not only outlaw discrimination, but also require an entity to take proactive steps to offer equal opportunity to those with disabilities.
“One law all practices should be aware of is Section 1557 of the ACA,” says Mollie Gelburd, associate director for government affairs at the Medical Group Management Association. “The higher standards in the law require practices now give primary consideration to the type of auxiliary aid requested by an individual with a communications-based disability.”
