Primary Care Coding Alert

Primary care practices see patients of all ages and abilities, and making sure all clients can easily access services is a fundamental aspect of excellent healthcare. However, not doing so could lead to more than just unhappy patients.

Recently, the Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) and the Department of Justice (DOJ) took enforcement actions against a medical practice due to non-compliance with the accessibility standards for deaf individuals, as outlined by the Americans with Disabilities Act (ADA). If you’re now wondering how deaf-accessible your practice is, and what you might do to improve (and why), keep reading.

Prioritize Making Interpreters Available

Why? Patients who are deaf or face other barriers to communication need to be completely involved in their care, and it’s the provider’s responsibility to ensure the patient is fully informed and has provided consent to services and treatment. “Language and cultural barriers, with no interpreter support, can lead to miscommunication and misdiagnosis. Bringing in a medical interpreter who is certified in American Sign Language (ASL) helps bridge the communication barrier,” explains Maureen Leahey, CHC, CPC, Compliance Coding Auditor at Sentara Health in in Norfolk, VA. On top of that, it’s the law.

Reminder: The ADA, which was first implemented in 1990, continues to outline rights for people with disabilities and organizations’ responsibilities in accommodating their needs. The ADA has requirements for medical institutions and puts the costs of those accommodations on the providers and facilities instead of patients who require access and assistance.

“Federal civil rights laws are clear that health care providers must provide those who are deaf or hard of hearing with appropriate auxiliary aids and services, such as an ASL interpreter, when requested,” says Melanie Fontes Rainer, OCR director, in a release on the case. “Providers are required to follow the law and provide care in a manner that is free from discrimination.”

Emphasize Patient-Centered Care

In addition to reviewing the federal requirements and updating your policies accordingly to ensure administrative and clinical staff understand the law, you should remember that providing individualized care means accommodating individuals’ needs, which can vary greatly depending on the level of hearing loss and the type of communication preferred by the patient.

For example, “some individuals may require interpreters who are fluent in American Sign Language, a language with grammar and syntax that is different from the English language,” the National Association of the Deaf explains in its online resource guide for healthcare practitioners. “Others may require interpreters who use Signed English, a form of signing which uses the same word order as does English. Still others who do not know any sign language may require oral interpreters, who take special care to articulate words for deaf or hard of hearing individual, or cued speech interpreters, who give visual cues to assist in lip reading (also called speech reading).”

Aim for Preserving Patient Dignity and Privacy

If your practice doesn’t offer many or any accommodations for deaf people, you can make some small, inexpensive changes as well as some bigger investments to boost accessibility.

Here are five options:

1. Keep a whiteboard on hand in exam rooms and in whatever room you might hold practice-wide staff meetings. Being able to communicate a phrase or concept through written words or even a quick sketch can boost accessibility for people who are deaf or hard of hearing.
2. Make written materials available. All patients are used to being handed paperwork when visiting a practice for the first time, but make sure your written materials include any important instructions as well. If a staff member requires accommodations, make sure you provide written materials for meetings.
3. Clearly label rooms and check-in spaces with easy-to-read signage so patients can navigate to exam rooms, to check-in/check-out spaces, to the bathroom, or anywhere else they may need to go during their visit.
4. Be proactive in your understanding of how people prefer to communicate. Some may prefer lip reading versus American Sign Language versus Signed English; having staff with at least a little knowledge of any of these languages can be a big head start, in terms of basic accessibility, though a properly qualified, fluent interpreter may still be required in any number of situations (and by law).
5. Consider adding communication technology to your practice space. For example, a secure text messaging system or a buzzer that flashes lights and vibrates can alert patients that their exam room is ready.

Consider Your Accommodations

Make sure your accommodations are helpful but also sensitive to individual dignity.

Take a look at this guidance from the National Association of the Deaf when updating your accommodations for deaf patients:

• What policies have been established to accommodate patients and offer access to care — and do all staff understand the procedures?
• How do you identify deaf or hard-of-hearing patients to ensure assistance and aid while avoiding discrimination and protecting privacy?
• Are visual aids available for both clinical and adminis­trative questions?
• Do any providers know ASL, or are there any staff with a basic knowledge?
• Are language interpreters properly trained and certified by an accrediting body?
• Do all staff know the existing laws and the consequences for failure to help individuals with language interpretation requests?

Don’t forget: While you’re evaluating your communication methods and protocols, make sure you have a plan for emergencies and disasters. One crucial part of accommodating disabilities during emergencies is making sure everyone on staff understands plans beforehand. It may be impossible or even dangerous to get an interpreter to your practice or facility during an emergency, so taking the time to make sure anyone who needs accommodations is well-versed in the emergency or disaster plan could be crucial for health and safety.

Resource: Review the OCR/DOJ case and resolution details at www.hhs.gov/about/news/2023/03/23/hhs-office-civil-rights-us-attorneys-office-eastern-district-michigan-resolve-federal-civil-rights-complaint-regarding-doctors-alleged-failure-pr­ovide-sign-language-interpreter.html.