ADA Compliance for Medical Offices: A Review of ADA Accessibility Standards

Providing a welcoming and accessible medical practice is essential to delivering quality health care to everyone in your community. The Americans with Disabilities Act (ADA) sets clear standards to ensure that people with disabilities have equal access to the care they need. This resource will break down a key element of ADA compliance: improving access to care for patients and companions with mobility issues.

You may be asking how to practically address patients’ mobility issues. These questions may include how to assist patients who, for example, struggle to step onto scales, use a stepstool to reach an exam table or maneuver a walker or wheelchair to and through the practice’s lab to have blood drawn. Medical practices should have a disability action plan that improves access to care for patients and their companions with mobility disabilities.

Gather Key ADA Resources for Accessibility Requirements 

First, collect credible guides and instructions on the Americans with Disabilities Act of 1990 (“ADA”). Your resources should at least include the following:

• The “ADA Standards for Accessible Design” is divided into two parts: 2010 Standards for State and Local Government Facilities Title II and 2010 Standards for Public Accommodations and Commercial Facilities Title III. Most medical offices and practices should follow the Standards for Public Accommodations and Commercial Facilities: Title III., which focuses on public entities and public accommodations. Private medical practices would fall under “public accommodations. Note: Title II applies to government, not private businesses. 
  
  
• Office or building leases may address ADA issues and accommodations for patients or companions with mobility disabilities, including parking lots or decks, accessible parking spaces, restrooms, and elevators.
  
  
• The U.S. Department of Justice’s (“DOJ”) and the U.S. Department of Health and Human Services’ (“HHS”) detailed guide for medical offices and practices working to improve access for patients and their companions with mobility disabilities.
  
  
• The American Medical Association’s (“AMA”) free easy-to-follow “ADA Checklist for Existing Facilities.” The checklist includes pictures, diagrams, calculations, measurements, and ADA requirements.
  
  
• The medical office/practice floorplan, a sketch or diagram of the building’s exterior showing key mobility-related elements, and a smartphone or camera will save you from having to remember everything and serve as documentation of compliance efforts.
  
  
• MICA Members: Another resource is the MICA Risk Management Services Hotline at rm_help@mica-insurance.com or direct and toll free at 800-705-0538.

Mobility Assessment of Your Medical Practice

Conducting a mobility assessment in your office or practice should cover two areas: the physical plant and the practice’s policies, procedures, processes, and conduct. 

A comprehensive mobility assessment is necessary to identify barriers for mobility impaired individuals. This involves a detailed evaluation of your medical facility to ensure it is accessible to people with disabilities, which is in line with the Rehabilitation Act and ADA. 

Assessing Your Building and Grounds

You can use the AMA’s “ADA Checklist for Existing Facilities” to assess the office or practice, building, common areas, and grounds.

• Physicians, advanced health care practitioners, clinical staff, and administrative and support staff should walk-through a patient’s experience of the physical obstacles and barriers in the practice. Remember, some patients with limited mobility may not use any assistive device (e.g., wheelchair, scooter, walker, braces, or crutches).
  
  
• Practice administration professionals should read all leases and other contracts to see if the landlord, equipment vendor, or the practice is responsible for ensuring physical accessibility to the office and equipment. The practice’s business or health care attorney or a practice management consultant can interpret contract language and explain your obligations.

The ADA Standards for Accessible Design are divided into two parts: standards for state and local government facilities (Title II of the ADA) and standards for public accommodations and commercial facilities (Title III of the ADA). 

• The standards for public accommodations and commercial facilities contain a subsection for licensed medical care and long-term care facilities with patient or resident sleeping rooms.
  
  
• The licensed medical care and long-term facilities standards specifically address toilets for critical or intensive care patient sleeping rooms, dispersion of accessible sleeping rooms, and alterations or additions related to sleeping rooms.

Most medical offices and physician-owned practices are not licensed and/or do not accommodate overnight patients and should use the other standards for places of public accommodation and commercial facilities.

Evaluating Policies and Procedures

Update your policies and procedures to reflect a commitment to ADA compliance, ensuring medical care is accessible to all. This includes reviewing the obligations under the ADA and making necessary adjustments to facilities and services.

The ADA prohibits discrimination based on disability and requires medical offices and practices to offer or arrange for effective facilities and services for patients with and without disabilities. Practices should consult a business or health care attorney about providing effective facilities and services for patients with disabilities that are separate or distinct from effective facilities and services for patients without disabilities. One of the goals of the ADA is to provide facilities and services in the most integrated setting that is still appropriate to the patient’s or companion’s needs.

The mobility assessment result should be the basis for an ADA action plan. The plan will likely include modifying layouts, buying or leasing equipment, educating and training everyone in the practice, revising policies and procedures, and improving processes.

When Full Compliance Isn't Possible

The ADA standards for public accommodations and commercial facilities include the phrase “to the maximum extent feasible” in several places. The standards recognize that in some situations full compliance with the accessibility standards may be “virtually impossible.”

In those situations, explained further in the standards, medical offices and practices must provide facilities and services to the “maximum physical accessibility feasible.”

Physicians, advanced health care practitioners, and clinical staff must be able to provide care, treatment, and services in an accessible manner to patients and their companions with disabilities. This may not require medical practices to install accessible examination tables with sufficient clear floor space next to the tables in every examination room, for example. The number of accessible examination tables with adequate space depends on the size of the medical practice and the number of patients or companions with mobility disabilities.

Practices may find there is not enough physical space for certain equipment or renovations without making the costs seem untenable. In this case, consider the following:

• Practices should consult with an accountant or tax attorney about credits and deductions, including the following:
  
  
  • The Internal Revenue Service’s Disabled Access Credit for practices with 30 or fewer full-time employees or with total revenues of $1 million or less in the previous tax year, and
    
    
  • The Architectural Barrier Removal Tax Deduction for costs incurred by practices of all sizes in removing architectural barriers.
    
    
• A business or health care attorney or consultant should guide decisions about requirements, costs, and priorities.

There is not an ADA compliance certification for consultants so practices should ask consultants about their experience and check references.

Disability action plan

Education and Training: The Foundation of Accessibility

Most disability action plans include initial and ongoing education and training for everyone in the practice. Education and training opportunities should include:

• Asking patients, before beginning an appointment and outside of a companion’s hearing, if they want the companion to remain in the room for the appointment;
  
  
• Directly speaking to patients with mobility disabilities, not the companion, because generally mobility disabilities don’t impact patients’ ability to speak for themselves or understand conversations about their medical care; and
  
  
• Asking patients with mobility disabilities during an appointment if they require assistance and, if so, what is the best way to help.

Practices should start with the DOJ’s free online course, “Reaching Out to Customers with Disabilities,” with short stand-alone lessons on accessible design and removing barriers.

Patient-Focused Policies for Mobility Assistance and Accessibility 

The DOJ’s advice should guide the review, revision, or development of policies, procedures, and mobility-related processes. For example, the following advice from DOJ should be included in a policy, procedure, or process.

• Medical practices must provide patients with mobility disabilities reasonable assistance with dressing and undressing, transferring to and from the examination table or other equipment, and balancing and positioning while on the table or other equipment.
  
  
• Medical practices cannot require patients with mobility disabilities to bring and/ or pay for family, friends, paid caregivers, or medical transport staff to assist with dressing, undressing, transferring, balancing, and/or positioning.
  
  
• Scheduling staff should ask patients if they will need any assistance during the examination and document any physical or mobility needs.

The DOJ says that patients with disabilities should be scheduled in a way that ensures their access to necessary equipment without waiting longer than patients without disabilities would wait.

This may mean “reserving” an accessible examination room before and/or after appointments for patients with mobility disabilities to allow for more appointment time and decrease waiting time. This may also require the practice purchase additional equipment or train more staff for safe transfers.

Medical offices and practices can adopt and tailor HHS’ Office of Civil Rights’ sample policy and procedure for providing appropriate auxiliary aids and services to patients and their companions with disabilities.

The Cost of Noncompliance

Fines for ADA violations range from $75,000 for a first offense to $150,000 for each subsequent violation. Spending on the front end for accountants, attorneys, consultants, training, and equipment may save the practice from lawsuits and hefty legal bills on the back end.

Plus, it can impact the patient's experience and quality of care provided. For example, imagine a patient with limited mobility who has to struggle onto a traditional exam table. This may cause the patient to experience increased pain or anxiety, making it difficult for a provider to get an accurate assessment of their condition. An adjustable-height table enables a smoother, safer transfer, improving the patient's comfort and the quality of the exam.

The Benefits of a Proactive Approach

Patient mobility is key to preventing deep vein thrombosis, pressure ulcers, muscle atrophy, bone demineralization, and other potentially serious conditions. Patient mobility also protects patients’ physical and emotional well-being. Their mobility in and around the medical office or practice may be legally required under the ADA and is also part of care and treatment. Ensure that all areas of your practice, from parking to patient care areas, comply with the ADA Standards for Accessible Design. 

By fully embracing the guidelines of the Americans with Disabilities Act your medical facility can provide high-quality medical care. It's about more than just complying with the ADA; it's about ensuring accessibility and non-discrimination in patient care. Remember, the goal is to ensure equal access to care for all patients, in line with the principles of the Rehabilitation Act and the ADA. 

Additional Resources

Articles: Close to Home ADA Enforcement Actions in the Southwest 

PDF: Essential Basics of ADA Service Animal Requirements 

PDF: The ADA's Effective Communication Requirements

PDF: The ADA's Accessibility Requirements My Wheelchair Won't Fit

Sample Policy Template: Providing Auxiliary Aids or Services for Effective Communication With Individuals With Hearing Disabilities