Breslin, Mary Lou

Kailes, June Isaacson

Mudrick, Nancy R.

English

Syracuse University Research Facility and Collaborative Environment

Syracuse University SURFACE School of Social Work David B. Falk College of Sport and Human Dynamics November 2011 Response to the Data Challenges of the Affordable Care Act: Surveys of Providers to Assess Access to Care for People with Disabilities and the Presence of Accessible Exam Equipment Nancy R. Mudrick Syracuse University Mary Lou Breslin Disability Rights Education and Defense Fund June Isaacson Kailes Harris Family Center for Disability & Health Policy Western University of Health Sciences Follow this and additional works at: https://surface.syr.edu/swk  Part of the Health Services Research Commons, Public Affairs, Public Policy and Public Administration Commons, and the Social Work Commons Recommended Citation Mudrick, Nancy R.; Breslin, Mary Lou; and Kailes, June Isaacson, "Response to the Data Challenges of the Affordable Care Act: Surveys of Providers to Assess Access to Care for People with Disabilities and the Presence of Accessible Exam Equipment" (2011). School of Social Work. 1. https://surface.syr.edu/swk/1 This Presentation is brought to you for free and open access by the David B. Falk College of Sport and Human Dynamics at SURFACE. It has been accepted for inclusion in School of Social Work by an authorized administrator of SURFACE. For more information, please contact surface@syr.edu. Response to the Data Challenges of the Affordable Care Act N.R. Mudrick, PhD, Syracuse University M.L. Breslin, MA, Disability Rights Education & Defense                                  Fund J.I. Kailes, MSW, Harris Family Center for Disability &                 Health Policy, Western University of Health Sciences  Contact: mudrick@syr.edu  Surveys of Providers to Assess Access to Care for People with Disabilities and the Presence of Accessible Exam Equipment    Presented at the annual meeting of the American Public Health Association, Washington, D.C., November 2, 2011  For further information or permission to cite contact   Nancy R. Mudrick, mudrick@syr.edu  How The Affordable Care Act Addresses Access to Medical Care Facilities  The ACA contains no language requiring architectural, programmatic, or equipment accessibility in medical office sites.  BUT, contains requirements to 1) collect information regarding where patients with disabilities receive care 2) collect information about the physical and programmatic access of medical providers 3) set standards for accessible exam and medical diagnostic equipment  [S]urvey health care providers and establish other procedures in order to assess access to care and treatment for individuals with disabilities and to identify—   (i) locations where individuals with disabilities access primary, acute (including intensive), and long- term care;   (ii) the number of providers with accessible facilities and equipment to meet the needs of the individuals with disabilities, including medical diagnostic equipment that meets the minimum technical criteria;   (iii) the number of employees of health care providers trained in disability and patient care of individuals with disabilities. Section 4302  of ACA requires the U.S. Department of Health and Human Services to: a) criteria for medical diagnostic equipment used in physician's offices, clinics, emergency rooms, hospitals, and other medical settings.  b) equipment to be accessible and allow independent entry to, use of, and exit from the equipment  c) includes examination tables and chairs, weight scales, mammography equipment, x-ray machines, and other radiological equipment Section 4203 of ACA requires standards for accessible medical diagnostic equipment What is required to implement these provisions? 1. Consistent means for identifying patients with disabilities 2. Measurement tools to gather information on: a) accessibility characteristics of provider facilities b) Presence of provider staff trained in disability and patient care 3. Accessible equipment standards 4. Procedures for gathering data on providers’ facilities and training Measuring Provider Office Accessibility Studies of provider office accessibility have found numerous barriers  Three methodologies for data collection:  Surveys and interviews with patients  Provider self-administered surveys  Independent on-site reviewers Why Access Data are Important: Findings from Prior Studies Medical building exterior and public interior spaces are largely accessible.    BUT Barriers remain inside physicians’ suites.   On-site review of 2389 California providers:  91.6%  do not have a height adjustable exam      table 96.4%  do not have an accessible scale 83.4%  have inadequate space in bathrooms 69.9%  have restroom door hardware that does      not meet ADAAG standards Measurement of Provider Office Accessibility: State of the Art  Several tools have been used to examine medical office access; each has a different number of items  Most tools use selected items from the architectural elements of the ADAAG  Only one or two instruments have been evaluated for reliability and/or validity  Use across the U.S. has been uneven, with small sample sizes, often voluntary sites Tools Used to Measure Outpatient Health Provider Office Accessibility  California Health Plans ADA Facility Site Review 2002-2010 (used by Mudrick, et al.)  55 items, 53 architectural, 2 equipment  41 correspond to 1991 ADAAG  Health Care Accessibility Survey for People with Disabilities 2007 (Respect-ABILITY Coalition & Disability Rights Advocates)  61 items, partially from ADAAG  Includes communication & equipment items  Health Care Provider Disability Awareness and Capability Interview 2006 (San Francisco Health Plan)  33 items  Communication and programmatic items Tools Used to Measure Outpatient Health Provider Office Accessibility  Outpatient Health Care Usability Profile 2008 (Drum, et. al.)  158 items, architectural, based on ADAAG  Items tested for validity with people with disabilities and ADA experts  ADA Assessment Checklist 2008 (Graham & Mann)  93 items, architectural  Based on amended 2002 ADAAG  Adaptive Environment Center’s Checklist for Existing Facilities 1995 (elements essential for health facilities, used by Sanchez et. al.)  Based upon 1991 ADAAG Tools Used to Measure Outpatient Health Provider Office Accessibility  State of California ADA Facility Site Review 2011 (put into use 2/1/2011)  86 items: 82 architectural, 4 equipment  1991 ADAAG and 2012 ADAAG  Expanded version of 55-item tool in use 2002-2010   California’s 2010 1115 Medicaid Waiver requires an on-site accessibility audit for all primary care providers working with the 22 health plans participating in the waiver    Measurement of Provider Office Accessibility: State of the Art Elements of access missing from the existing measurement tools: 1) Communication access indicators 2) Programmatic access indicators 3) Diagnostic equipment access beyond exam table and weight scale 4) Training of provider staff to provide care to patients with disabilities Lessons Learned from Provider  Accessibility Studies 1) Measurement of provider accessibility results from pressure and input from disability advocates and federal and state health agencies.  2) Accessibility tools need to be standardized for use across the U.S.  3) The ADAAG can provide the basis for some elements, but provides no guidance for other crucial elements.   Lessons Learned from Provider Accessibility Studies 4) Medical office accessibility MUST be assessed by on-site reviewers.  5) Accessibility tools need to be developed with the care of research instruments, field-tested, assessed for reliability and validity.   6) Plans for collecting provider accessibility audits must include procedures for aggregation, analysis, and utilization of findings. Lessons Learned from Provider Accessibility Studies 7) An effective access instrument meets the needs of multiple audiences. Its development requires collaboration involving disability advocates, providers, state or federal agencies, and researchers. Training for Disability Awareness and Patient Care of Individuals with Disabilities Medical students and practicing physicians report in surveys they have inadequate training for patient care of individuals with disabilities  Training in disability is not required as part of accredited medical curricula, professional licensing, or facility licensing or accreditation Training is Available  A number of guides, videos, and training modules are available for physicians and other health providers.   Some training is occurring in medical schools.  A 2009 poll of 70 medical schools found that 26 had some sessions on disability (AAHD fact sheet). Training for Disability Awareness and Patient Care of Individuals with Disabilities The content of training offered varies; no current consensus regarding necessary elements, or who requires training  Much of the training is not competency-based, but focused on  disability awareness Content Issues for Measurement of Provider Training  Scope  Clinical   Accommodations  Policies and procedures  Standardized  Measure competencies for different groups—physicians, dentists, nurses, physicians assistants  Add to continuing education   Questions and Decisions  What should be the content of qualifying training?   Should mastery be indicated by certification or other means in order to consider an employee trained?   Through what data collection vehicles will the extent of employee training be reported? Training Data Collection: Methodological Concerns and Challenges  Complex data collection challenges   Requires a high level federal/academic/disability policy work group to determine the way forward   Should build on existing work with training modules and research on training receipt and outcome  Items from California Department of Health Services Site Review Survey ACA Mandate for Standards for Medical Equipment  ADAAG standards for:  examination tables, examination chairs (includes eye and dental), weight scales, x-ray machines, and mammography & other radiological equipment commonly used  within 24 month period (March 2012)  Dept. of Justice plans ADA Titles II & III regulations: standards for numbers and types of medical equipment  Standards can be used in provider access instruments and surveys Potential Strategies and Final Thoughts Real change: Leadership Levels  Federal Roles (HHS, CMS, DOJ, NIH)  Vision  Funding  Coordination  Research  State Mandates and Actions  1115 Waiver requirements—CA as example  MMCO/Benefits exchanges/health plans  Accreditation and Licensing  Medical education requirement  Joint Commission physical & programmatic access measures     

Response to the Data Challenges of the Affordable Care Act: Surveys of Providers to Assess Access to Care for People with Disabilities and the Presence of Accessible Exam Equipment

https://surface.syr.edu/cgi/viewcontent.cgi?article=1000&amp;context=swk

Response to the Data Challenges of the Affordable Care Act: Surveys of Providers to Assess Access to Care for People with Disabilities and the Presence of Accessible Exam Equipment

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