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steven p. rosenberg, m.d., p.a. elaine zoberman-saltiel, m.

d, DIPLOMATES OF THE AMERICAN BOARD OF DERMATOLOGY FELLOWS OF THE AMERICAN ACADEMY OF DERMATOLOGY August 2, 1993 Congressman Clay Shaw 1512 East Broward Boulevard Ft. Lauderdale, FL 33301 Dear Congressman Shaw: I would appreciate your helping to clarify a matter that developed today in reference to our compliance with the Americans with Disabilities Act. I have supported the principles and concepts of the ADA, but as a result of some confusion today I realize that this is a complicated issue. Specifically, a patient was provided an appointment who is hearing impaired and she demanded that we provide an interpreter. The legal advice that I was able to receive from the Florida Medical Association indicates that we are required to "ensure effective communication". I have been practicing for approximately fifteen years and have taken care of numerous patients with various disabilities. In the past we have never had difficulty by communicating with written notes in those individuals who are hearing impaired. The nature of the dermatology practice is such that the majority of issues are relatively straightforward and can be handled efficiently in this fashion. As there appears to be some confusion between the patient's demands and the legal advice that I had received which indicates that such notes should be acceptable unless the physician feels otherwise, I would appreciate clarification. I would also like to point out that the cost for obtaining an interpreter have minimum charges of between $60.00-$75.00. An initial office visit is $50.00 and as you are aware, many third party payers including Medicare reimburse office visits in the $22.000-$40.00 range. This would result in a net loss per patient visit in a situation where our overhead costs are already astronomical. I am curious whether this places an "undue burden" according to the definitions of the act.

In addition, I would like to know whether we can bill the patient for the cancellation fee that the interpreter charges should the patient fail to keep their appointment. The interpreter services indicated that if the services are not cancelled with twenty four hour notices that there is a charge and that we would be responsible for the full amount even if the patient does not show. I understand my financial responsibility to provide this service for the hearing impaired but I am also concerned that there may opportunities where patients cancel at the last minute or do not show and therefore these costs would not be associated with my actually providing an office visit. 01-02665 Page 2 Finally, I would like to know whether third party payers including Medicare will reimburse for interpreter services and if so, more specifically how should we go about obtaining such payment from Medicare. Your prompt help and cooperation would be appreciated. Please do not hesitate to contact me by phone should that be necessary. You may also fax information to me at 407/640-8098. Sincerely, Steven P. Rosenberg, M.D. SPR/dm