Is Your Dental Practice’s Digital “Front Door” Accessible To People With Disabilities?

Jordan Uditsky • August 2, 2023

Why Your Website Must Comply With The ADA And How To Do So

As a dentist and a practice owner, you are likely aware that you have a legal obligation to make your offices and services accessible and available to people with disabilities under Title III of the Americans With Disabilities Act (ADA). That is why you have a ramp to your front door, a wheelchair-accessible restroom, designated parking spaces, and other physical modifications to ensure that all current and prospective patients can avail themselves of the dental care you provide.

 

But the ADA’s accessibility requirements are not limited to your practice’s physical facilities and presence. Your virtual front door – your practice’s website – must also be accessible to people with disabilities especially if you are providing services through your website, such as a scheduling feature or other informational videos. Your website should accommodate visitors who are blind or have limited vision, are deaf or have hearing loss, or have limited movement, speech disabilities, photosensitivity, and other conditions that impact their ability to view, navigate, and interact with a site.

 

Failure to have an ADA-compliant website could subject you and your practice to the same potential lawsuits and liability you would face if a patient in a wheelchair rolled up to your offices and looked up at a flight of stairs that prevented them from getting the dental care they needed. And the risk of your practice becoming the target of such a suit is far from theoretical. In 2022, plaintiffs filed 3,255 web accessibility lawsuits in federal court, a 12% increase from 2021.

 

That is why dental practice owners who may not have been aware of their website accessibility obligations need to understand those imperatives and take the steps necessary to ensure compliance. But the odds of even the most web-savvy dentists knowing how to do that on their own are slim to none.

 

DIY On ADA Compliance Is Ill-Advised

 

Like most business owners, dental practice owners have little or no clue about the inner workings of website design generally, much less the technical steps and requirements involved in making a website ADA-compliant. That is why they hire web designers and digital marketing specialists to create and manage their online presence. And if you entrust your website’s appearance, user-friendliness, and effectiveness to such a company without ensuring that they are doing what needs to be done to comply with the law, you leave your practice exposed to unnecessary and avoidable risk – and leave behind patients who want and need your services.

 

“Many, if not most, of our clients aren’t even aware that the ADA applies to their website or that they need to factor accessibility into its design,” says Nat Rosasco, Principal and Chief Marketing Officer of Villa Park-based digital marketing firm Olive Street Design.* “But we certainly are, which is why we make it a core part of our services, integrating fully compliant accessibility features into our sites as a matter of course.”

 

Why Dental Practice Websites Must Be Accessible And What That Means

 

Title III of the ADA prohibits discrimination on the basis of disability by places of public accommodation, which includes any business open to the public. Businesses open to the public must take steps to provide appropriate communication aids and services where necessary to make sure they effectively communicate with individuals with disabilities.

 

When the ADA was signed into law in 1990, the internet was in its infancy and commercial websites were non-existent. Legislators did not and could not conceive how much the internet would come to dominate so much of our commerce, business, and lives. Because a website with inaccessible features can limit the ability of people with disabilities to access a public accommodation’s goods, services, and privileges, the Department of Justice (DOJ), which enforces the ADA, has taken the position that Title III’s accessibility requirements apply to business websites. However, to the frustration of businesses and disability activists alike, the DOJ has never issued regulations specifying exactly what must be done for a website to comply with the ADA.

 

In March 2022, however, the DOJ issued its long-awaited guidance on website accessibility under the ADA. While emphasizing that businesses still “have flexibility in how they comply with the ADA’s general requirements of nondiscrimination and effective communication,” the guidance recommended that businesses use existing standards like the Web Content Accessibility Guidelines (WCAG) and the Section 508 Standards, which the federal government uses for its own websites.

 

Olive Street Design’s Rosasco says that they have been following WCAG standards and other technical accessibility protocols for years, including providing users with various accessibility options.

 

“It is really about giving people a menu of alternative ways to view and use a site that they can tailor to their needs or limitations,” he says. “That could mean anything from larger fonts and modified color schemes, to making all functionality available from a keyboard, to providing users additional time to read and use content, to not designing content in a way known to cause seizures.”

Rosasco says that all of these accommodations can be typically incorporated in a separate menu such that the overall look and functionality of the website is unaffected.

 

“If you understand the technical, coding aspects of website accessibility, it is a relatively easy fix,” he says. “We can still give the client the website they want while ensuring they can serve all clients or patients regardless of disability. Even putting legal obligations aside, that is a definite win-win.”

 

We Focus on You So You Can Focus on Your Patients

 

At Grogan Hesse & Uditsky, P.C., we focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you.

 

Please call us at (630) 833-5533 or contact us online to arrange for your free initial consultation.

 

*Olive Street Design designed and manages Grogan Hesse & Uditsky’s website, including its ADA-compliant accessibility features.

 

Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices. This blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.  


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Whatever shortcomings and deficiencies there may be in the dynamic between dental practices and insurance companies, their distinct roles in patient care are not among them. While dentists certainly want to maximize reimbursements for the services they provide, they are not beholden to insurers and remain in a position to advocate for their patients and challenge an insurer’s cost-related decisions without fear of retribution. But a recent unprecedented move by Delta Dental in Wisconsin threatens to upend this relationship model and has raised serious concerns among industry groups, patient advocates, and regulators about conflicts of interest, competition, and provider independence. Over the summer, Delta Dental announced that it had acquired Cherry Tree Dental, which owns and operates 31 clinics, 25 of which are in Wisconsin. The American Dental Association (ADA) is among several organizations that have vocally opposed the transaction. As the ADA wrote shortly after the deal was announced: When an insurance company becomes both health care provider and insurance payer, questions arise regarding potential conflict of interest. From a business standpoint, dental insurance companies seek to minimize cost and maximize profit. As a result, patients may find their treatment options limited to what is most cost-effective for the insurer, not necessarily what is most effective for their oral health. The ADA believes that the health interests of patients are best protected when dental practices and other private facilities for the delivery of dental care are owned and controlled by a dentist licensed in the jurisdiction where the practice is located. In November, the ADA filed a letter with the Wisconsin Office of the Commissioner of Insurance expanding on its concerns and opposition, including worries about provider independence in making care decisions: Direct ownership by Delta Dental could compromise dentists’ ability to advocate for patients. In traditional arrangements, dentists can appeal plan decisions regarding patient care or choose to leave a network if plan policies are overly restrictive. However, the ADA warned that when dentists are employed by the payer, challenging cost-related decisions could label them as “problem employees,” potentially discouraging proper patient care. The potentially anti-competitive effects of such arrangements were also raised by the ADA, which noted that “Delta Dental’s acquisition could influence agreements, business practices, and fee schedules between Cherry Tree and other payers, potentially creating unfair competition.” In addition to the ADA, the acquisition has drawn concerns from the Wisconsin Dental Association, the American Economic Liberties Project, and the Alliance of Independent Dentists. The fallout of this acquisition, if consummated, could ripple through other markets, potentially leading to a seismic shift in the provider-insurer landscape. We will continue to monitor developments and provide updates as warranted. We Focus on You So You Can Focus on Your Patients At Grogan Hesse & Uditsky, P.C., we focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Please call us at (630) 833-5533 or contact us online to arrange for your free initial consultation. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices. This blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals. 
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Whether you are the associate or the practice owner in such an anticipated transaction, you should consult with an experienced dental practice attorney to understand your options and determine which structure provides you with the most value. Your discussions with your attorney will likely include some or all of these common dental associate buy-in arrangements: Cash Purchase A cash purchase is the most straightforward buy-in model. With either cash on hand or through financing (the more likely scenario), the associate purchases an agreed-upon percentage of the practice (for example, 25% or 50%) for a lump sum based on the appraised value of the practice. That appraisal will likely use metrics such as collections, earnings before interest and taxes (EBIT), or a percentage of annual gross revenue. The main advantage of a cash purchase is its simplicity and immediacy. The associate becomes an owner right away, while the practice owner receives a clean and full payout for the equity sold. However, obtaining the needed financing may be easier said than done for an associate dentist, and a large cash payout may also come with unwanted tax ramifications for the owner. Buy-in documents for a cash purchase should address governance rights, profit distribution, and exit mechanisms. They should also define what happens if an associate departs, how future buyouts are valued, and whether non-compete or non-solicitation covenants apply. Installment Sale An installment sale allows the associate to purchase equity over time, making periodic payments instead of an upfront lump-sum payment. After the practice value is determined, the associate agrees to buy a certain percentage of ownership through regular payments (e.g., monthly or quarterly) over several years. Payments may include interest, and ownership may be transferred incrementally or upon full payment. This is a good option for associates who do not have the means for a full cash buy-in immediately. For owners, this arrangement provides a steady income stream – so long as the associate does not leave before completing payments. That is why the documentation should clearly outline the timing of ownership right transfers and provide robust default remedies, such as forfeiture of prior payments or reversion of ownership interests. Sweat Equity In a sweat equity buy-in, the associate essentially cashes in their years of service, earning ownership over time based on their contribution to the practice’s growth or profitability rather than through an immediate cash investment. In a typical sweat equity arrangement, the associate receives equity credits or options tied to measurable performance benchmarks, such as production levels, collections, or tenure. Once those targets are met, a portion of ownership is granted or sold at a reduced price. This structure enables talented but liquidity-challenged associates to become owners without initial financial strain. It also incentivizes them to grow the practice and stay long-term. Shadow Account (a/k/a Phantom Equity) As I discussed in detail in this post , a shadow account (also known as a phantom equity plan) is an increasingly popular buy-in model, especially when the owner is not yet ready to transfer real equity but wants to reward the associate as if they were an owner. In this model, the associate receives the right to cash payments equal to the value of the shares at a specified later date or distribution event. That value can be established through an appraisal or an agreed-upon formula. The selected events that give an associate a right to a payout can include such things as achieving performance goals, termination, or retirement. There are two types of shadow account/phantom stock plans. In an "appreciation only” plan, the cash payout upon vesting does not include the value of the underlying shares, only the increase in value of that stock since it was granted. In a “full value” plan, the practice pays both the underlying value of the stock and the amount the stock has appreciated while held by the associate. Like actual stock, phantom stock has a defined value and tracks the practice’s performance, but an associate holding phantom stock typically does not have either minority shareholder rights or voting rights in the practice. This makes phantom stock plans attractive for owners who want to provide associates with a sense of equity ownership without giving up any actual control. The practice has broad discretion and flexibility in designing the plan, including valuation formulas and vesting conditions, and the administrative burdens are less than for traditional stock option plans. As noted, the “best” buy-in structure depends on the unique goals of both parties. No matter which model is ultimately adopted, well-crafted documentation, preceded by careful consideration and consultation with counsel, is essential. That is because these deals do more than just transfer ownership - they can lay the foundation for a stable, profitable partnership that preserves the practice’s legacy and rewards everyone’s investment, financial or otherwise. We Focus on You So You Can Focus on Your Patients At Grogan Hesse & Uditsky, P.C., we focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Please call us at (630) 833-5533 or contact us online to arrange for your free initial consultation. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices. This blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
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