Survey: LEP programs lack resources, funding
Survey: LEP programs lack resources, funding
Only 3% receive any reimbursement
While 80% of hospitals frequently treat patients with limited English proficiency (LEP), only 3% receive reimbursement for providing translation and interpretation services, according to a survey conducted by the American Hospital Association's (AHA) Health Research & Educational Trust (HRET) affiliate.
About one in five U.S. residents speak a language other than English at home. Hospitals responding to the survey reported encountering a wide variety of languages, including Spanish, Chinese, Vietnamese, Japanese, and Korean. At least 20% of respondents frequently encountered 15 of the 32 languages included in the survey.
The most frequent barrier hospitals faced in providing language services, the survey found, was that staff had no means of identifying patients who needed language services before they arrived at the hospital. That concern was followed closely by concerns over cost and reimbursement for providing language services.
Virtually all hospitals are required to provide language services to patients with LEP under Title VI of the Civil Rights Act of 1964, says Steve Hitov, JD, managing attorney for the Washington, DC, office of the National Health Law Program (NHLP). His organization, as an outgrowth of its National Language Access Advocacy Project, engaged AHA's research affiliate to conduct the survey.
Title VI says that recipients of federal funds can't discriminate against people on the basis of race, religion or national origin, Hitov says, and "national origin" is considered to include those with LEP.
Of the 3% of hospitals that do receive reimbursement for providing interpretation and translation services, 78% say that reimbursement comes from Medicaid.
There are 13 states for which Medicaid will pick up some of the tab, Hitov explains. "That doesn't mean it is adequate reimbursement, but if claims are submitted properly, they will reimburse."
Additionally, in some states there are pools of state dollars that are designated for language services in the health care arena, he notes, "but nobody is getting their costs covered."
Providing interpreter services is a very large expense for Chicago's Swedish Covenant Hospital, which is located in one of the most diverse neighborhoods in the country, says Gillian Cappiello, CHAM, senior director for access services and chief privacy officer.
Those services, she adds, include on-site interpreters employed by the hospital, a telephone language line, bilingual staff competent in providing medical interpretation, and having patient consent forms and other documents translated.
The vast majority of survey respondents are connected with telephonic services for interpretation, says Romana Hasnain-Wynia, lead author and HRET vice president of research, and are "trying to work out if it's possible to have staff interpreters, trying to find mechanisms to do that."
"We didn't ask a lot about organizational structure, but we did ask whether staff interpreters were available," she notes. "Part of the reason was if there are staff interpreters, usually there is an entity responsible [for oversight], and 68% said they have staff interpreters."
In another study that HRET conducted with the American Medical Association called Promising Practices, Hasnain-Wynia adds, "we wanted to find out the common denominator shared by hospitals that are effective in providing high-quality language services."
"The key element for the eight that received recognition was a charismatic leader who really took the issue on, usually someone who was director of language or interpretive services," she says.
Cristina Krasny, manager of interpretation and translation services at WakeMed Health and Hospitals in Raleigh, NC, described her hospital's efforts to improve services for patients with limited English proficiency, recommending all hospitals appoint a staff person to oversee interpretation and translation services.
"Without a dedicated staff person, a hospital will not be able to develop a language-assistance program that touches every aspect of the organization, from signs and maps to interpretations and staff training," she said.
Many hospitals reported that they need additional resources, tools, and training, says Hasnain-Wynia. When asked what they would find useful, she notes, 70% said they "really wanted training to help them respond in a culturally competent way to those who do not speak English."
One of the principles of the coalition of groups that came together at the invitation of NHLP to advocate language access, Hitov points out, is that since the federal government decided — with Title VI — that service to people with LEP is worth pursuing, it's worth paying for, and shouldn't exist as an unfunded mandate.
"As an advocate, I believe that it is a mandate [either way]," he adds, "but everybody knows it will happen more readily if it is supported. Hospitals are businesses.
"The entire group has signed on to the principle that it is the goal and obligation of society, as a whole, to pay for this — not just from the civil rights perspective, but because it also directly impacts the quality of care people receive."
A report by the Boston-based Access Project that was cited in the survey found that 161 uninsured patients who received health care at 23 primarily safety net hospitals had differing experiences based on access to an interpreter. Patients who needed and got an interpreter rated their hospital experience and the care they received more positively than patients who needed an interpreter but did not get one.
It was also noted in the survey report that in January, the Joint Commission on Accreditation of Healthcare Organizations instituted a new standard requiring hospitals to collect and document language information about their patients as part of its accreditation process.
In a recent development designed to facilitate communication with patients with LEP, an advance care directive developed by the Aging With Dignity organization has been released in 20 languages.
A CD with sample copies of the document will be sent to hospitals and hospices by a collaborative that includes the United Health Foundation, Aging with Dignity, the American Hospital Association, and the National Hospice and Palliative Care Organization.
In addition, 100,000 language-specific versions of the directive will be provided free of charge to individuals and community organizations. The "Five Wishes" directive meets the legal requirements for an advance directive in 38 states.
While 80% of hospitals frequently treat patients with limited English proficiency (LEP), only 3% receive reimbursement for providing translation and interpretation services.Subscribe Now for Access
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