Phone interpreters save money, protect privacy
Phone interpreters save money, protect privacy
System aims to cut costs by 60%
Providence Health System in Portland, OR, has a new way of providing interpreter services that could cut its annual cost by more than half while providing more confidentiality for patients.
Statewide, the health system spends about $2 million to provide interpreters to facilitate patient care, says Barbara Wegner, CHAM, regional director of access services, including $1.6 million in the Portland service area. The goal is to reduce the interpreter costs by 60% by using telephone interpretation and some other cost-saving initiatives, she says.
"We’ve been using on-site interpreters through a contract with two different vendors in town," Wegner adds. "The language depends on the area. In one area, it’s Spanish, and across town, the primary language is Vietnamese. There’s also a very high usage of Russian."
Use of the on-site interpreters is extremely expensive, she says, primarily because of the wait time involved. "Our experience has been that the on-site interpreters spend most of their time waiting to interpret," Wegner notes. "They may be waiting for someone to go to surgery or to wake up from surgery. They may be in line at the pharmacy or waiting in the X-ray department or at the doctor’s office.
"The average length of time interpreters spend here is near two hours, but we have many who are here for six to eight hours," she says. "If the patient is in the labor room, the interpreter may be waiting for hours."
In an effort to make the service more cost-effective while keeping the same standard of excellence, Wegner says, Providence is working with its two vendors — Pacific Interpreters and Andelex — to make the transition to using the telephone for interpreter services. Both Portland-based companies have sophisticated telephone systems designed to do a high level of interpretation by phone, and both do telephone interpretation in many other areas of the country, she adds.
The new system employs a 900 MHz portable telephone, designed by Sanyo, with a speaker in the handset, Wegner explains. "The handset can be a long distance from the base station and it can be away from the station for several hours at a time."
The clinical staff can take the handset to wherever the patient is being seen, she adds. "It may be a patient treatment room or the emergency department or a physician’s office. Depending on its size, each department may have several phones available for telephone interpretation." Using the phone, rather than having an extra person present, also provides more privacy for the patient, she notes.
"We have the two interpreter vendors programmed in under speed dial," Wegner says. "When they answer, we say, This is Providence. We need a Spanish interpreter.’" The sound quality of the telephone, she adds, makes it seem as though the interpreter is in the room. "The volume can be turned up very loud, and the clarity is excellent. It works just like the AT&T language line, but it’s a lot more cost-effective."
Hospital personnel can use the telephone interpreter, hang up, and then use speed dial when they need to get an interpreter back, she says. The cost is much less, she notes, because the on-site interpreter is not waiting for the next time he or she is needed. The health system pays by the minute only for the time the interpreter is working, Wegner says.
Selling the idea
The project has been under way for a year, she says, and so far some 25 hospital departments and 10 physician or satellite clinics have made the transition to using the telephone for some of their interpreter needs. Wegner says she and two of her managers have spent a significant amount of time educating system personnel about the system. "What we have to do is sell it — [explain] that it works, how it works, and that it will be much more cost-effective for the organization while still maintaining the same standard of excellence. We make a presentation at a department meeting. Some departments are excited and embrace the idea more readily than others."
Wegner or her staff talk to the department director and make an appointment to have an analog line installed in the desired location, she says. The line is dedicated for that telephone. "We know we need to make this easy for the clinical staff to use. We don’t want them to have to disconnect a computer or a fax machine to use the phone. We mark the line interpreter phone only’ so it’s always there, always available."
Wegner’s staff monitor the level of activity for on-site and telephone interpretation, and she provides a monthly report to the director of that department. The individual clinician makes the decision on whether to use on-site or telephone interpretation, she says, but the goal is to reduce the interpreter account by 60%.
"I don’t know if it will ever be possible to do 100% [of the interpretation] over the phone, but a very large portion of the business could be handled that way," she adds. "It is the trend all over the nation to try to employ the use of telephone interpretation because of the high cost to the health care provider for interpreter service."
The areas transitioned so far — those identified as the heaviest users — represent about half of the system’s interpreter business, she says. Meanwhile, to address the cost issue from another direction, Wegner is working with the interpreter vendors on a pilot project aimed at reducing the number of patients who don’t keep their appointments. In some cases, she notes, patients don’t call to cancel because they don’t speak English.
"We have a lot of patients who are no-shows, and we have an on-site interpreter here who we have to pay anyway," Wegner says. As part of the pilot project, she adds, "our interpreter agency will call to reconfirm the appointment with the patient. Many thousands of dollars could be saved simply by verifying the appointment with the patient."
Providence will track the number of times an interpreter vendor is unable to reach the patient, the number of times the patient’s phone number is incorrect or disconnected, and the number of times the patient does not inform the health system that he or she will not keep the appointment, Wegner says.
"The result of this pilot project should be the conclusion that Providence can reduce the cost of interpreters by reducing the number of no-shows," she notes. The health system can do this, she says, "by making it more clear to patients that it is their responsibility to communicate when there is a change in their plan to keep an appointment. We have to change the culture of the organization."
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