Language access: Meeting patient needs while increasing compliance and improving outcomes
By Chris Richardson
One in five people in the United States speak a language other than English at home, and 41% of these individuals, or 25.1 million people, are considered limited English proficient (LEP). The growing LEP population across the nation is creating an increased demand for language access, and this demand is no more prevalent than within healthcare. As we grapple with how to accommodate the needs of LEP patients, as well as patients who are deaf or hard of hearing, it’s important to consider why prioritizing patient language access is so important and how to do this consistently across a healthcare facility or health system.
Patient safety as priority
It’s not uncommon for healthcare providers to use any interpreter who is available—even if that means a family member or another staff member who speaks a patient’s language. However, in addition to an increased liability for the healthcare organization and a potential HIPAA violation, this can also create a challenge in accurately communicating all information to patients. As providers, it is important to ensure that patients can understand their clinicians and have a complete picture of their health challenges, medication needs, and discharge instructions.
A study published in Medical Care, titled “Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Limited English Proficient (LEP) Patients,” discovered that providing easy access to interpreters in acute care hospitals was associated with decreased 30-day readmission rates for patients with a language barrier. This improvement was lost once interpreters were less accessible. Providing clinicians with immediate access to qualified interpreters, at any time, was a key component to the success of the intervention and improved care quality for LEP patients.
The above results are consistent with a Journal of General Internal Medicine study conducted in 2012, “Professional Language Interpretation and Inpatient Length of Stay and Readmission Rates,” that demonstrated a decrease in readmission rates associated with using qualified interpreters at admission and/or discharge. This study was the first to demonstrate that increased systemwide access to interpreters throughout the hospital stay can decrease readmission rates and lower hospital expenses.
It’s the law
Healthcare organizations are legally required to provide access in a patient’s preferred language. If your organization receives Medicare, Medicaid, or other reimbursement from federal health programs, you have a legal obligation to provide language access services to LEP, deaf, or hard-of-hearing patients. Healthcare organizations that receive federal funds are obligated to provide oral interpreters and written translations of documents.
In fact, failing to provide language access services to LEP patients is a form of national origin discrimination. There is case law going all the way up to the United States Supreme Court (Lau v. Nichols, 1974) that establishes this basic principle. Section 1557 of the Affordable Care Act (ACA) requires covered entities to take reasonable steps to provide meaningful access to “each individual with limited English proficiency eligible to be served or likely to be encountered.”
Federal law, state law in all 50 states, and multiple judicial decisions refer to the need for healthcare organizations to provide language access services. Additionally, the major language access provisions of Section 1557 of the ACA require the use of qualified interpreters and significantly restrict the use of untrained family members and friends, minor children, and untrained bilingual staff as medical interpreters.
What is the solution?
It is nearly impossible to have an on-site interpreter, or even a staff interpreter, available for every single language request. Therefore, it’s important to round out a language access program with several modalities across the continuum of care to bridge the language gap between clinicians and their LEP, deaf, and hard-of-hearing patients.
These modalities can include a mix of on-site interpreters, assessed and trained bilingual staff, over-the-phone interpreters, and the addition of written translation services. Combined with the immediacy of video remote interpreting (VRI), this mix provides an effective balance of language options to serve the needs of patients and providers. The use of VRI can improve the staff’s ability to immediately reach a medically qualified interpreter at any time while remaining compliant with federal and state regulations. This can also prevent care from being disrupted due to canceled or delayed appointments.
A comprehensive language service mix can improve satisfaction among patients, families, staff, and physicians while reducing the risk of miscommunication and complying with federal and Joint Commission requirements. With this in mind, an effective language access program can create continuity of care, increase efficiency, and improve patient and provider communication—and, ultimately, patient outcomes.
Chris Richardson is the CEO at AxessPointe Community Health Centers, Inc., a federally qualified health center (FQHC) serving more than 18,500 patients in 2017 throughout Summit and Portage counties in Northeast Ohio.