Despite its mandates, standards, and recommendations, however, the U.S. government has not included provisions for or suggestions about paying for compliance.
Benefits of a Language Access Program
Nevertheless, in addition to complying with governmental regulations and meeting accreditation standards, hospitals can derive benefits from an interpreter program. First and foremost, using interpreters with LEP individuals allows a hospital to fulfill one of its most important professional obligations: providing the best care possible to each patient. The clinician understands the patient’s symptoms, and the patient understands the doctor’s diagnosis and instructions. Together they can form a partnership to meet the physical, psychological, and cultural needs of the patient and to afford a sense of satisfaction to the caregiver.
Secondly, providing linguistic access can make hospital services more cost effective. Visits are fewer and shorter. There are not as many follow-up appointments or repeat admissions because patients understand their physicians’ instructions. Clinicians avoid unnecessary, inadvisable, or inappropriate tests because they understand the patients’ symptoms. Overuse of emergency department services for primary care decreases because patients are comfortable establishing a more conventional primary care relationship. And, as Roat points out, “if a hospital can develop an access program that does not rely on ad-hoc interpreters, the organization can avoid the hidden costs of lower productivity and higher turnover among those ad-hoc interpreters who are asked to interrupt their regular work to provide language access.”
Finally, there are benefits associated with legal and liability issues. Among them: fewer mistakes in diagnoses and treatment because the patients can communicate with their care providers. Also, patients are able to follow directions correctly and understand the need for follow-up or referrals, thus averting an unnecessary tragedy or potential lawsuit. Glenn Flores, MD, director of the Center for the Advancement of Urban Children and professor of pediatrics, epidemiology, and health at the Medical College of Wisconsin, can cite examples of medical errors attributable to language misunderstandings.
“Lack of language services can affect instructions about giving medications, such as the mother who thought she should apply a cortisone cream to the child’s entire body rather than just to the facial rash,” he says. “There is also the problem of possible overdoses. And a single misinterpreted word in one case led to a $71 million lawsuit in Florida a few years ago. This is a major patient safety issue.”
Another safety issue for hospitals is informed consent. Hospitals that provide language services are more likely to ensure that their LEP patients understand and agree to sign the informed consent form.
Paying for Language Access Services
The benefits of offering language access services may be self-evident, but who pays for them? Certainly not private insurers. At least not yet. But, as professionals in the field, both Roat and Dr. Flores see a need for private insurers to assume part of the financial cost. Although Roat believes the costs should be shared among hospitals/clinics, public financing, and commercial insurers, “Advocates of language access need to start a dialogue with commercial insurers and point to HMOs as examples of how these services are being covered,” she says.
Multiple approaches may be necessary to set up coverage from private insurers. Dr. Flores suggests that one possible course is insurance reimbursement for professional interpreters, paid for by the hour or by the visit. Another alternative might involve establishing contract services with outside agencies, community organizations, or video- or teleconferencing companies to recruit, train, and assign medical interpreters for healthcare organizations. These groups could provide services and bill the insurer directly.
“There are also ways to use public funding,” observes Roat, “and there should be more pressure on the federal government to pony up more money for this.”