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(HealthNewsDigest.com) – The health care reform debate has been dominated by the central questions of how to expand access to insurance and how to rein in medical costs. But beneath these larger concerns, and beyond the disagreement over the public option, are critical details that often receive too little attention. One of these details involves an issue that affects millions of Americans who have limited English proficiency (LEP), and millions more who pay for the inefficiency of a medical system that often fails to communicate with every patient, regardless of their native language.
The detail in question is the issue of reimbursement for trained medical interpreters – the professionals who serve as the vital link between LEP patients and caregivers. Professional interpreters, who provide services in hundreds of different languages, work in hospitals and other health care settings across the country. Some work remotely via telephone, while others work on staff or on contract at medical facilities. Their crucial responsibility is to accurately and securely communicate critical medical information, with the ultimate goal of improving medical outcomes and heightening efficiency by helping physicians avoid costly errors and unnecessary duplicative testing.
Several provisions in the House Tri-committee bill before Congress recognize the importance of language services to the health of patients and the health of the medical delivery system overall. House Bill 3200 provides for a feasibility study related to the development of a Medicare payment system for language services, along with demonstration grants for reimbursement. These provisions represent an important first step toward developing a comprehensive solution to a problem that is redefining our nation at every level: growing linguistic diversity. As the health care reform legislation moves forward, the House provision should be retained and strengthened with the inclusion of language that requires reimbursement be provided specifically to “credentialed” medical interpreters, thus beginning the process of creating a national standard for the certification of interpreters.
Title VI of the Civil Rights Act has long required organizations and agencies that receive federal funding to provide language services. This requirement represents a protection against discrimination based on national origin. Despite this obligation, however, many hospitals and other medical facilities provide language services in name only, often relying on untrained bilingual staff. Many hospitals and caregivers even ask a patient’s family members, including young children, to serve as interpreters, despite the obvious conflicts and potential embarrassment. The reason for the inconsistent use of professional medical interpreters relates to the basic issue of cost. Because Medicare, Medicaid and private insurers have not provided reimbursement for language services, the services themselves have suffered, along with the patients who need them.
Some may consider the issue of reimbursement for medical interpretation to be a sidebar in the health care reform debate — a niche issue with limited impact. Nothing could be further from the truth. Not only is the statistical growth in language diversity staggering, the financial impact of medical errors and misdiagnoses due to communication errors is having a very real and measurable impact on the health care system overall.
Consider the numbers. According to U.S. Census data, over 47 million people in the country speak a language other than English at home, and nearly 24 million are considered LEP. The number of foreign-born individuals in the country has now reached an all-time high of 38.1 million, according to the Census Bureau’s 2007 American Community Survey. Statistics clearly demonstrate that the ethnic and linguistic make up of the United States is changing rapidly. In urban and rural areas, alike, an increasing number of languages are spoken by a growing number of residents. Today, more than 176 languages and various dialects are spoken in the United States. Languages once considered rare in certain parts of the country are now heard more frequently.
Census information also clearly maps the rate and nature of linguistic change. Between 1990 and 2000, for instance, the percentage of Americans not speaking English at home rose from 13.8 percent to 17.8 percent, and the LEP population increased from 6.1 percent to 8.1 percent. In addition, evidence shows that limited English speakers come from all age and income groups.
Given these basic numbers, it is not surprising that the health care system is seeing a rising number patients who speak a language other than English. More LEP patients are visiting our nation’s hospitals for emergency care, outpatient treatment and hospital admissions. More LEP patients are visiting neighborhood clinics, and more are seeking medical tests and procedures. As a result, physicians, nurses and administrative staff find themselves increasingly in the position of having to assess symptoms of patients whose languages they do not understand. They must collect their medical histories and explain treatment options to them.
Because medical interpretation is not consistently available, miscommunication is common and the result is bad news for all of us. Statistics show that language is a major factor in cases of misdiagnosis and instances of poor treatment at hospitals, and delays in service or access to preventive care. Medical error in general is a troubling issue, but patients with limited English proficiency are almost twice as likely to suffer adverse events in U.S. hospitals, resulting in temporary harm or even death, according to a pilot study by The Joint Commission. The bottom line is painful, both in human and financial terms.
The evidence also clearly demonstrates that comprehensive language services are the answer to the communication problem. A study published in Health Affairs, for instance, shows that patients with limited English skills who are provided with interpreters make more outpatient visits, have better outcomes and higher patient satisfaction. The fact is, credentialed interpreters are trained to understand medical terminology, hospital processes, and privacy issues. Like medical equipment operators, whose services are reimbursed, interpreters provide a vital health-related service.
During the course of the public and congressional debate on health reform, there has been a great deal of discussion about improving efficiency, reducing health care costs, and shifting the health care dynamic so that consumers are more involved and more inclined to pursue preventive health behaviors. While the issue of medical interpretation and language services in general may seem to apply only to a select group, the truth is that it represents a concrete and proven path to many of the stated goals of reform.
Ultimately, one of the best arguments for Medicare reimbursement for language services is that the services themselves represent the linguistic equivalent of preventive care. By spending modestly up front to communicate effectively with LEP patients, Medicare — as well as Medicaid and private insurers — can save significantly through the prevention of costly errors. As the health reform legislation moves through the Senate, and on to conference, that is something worth speaking up for.
Louis Provenzano is President and COO of Language Line Services, a leading interpretation company that provides language services to nearly 90 percent of the nation’s 911 emergency first responders, thousands of hospitals and more than 75 percent of the Fortune 500. Mr. Provenzano’s realm of experience also includes previously sitting on the board of the California Healthcare Interpretation Association and fluently speaking numerous languages. For more information on Language Line Services, visit www.languageline.com.
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