Lobbying for national language access reimbursement for all States.
Why does it matter to have credentialed medical interpreters?
By: Louis F. Provenzano Jr and Eric Candle
According to the U.S. Census Bureau there are approximately 60 million people in the United States today that speak English less than very well. This is a significant portion of the U.S. population and as evidenced in recent elections the demographics of this country are changing rapidly. Furthermore, the U.S. Census predicts that by the year 2045 the minority in the country, the Hispanic population, will become the majority.
In addition to the Hispanic population, there are over 170 languages spoken in the United States and approximately every 23 seconds a legal immigrant enters the country. (This amount is significantly greater when you factor in undocumented immigrants) The demand for interpreters and translators continues to soar particularly in the areas of healthcare, emergency first respondents and the legal interpreting.
Why does it matter to have credentialed medical interpreters?
Having no credentialed medical interpreters or not using certified interpreters has long-term negative consequences for patient safety, quality of care, hospital liability and compliance with laws and regulations.
The costs to the hospital and the errors that can occur by not offering trained and qualified medical interpreters are huge. The landmark case in the industry is the case of Willie Ramirez who was left quadriplegic due to a misdiagnosis. The confusion was centered around the use of the Spanish word “intoxicado” which is not equivalent to the English word “intoxicated”. The hospital was found responsible for this egregious error and ordered to pay Mr. Ramirez and his family $71million.
Tragic as this case may be, studies show that family members, friends, and untrained staff are significantly more likely to make mistakes and to omit valuable information when interpreting than are professional interpreter. Often family members will omit important detail or change the meaning of the translation to protect their family members.
Do Limited English proficient patients require special assistance?
The answer is an astounding yes. Regarding patient safety for all LEP patients, it should be noted that:
Pharmacies in the country must take great care when telling Hispanic patients for example, to take medicine “once” every three hours. “Once” in Spanish is eleven which has already lead to disastrous and terminal consequences. Proper instruction must be given to all patients and if a patient is a LEP than extra caution needs to be taken to ensure that the patient understands the instruction in the native language.
It is the job of a credential medical interpreter to effectively and correctly remove the language and cultural barriers, to ensure that the patient and the medical team fully understand one another, and that a proper diagnosis and care can be given. Only then will a hospital’s goal of achieving patient safety be fully met and their financial liabilities properly mitigated.
Why is it important to remove language and cultural barriers in a medical setting?
Removing language and cultural barriers in the provider-patient communication is the vital responsibility of a credentialed and certified medical interpreter.
Regrettably, according to research done by Wirtlin Worldwide, many of the healthcare providers and hospitals do not provide language assistance citing cost as the primary reason.
In addition to the LEP-patient care continuum quality; there is a paramount legal requirement that involves adhering to Title VI of the Civil Rights Act.
This act, known as Title VI of the Civil Rights Act of 1964, and Executive Order 13166, requires any organization receiving federal funding, including pharmacies that receive Medicare or Medicaid patients, to provide language access. These federal mandates require pharmacies in all 50 states, Puerto Rico and Guam to offer language services to LEP patients. The key to these federal mandates is that pharmacies take reasonable steps to ensure meaningful access to pharmacy services for patients with limited English proficiency.
Title VI violations are investigated and fall under the jurisdiction of the Department of Justice. According to Bruce Adelson, former senior attorney for the DOJ and currently CEO of Compliance Consulting, LLC “Title VI violations can typically result in very large court judgments”. In addition he states “there is also a new development where multi-million dollar lawsuits are being filed by the patient’s relatives against medical providers for interpreting services delivered by ad-hoc interpreters. A recent case involves patients/parents filing – and winning – a seven-figure lawsuit against the surgeon and the hospital for interpreting services provided by the patient’s sister”.
Over the years, states have even passed legislation requiring pharmacies to offer both verbal interpreting and written translation of prescription medication information. Most notable are pharmacy language laws in California and New York.
According to the NYC Language Assistance Services in Pharmacies legislation, oral interpretation for the purposes of counseling shall be offered to all LEP individuals in their primary language. Written translation of labels and information sheets is required for customers who speak one of the top seven foreign languages in New York City. These languages – currently Spanish, Cantonese, Mandarin, Russian, Korean, Italian, French Creole, and Bengali – are spoken by over 80 percent of the LEP population in the City. Pharmacies are also required to post signs alerting consumers that language assistance services are available.
It has been estimated that twenty-two percent of all hospitalizations are a direct result of patient non-adherence to prescription medication directions for use. States pass pharmacy language requirements to increase adherence to prescription instructions. Tragic deaths caused by Hispanic patients taking their medication “once” (11) times instead of (1) time will easily be averted if patients properly understand the medication that they are supposed to take and the frequency with which they must take it to be in adherence with their doctor’s instructions.
What is the importance of a professional certification in modern society?
A profession requires proper training, testing, credentialing, and in many cases, licensing. Imagine going to a hospital and being told your doctor or anesthesiologist are not licensed to practice medicine in your State. Every member of any medical team must comply with strict training, assessment and certification requirements.
Yet, the medical interpreter that can inflict irreparable harm on the patient is not required to be certified. How can this be possible?
Over the past few years there has been great progress in advancing National Certification from two entities (The National Board for Certification of Medical Interpreters – www.certifiedmedicalinterpreters.org, launched in October 2009, and the Certification Commission for Healthcare Interpreters – http://www.healthcareinterpretercertification.org, launched in late 2010 ). However, National Certification is still not a requirement in most States, and there are far too few medical interpreters that have become credentialed to reach a critical mass for a State-level recognition.
Most recently, the State of Oregon passed a bill (SB 1580) stating that medical interpreters in the State working with Coordinated Care Organizations (CCO) must be nationally certified. In addition to that, the State California now requires National Certification for medical interpreters providing language services in some workers compensation hearings.
This is certainly a welcomed leadership position for the industry that will not only increase patient safety but will protect all parties involved in the medical interaction. Undoubtedly, more States will follow these significant milestones in the evolution of medical interpreter services.
Only 14 states in the country provide Medicaid reimbursement for language services. New York State is one of them. Currently under the HCPCS Code T1013 the State reimburses 23 or more minutes of medical language interpreting services at $22.
Although reimbursement exists and is a big step forward to ensure patient safety, New York does not require Medical Interpreter Certification. The legislation currently reads “The interpreter providing language services must demonstrate competency and skills in medical interpretation techniques, ethics and terminology. It is recommended, but not required, that such individuals be recognized by the National Board of Certification for Medical Interpreters (NBCMI)”.
While there is more movement on this issue in other states, the pace is slow. DHHS reminded states in 2000 that they can apply for federal matching funds for language services for Medicaid & CHIP enrollees provided by staff/contract interpreters or through a telephone service. Each health care provider receiving Federal Funds must provide meaningful language access to their key LEP population. While support exists on the Federal level, states do not have to reimburse providers for these expenses. To make things more challenging, each state makes its own determination on interpreter’s reimbursement. (Hence the range of $12 – $190 per medical encounter). Lastly, until the state adds language to their current Medicaid plans, individual providers cannot seek reimbursement prior to the State decision.
What is New York State doing about this challenge?
In 2011 Governor Cuomo signing Executive Order 26, a statewide order which requires all state agencies with direct public contact to translate vital documents into the top six languages spoken by LEP individuals in New York State, provide interpretation services for all New Yorkers in their primary language, develop a language access plan and designate a language access coordinator.
This executive order is the first of its kind in the country while many other states in the union are implementing anti-immigrant measures trying to do the exact opposite. New York was able to show that there are better ways to eliminate language barriers and ensure patient safety for all limited English individuals.
In New York City, former Mayor Michael R. Bloomberg signed the City’s first Language Access Executive Order, establishing a uniform policy and standards for translation and interpretation services for City agencies that have direct interaction with New Yorkers. Executive Order 120 requires every such City agency to provide language assistance in the top six languages spoken by New Yorkers.
But despite this great progress in the State, more work needs to be done to ensure that all hospitals recognize the need for language services and provide certified medical interpreters for all interactions.
Does the success of healthcare reform in the U.S. depend on access to qualified medical interpreters?
The success of healthcare reform in the U.S. depends on access to qualified medical interpreters. Approximately one-third or more of the patients expected to gain access to healthcare under the Affordable Care Act, ACA, are not in the position to communicate with their providers without an interpreter”. In order to ensure that all parties involved in the delivery of healthcare services are properly served, there is a strong case that can be made that if credentialed/certified medical interpreters were used in all encounters, it can be unequivocally proved that (1) 30-day hospital readmission rates will drop substantially, (2) the cost of tests and procedures needed due to inefficient doctor-patient communication will be dramatically reduced, (3) patient safety will be dramatically increased, and (4) provider liabilities will be substantially mitigated.
In order to prove once and for all that this can be accomplished by using credentialed medical interpreters more pilot testing needs to be done. If hospitals in New York State were to conduct a study using credentialed medical interpreters in one sample group vs. those hospitals that used ad-hoc language resources (e.g. bi-lingual individuals, family members, ad-hoc interpreters, etc.) than over a controlled period of time the results evaluating re-admission rates, cost of excessive tests and procedures due to communication challenges can be properly tested and documented. The findings can be analyzed to see what impact credentialed medical interpreters played in meeting these noteworthy goals. It is our strong belief that the results will show exceptional difference in the two study groups.
If the results are significant as we believe they will be, than further studies should be expanded throughout the State to determine the overall positive financial impact to the hospitals in New York. Further extrapolation can be done on a nation-wide basis.
The Professional Interpreter:
Bilingual Person: a person who can render a message spoken in one language into a second language
Interpreter: a bilingual person who renders a message spoken in one language into a second language, and who adheres to a code of professional ethics
Professional Interpreter: an interpreter with appropriate training & experience who interprets with consistency and accuracy and who adheres to a code of professional ethics.
Credentialed/Qualified Interpreter: a professional interpreter who is checked/tested for proficiency in both languages.
Certified Interpreter: an interpreter who has met the prerequisites and successfully passed a national certification exam.
These results will then be presented to Health and Human Services and Medicare officials to make the final case that by allowing for reimbursement for credentialed medical interpreters, overall health care costs in the new Affordable Care Act will be reduced, patient safety will be increased to the highest level in the history of our country for LEP patients and hospitals will have fewer penalties for readmissions due to improper communication with LEP patients.
If further testing and research is needed to prove this theory, then why not start now and get the results needed to ensure that all parties in the healthcare equation for LEP patients are properly served and protected. Using credentialed medical interpreters saves lives and reduces overall healthcare costs. Ultimately, the commitment to credentialed medical interprets across the board, will lead to dramatic improvement of patient safety and quality of care for the LEP population groups. Moreover, a substantial portion of the new entrants to the Affordable Care Act would have the proper care that is needed to avoid costly mistakes and errors due to the language barriers and communication challenges that exist in a rampant form today.
Martin Luther King Jr. once said “’Of all the forms of inequality, injustice in health care is the most shocking and inhumane”.
Credentialed Medical Interpreters are at the forefront of eliminating the remaining vestiges of injustice in the rapidly changing U.S. health care environment.
About the Authors
Louis F. Provenzano Jr.
Louis is the CEO of China Development Partners, S.A., an investment advisory firm based in Paris. He is the immediate past President and CEO of Language Line Services, the world’s largest interpreting firm.
He is the recipient of the prestigious “Raquel Cashman Language Access” award from the International Medical Interpreters Association (IMIA), and the “Friend of CHIA” award from the California Healthcare Interpreting Association (CHIA) in recognition of his efforts to create new solutions to improve healthcare for limited-English speakers.
Louis is the co-founder of the National Board of Certification for Medical Interpreters (certifiedmedicalinterpreters.org). and the founder of the Louis F. Provenzano Foundation for Medical Interpreters (medical-interpreters.org).
Louis received his B.A. from Boston College in Romance Languages and International Business Law. He speaks six languages and lives in Paris and New York.
You can read Louis’ comments on the language industry, legislation and other topics at louisprovenzano.com, his recent language blog at languagetime.org or on Twitter twitter.com/louisprovenzano
Eric is the President of ECdata National Training Institute, a NY-based interpreting and cross-cultural communication training and language access consulting company and is the International Medical Interpreters Association (IMIA) U.S. Coordinator and NY State Chapter Chair.
He is a qualified medical interpreter with 15 years of professional experience at the largest NY State hospitals, a credentialed translator, and a licensed Community Interpreter trainer.
Eric is a lecturer at the State University of New York and has studied and taught in Canada, Germany, Austria, Norway, Ukraine and Russia.
He is a passionate advocate of the meaningful LEP patient’s access to healthcare services and has delivered numerous presentations all over the world on professionalization of Medical Interpreting, National Certification and new modalities in delivering language services.
He holds a MS degree in Computer Translation and Computer Science, and an advanced Certificate “Creating and Leading Strategic Growth”. His college graduation work was executed and presented in English, German and Russian languages.
By John Gonzales | October 8, 2013
As President Obama’s health law pushes through the government shutdown, California officials are looking for ways to leverage funding and make the sprawling effort work in a state with unparalleled demographic challenges.
In the universe of proposals there is a measure, backed by the American Federation of State, County and Municipal Employees, that seeks to unionize medical interpreters and subject them to a stringent test of their skills.
These translators would help nearly seven million limited-English-proficient Californians navigate the larger health system created by the Affordable Care Act.
In a state where pre-teen children of non-English speaking parents sometimes become ad-hoc linguists for everything from doctor’s orders to diagnosis, codifying professional standards for medical interpreters could save lives, experts say.
The proposal, AB1263, has passed the Senate and Assembly and currently sits on Gov. Brown’s desk. It would create a so-called “CommuniCal” program to work with California’s low-income Medi-Cal enrollees, who are projected to increase by about 1.4 million under health reform.
The bill would also allow CommuniCal translators to engage in collective bargaining with the state, as the federal government grants California more than $3 billion to pay for those new Medi-Cal patients.
Admittedly, the AFSCME union is largely interested in expanding its already considerable membership and political influence.
But beyond the power play, California hospitals have grappled with medical translation for decades.
Bill Glasser, owner of Language World Services, a Carmichael, Ca. company that is a leading provider of medical translators in the state, said the industry has found novel ways to comply with the 1964 Civil Rights Act that requires medical translation be available at our hospitals.
To read more of this article courtesy of the California HealthCare Foundation Center for Health Reporting, click on the link below.
October 03, 2013
Recently, GALA asked Louis Provenzano, longtime interpreting advocate and former CEO of Language Line Services, about his new foundation to support interpreter training and certification. We also asked Izabel Arocha, Executive Director of the International Medical Interpreters Association (IMIA), to share some of her insights on this topic. Here is what they had to say:
GALA: What is the mission of the foundation?
Louis Provenzano: The Foundation’s principle mission is to provide funding that is sorely needed for the training expenses as well as the application costs for the tests from The National Board of Certification for Medical Interpreters to get certified as a medical interpreter.
Izabel Arocha: The Louis Provenzano Foundation will be a great resource for those that advocate for safe and accurate communication between providers and patients who do not speak English. Until we have all interpreters nationally certified, we simply cannot ascertain which interpreters are minimally competent to interpret in a health care situation. It is too risky to leave it up to hospitals to assess language and interpreting skills. National certification has been well accepted and hospitals can save money now that they can opt to hire previously trained and qualified nationally certified medical interpreters.
GALA: Why is medical interpreting so important?
LP: Often the difference between life and death is being understood. Just as you rightfully would expect a medical doctor, nurse or an anesthesiologist to be trained and credentialed, it must be no different for medical interpreters. The medical interpreters are the vital link in removing the language barrier between the patient and the medical team. It is critical that medical interpreters be certified and credentialed. Would you go to a surgeon that was not properly trained and credentialed? I am sure not —it is the same for medical interpreters that play such a pivotal role in removing language barriers in the medical field.
GALA: Why do interpreters need assistance in training and certification?
LP: The expenses to get trained and prepared for the National Board test and the test fees itself are an expense for which many medical interpreters need financial assistance. The Louis F. Provenzano foundation aims to help interpreters that need financial assistance so that they have the possibility of being credentialed and certified in a manner that does not cause any financial hardship.
IA: The demand for qualified medical interpreters keeps growing. The Foundation seems to address a major obstacle to national certification. Funding. Fully bilingual individuals who have the language proficiency to be trained and certified as medical interpreters sometimes lack the financial means to do so. Training has shifted from short intensive occupational programs to costlier university educational programs. Training is a pre-requisite to sit for the National Board Exams. After training takes place then cost might become a barrier to take the national certification exam as well. This has delayed the process and states cannot require national certification until we have a large enough number of certified medical interpreters (CMIs) to cover the needs of language minority patients.
GALA: How does the foundation work with the National Board and the IMIA?
LP: My foundation will shortly announce a formal Board of Directors and will shortly finalize the 501(c)(3) status to start the fund raising process. The Foundation will work with various members of the National Board and the IMIA to ensure that there exists a fair and transparent standard for grants to be distributed. As a co-founder of the National Board, my foundation will work closely with the IMIA and the National Board to ensure that this process is a fair and transparent process for grants.
GALA: How can interpreters apply for grants?
LP: Once the criteria for grants have been agreed by IMIA, The National Board, and the Foundation, there will be full details made available for medical interpreters that are interested in getting certified. At that time medical interpreters can visit the websites of the National Board of Certification for Medical Interpreters, IMIA or the Foundation for further information. All three organizations will be making this information readily available for interested parties.
GALA: How are you fundraising and how can others get involved?
LP: We plan to go to the various different hospital foundations such as Kaiser Permanente Foundation and other large charity organizations to seek funds for the Foundation. Additionally, there are many corporations and philanthropic individuals that have already expressed an interest in assisting the Foundation. There are numerous discussions underway with Government Health and Social Services that are interested in playing a key role to support the cause of certified medical interpreters for the United States and ensuring patient safety in all languages.
IA: I am very pleased that all those that advocate for safe language access in healthcare now will be able to support the Foundation by providing funding for this process to take place in a larger scale. Our ultimate goal in the IMIA is to get every medical interpreter certified in the future, to ensure the safety of language minority patients.
The Foundation welcomes all volunteers and those interested in looking to support the cause should contact Maria Schwieter, Interim Chair of the National Board at IMIAChair@certifiedmedicalinterpreters.org for more information.
The healthcare industry is moving toward requiring more “cultural competency” training for doctors, but more needs to be done to ensure accurate communication with patients of limited English proficiency, Reuters Health reports.
Dr. Darcy Thompson, who studies low-income and immigrant families at the University of Colorado Denver, told Reuters Health that medical schools and residency programs are not providing adequate training on the use of professional interpreters.
“I am not surprised that physicians are not using professional interpreters as frequently as they should be,” said Thompson, in reaction to a new study, conducted by the Johns Hopkins University School of Medicine and published in Pediatrics, that measured pediatricians’ use of formal language interpreters.
The study revealed that only 56 percent of pediatricians surveyed in 2010 said they used formal medical interpreters with their patients, while 57 percent relied on patients’ bilingual family members to help translate medical information.
Read more: Study: Medical interpreter use hindered by lack of reimbursement – FiercePracticeManagement http://www.fiercepracticemanagement.com/story/study-medical-interpreter-use-hindered-lack-reimbursement/2013-07-15#ixzz2ZWDC5Vip
To read more of this article courtesy of Fierce Practice Management, click the link below.