Ensuring appropriate healthcare access for every US resident is a monumental undertaking. Due to a great many factors (the nation’s hybrid healthcare model, government regulations, an increasing elderly population, and 36 million limited-English proficient US residents*), healthcare organizations are continuously striving to implement effective and compliant solutions to meet the rapidly changing needs of their growing and diverse patient population.
Healthcare services within the United States are covered through several means, including employer-covered health insurance, non-group health insurance (self-insured), and government-covered (Medicaid and Medicare) insurance. In fact, Medicaid and Medicare combined cover roughly 125 million US residents (38% of the total US population).
*(“Limited-English proficient” includes all persons who have a limited ability to speak, read, write, or understand the English language. 7.6% of the US population comprises the LEP “speaking” population1 and 3.3% of the US population comprises the D/HoH communities2, bringing the total US-LEP population to 10.9%)
Approximately 8.7% of the total LEP population receives Medicare, Medicaid, or both3, and 15% of Medicare beneficiaries are considered deaf or hard of hearing. Medicaid and Medicare represent the largest insurers in the United States and are governed by federal legislation that requires limited-English proficient (LEP) persons to “receive equitable access to care.”4 In particular, Section 1557 of the Patient Protection and Affordable Care Act requires any healthcare facility that receives federal funds to provide free language assistance services for their LEP patients.
The federal government has further implemented a number of initiatives, including the Hospital Readmissions Reduction Program (HRRP) and the Hospital Consumer Assessment of Healthcare Providers Survey (HCAHPS, or H-Caps). HRRP tracks 30-day hospital readmissions for qualified Medicare patients. Depending on the Excess Readmission Ratio (ERR) that hospitals receive, they risk losing up to 3% of reimbursement on their Medicare patient admissions.5 H-Caps, on the other hand, is a patient satisfaction survey. Not only does the federal government provide reimbursement based on each participating hospital’s H-Caps 5-star rating, but these ratings are also publicly accessible, which could either negatively or positively affect each hospital’s reputation. Since the vast majority of healthcare facilities within the United States depend (at least in part) on reimbursements through Medicaid and Medicare, it is within their best interest to adhere to these government mandates.
How Do Healthcare Facilities Remain Compliant?
Ensuring compliance might seem like an overwhelming challenge, but it doesn’t have to be. Healthcare facilities that take the time to develop a comprehensive language access plan will not only enhance the quality of care for their diverse patient population, but will also prepare their staff to meet the needs of their growing multilingual and multicultural communities. One of the initial steps to developing an effective language access plan is collecting patient demographic data. Which languages, for instance, are in high demand, and where are they found within the nation?
High In-Demand Languages
According to the Migration Policy Institute, there are only a few languages in the United States that represent the majority of languages other than English (LOTE) spoken in the home. In fact, the institute claims that speakers of Spanish, Chinese, and Tagalog account for “70% of the overall population of immigrants and US natives using a language other than English in the household.”6
Among these top 10 languages, an average of 40% identify as LEP. The highest LEP population was among Vietnamese speakers (58.9%) and the lowest was among German speakers (14.9%). Although the national LEP average is roughly 9%, as of 2015, seven states reported an even higher share of LEP residents, and four states reported the same share as the national average.
But developing a language access plan requires a lot more than simply knowing which languages are in high demand and where they are located within the United States. Healthcare organizations must also evaluate the 3 predominant interpreting modalities.
Healthcare Interpreting Modalities
It is important for healthcare providers to understand the differences between the three interpreting modalities used in the healthcare setting. While all modalities offer a great many benefits, there are also drawbacks to consider. Learning to implement the right interpreting modality for the right situation will save healthcare providers a lot of time, and therefore, money.
In-Person Interpreting (IPI)
In-person interpreting is often the preferred form of interpreting modality for both patients and healthcare providers. Not only does IPI offer a more interpersonal connection, but interpreters are also able to better read (and therefore, better able to interpret) a patient’s facial expressions and body language. However, with a growing number of rare languages in the United States, it can sometimes be difficult to find qualified in-person interpreters to meet these needs, especially during off-peak hours and in emergency situations when time is of the essence.
Over-The-Phone Interpreting (OPI)
When in-person interpreting isn’t an option, over-the-phone interpreting services can provide almost immediate access to a large pool of experienced interpreters for virtually any language. OPI is generally available around the clock and is an ideal choice for healthcare providers dealing with a large LEP patient population. One limitation to consider, however, is the lack of visibility when it comes to patient-interpreter communication.
Virtual Remote Interpreting (VRI)
Similar to OPI, virtual remote interpreting provides access to hundreds of languages at a moment’s notice. In addition, the interpreter is able to see the patient, further enhancing accuracy of interpretation (especially with regard to facial expressions and body language). However, although VRI is relatively easy to use and is generally cost-effective, healthcare providers must ensure they have a strong internet connection and appropriate video equipment.
Once healthcare facilities have a handle on their patient demographics and feel confident with regard to which interpreting modality (or a combination of all three) in which to invest, it’s time to consider the sea of language services providers (LSPs).
Choose The Best Language Services Provider (LSP)
In order to find the best LSP to meet the needs of its diverse patient population, healthcare facilities should ask the questions that matter most:
- How experienced is the LSP in handling healthcare interpreting?
- Can the LSP meet all compliance requirements?
- How many interpreters does the LSP supply?
- How many languages can the LSP accommodate?
- Which interpreting modalities does the LSP offer?
- Is the LSP able to integrate with your current and future operating systems?
- What technology (if any) does the LSP provide?
Due diligence will allow healthcare providers to sort through numerous LSPs that offer healthcare interpreting services in order to find an LSP best suited for their (and their patients’) needs.
Akorbi’s Multilingual Healthcare Interpreter Staffing
Well-versed in all federal government compliance regulations, Akorbi has implemented rigorous policies to ensure every interpreter meets – if not exceeds – government expectations. Akorbi’s unique business solution expedites the availability of resources onsite and minimizes idle time with billing and setting up fixed costs to the client. In addition to offering in-person interpreting staffing solutions, Akorbi has also developed its own in-house technology, providing both over-the-phone and virtual remote interpreting solutions.
As specialists in the healthcare interpreting space, Akorbi provides a broad base of the most qualified, pre-screened healthcare interpreters in hundreds of languages, and can confidently supply any healthcare facility with experienced, professional interpreters for rare and high, in-demand languages anywhere they are needed throughout the United States. Perhaps Akorbi’s Strategic Business Development Executive, Stacy Harjer, sums it up best:
“We are your strategic partner and trusted language services provider, offering professional interpreting services for rare and top in-demand languages. Akorbi provides high-quality solutions that mitigate risk, ensure organizational compliance, and improve health outcomes for your LEP patient population.”
Give Akorbi a call today.
Created in partnership with GIM Writing Services.
REFERENCE LIST: 1 Zong, Jie, et al. “The Limited English Proficient Population in the United States.” Migrationpolicy.org, 2 Mar. 2017, https://www.migrationpolicy.org/article/limited-english-proficient-population-united-states. 2 Mitchell, Ross E. “How Many Deaf People Are There in the United States? Estimates from the Survey of Income and Program Participation.” Journal of Deaf Studies and Deaf Education, U.S. National Library of Medicine, 2006, https://www.ncbi.nlm.nih.gov/pubmed/16177267. 3 Proctor, Kimberly, et al. “The Limited English Proficient Population: Describing Medicare, Medicaid, and Dual Beneficiaries.” Health Equity, Mary Ann Liebert, Inc., 1 May 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6071899/. 4 Proctor, Kimberly, et al. “The Limited English Proficient Population: Describing Medicare, Medicaid, and Dual Beneficiaries.” Health Equity, Mary Ann Liebert, Inc., 1 May 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6071899/. 5 Boccuti, Cristina, and Giselle Casillas. “Aiming for Fewer Hospital U-Turns: The Medicare Hospital Readmission Reduction Program.” The Henry J. Kaiser Family Foundation, 16 Feb. 2018, https://www.kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-turns-the-medicare-hospital-readmission-reduction-program/. 6 Batalova, Jeanne, et al. “Language Diversity and English Proficiency in the United States.” Migrationpolicy.org, 8 Mar. 2017, https://www.migrationpolicy.org/article/language-diversity-and-english-proficiency-united-states Graph #1: “June 2019 Medicaid & CHIP Enrollment Data Highlights.” Medicaid.gov, https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html. Jacobson, Gretchen, et al. “A Dozen Facts About Medicare Advantage in 2019.” The Henry J. Kaiser Family Foundation, 6 Aug. 2019, https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2019/. Graphs #2 and #3: Batalova, Jeanne, et al. “Language Diversity and English Proficiency in the United States.” Migrationpolicy.org, 8 Mar. 2017, https://www.migrationpolicy.org/article/language-diversity-and-english-proficiency-united-states