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Promising Practices in Healthcare
Language Access Advocacy Project California 2004
Promising Practices in Health Care Purpose of Presentation: To provide highlights of
existing promising practices in the provision and financing of language services in health care
Overview of Presentation Policies and Procedures Needs Assessment Delivery System Training and Competency Workforce Monitoring and Evaluation Use of Technology Financing and Reimbursement Ongoing Challenges
Policies and Procedures
Promising policies and procedures include elements that: Publicize patient rights and availability of
services Identify and assess language needs Assure proper documentation Provide timely telephone communication Ensure systematic data collection
Promising Policies and Procedures:Sequoia Community Health Foundation
Community clinic serving primarily farmworkers in southern Fresno County
Has a written policy on access to interpretation services
Includes specific procedures on how to access language line services
Incorporates written instructions in the personnel policies manual
Includes training for staff on policy and procedures in orientation process
Needs Assessments
Promising needs assessments include: An assessment of community language needs An internal assessment of institutional needs
Promising Needs Assessment: La Clínica de la Raza
Community clinic serving primarily Latino patients in East Oakland
La Clínica de la Raza conducted a Cultural Competence Assessment Survey Assessed staff views regarding cultural competency Was included as a component of the organization’s
quality assurance oversight plan Yielded results that illustrate a strong recognition
among staff of the importance of culture Identified needs
Materials and signs in different languages & cultures Training and information about non-Latino cultures
Promising Needs Assessment: L.A. Care
Health maintenance organization serving Medi-Cal, Healthy Families, and CaliforniaKids enrollees in Los Angeles County
As part of its assessment, LA Care conducted a survey of providers to identify needs and challenges 92% felt language and cultural issues are important in
delivering health care Over three-quarters would use translated materials or
interpreters if made available to them 50% would like training on how to use interpreters 49% would like staff trained as professional interpreters
Delivery Systems
Promising delivery systems include components such as: Coordinator and administrative structure Scheduling and tracking system Models of oral language assistance Guidelines for translation of written materials
Promising Delivery System: Asian Pacific Health Care Venture Community clinic serving Asians & Pacific
Islanders in Los Angeles
Components of its delivery system include: Bilingual staff hiring flow chart
Job descriptions for bilingual staff Hiring criteria Application process Oral interpretation test Written translation test
Translations of vital documents Trainings for Staff Patient satisfaction surveys
Promising Delivery System: Asian Pacific Health Care Venture
Source: “A Functional Manual for Providing Linguistically Competent Health Care Services as Developed by a Community Health Center”
Promising Delivery System: Golden Valley Health Center
Community clinic serving Latino and Southeast Asian communities in Merced
Cultural Mediators Provide language interpretation for Latino, Hmong and
Lao patients Receive 40 hours of training and tests for proficiency Serve as part of the clinical team to transmit cultural
understandings and beliefs between clinicians and patients
Cultural Competence Training Culture Clinic for residents Training to work effectively with interpreters
Promising Delivery System: Alameda Alliance for Health
Nonprofit health plan serving Alameda County
Makes arrangements and coordinates interpreter services
Pays interpreters directly at both the plan and provider levels
Identifies qualified interpreter services
Training and Competency
Key elements of promising training and competency activities include: Interpreter training Staff/provider training Competency assessment
Core skills Core knowledge Code of ethics
Promising Training and Competency: Asian Health Services
Community clinic primarily serving Asians & Pacific Islanders in Oakland
Interpretation and Translation Services Conducted in multiple languages: Cambodian, Cantonese, Farsi, Korean,
Mandarin, Spanish, Vietnamese Translation by a primary translator, Editing by a second translator,
Formatting of document, Proofreading, & Cultural adaptations of health materials
Health Care Interpreting Training 40 hour, 5 week training Covers interpreter skills, roles, and ethics
Cross-Cultural Health Care Training Training for health care staff on serving multicultural patients
Promising Training and Competency: Family HealthCare Network
Community clinic serving low-income, underserved individuals in Tulare County
Efforts to promote training and competency include:
Establishing a strong commitment to hiring bilingual staff from the community
Evaluating language proficiency Utilize standardized oral and written tests Bilingual staff shadow bilingual physicians initially to
ensure accurate language proficiency
Promising Training and Competency: SSG/PALS for Health Program
Community based language access program serving Los Angeles and Orange County.
PALS for Health conducts language proficiency assessment in 10 languages
48-hour Health Care Interpreting Training Language proficiency test is a prerequisite to enrollment Skills and knowledge building, standards, role plays, language
labs, medical terminology, continuing education and interpreter support.
Patient Education Informing LEP patients about language rights Distribution of “I Speak” cards
Workforce
Components of a promising language services program include: Workforce Recruitment Workforce Retention
Promising Workforce Program: CA Physician Corps Loan Repayment Provides loan repayment scholarships for physicians
who practice in underserved areas
Operated by the CA Office of Statewide Health Planning & Development
Focused on primary care physicians
Priority consideration given to those who: Come from an economically disadvantaged background Have significant training in cultural/linguistic issues Speak a Medi-Cal threshold language
Companion program for dentists to be implemented.
Monitoring and Evaluation
Key elements of monitoring and evaluation include: Patient satisfaction Process variables Outcome and quality measures
Promising Monitoring and Evaluation: Venice Family Clinic
Free clinic serving primarily Latino and low-income patients in Los Angeles
As part of its monitoring and evaluation efforts, Venice Family Clinic designed a quarterly patient satisfaction survey to obtain input from patients Assists the clinic in monitoring quality of care provided
to patients. Includes questions regarding cultural and linguistic
services
Promising Monitoring and Evaluation: National Health Services
Community clinic serving low-income and farmworker patients in Kern County
As part of its monitoring and evaluation activities, National Health Services has created a Language Barrier Log Records Patient’s Name, Arrival Time, Time Seen,
Native Language Reviewed as part of the quality assessment program Patients should not wait more than 15 minutes for an
interpreter or bilingual staff member
Use of Technology
Pilot projects are currently exploring and testing the use of new technologies: Remote simultaneous translation Videoconferencing
Promising Use of Technology: Gouverneur Hospital
Public hospital primarily serving Chinese and Latino immigrants in New York City
Implemented a remote simultaneous medical interpretation pilot Use trained medical interpreters who interpret for
providers and patients through wireless headsets Interpreter listens to what is said by one party and
transmits an interpretation to the other Provider and patient only hear their own languages
Promising Use of Technology: Alameda County Medical Center A system of public health care in Alameda County
with 3 hospitals and 4 clinics
Alameda County Medical Center is currently piloting a videoconferencing medical interpretation system
Provider and patient talk to one another in the exam room while an interpreter in another location interprets via videoconference
Medicaid/SCHIP Financing and Reimbursement
August 30, 2000 CMS Letter discusses how states can draw down federal matching funds for language assistance in Medicaid/SCHIP
Only 10 states have established direct reimbursement using federal matching funds to pay for language services
Four models of reimbursement – contract with language service agencies reimburse providers for hiring interpreters certify interpreters as Medicaid providers provide access to language line
Model 1 – Language Service Agencies
Hawaii, Washington, and Utah contract with interpreter organizations. Providers schedule interpreters who then bill the state.
Washington offers testing and certification of its interpreters. For seven prominent languages, the state administers a certification test, and for other languages, the state has a process for qualifying interpreters.
Model 2 – Provider Reimbursement Maine and Minnesota require providers to pay for
interpreters and then reimburse providers
Providers have discretion on who to hire
In Maine, interpreters must sign code of ethics; cannot use family members/friends
Considerations state oversight quality of interpreters provider concerns
Model 3 – Payments to Interpreters
New Hampshire requires interpreters to become Medicaid providers
Interpreters submit bills directly to the state
Considerations requirements of becoming a provider low reimbursement rates
Model 4 – Language Line
As of October 10, 2003, Kansas started paying for a telephonic language line which managed care providers can access for Medicaid/SCHIP patients
The language line is coordinated through the state’s fiscal agent (EDS) and providers receive a code for access
Estimated budget – $275,000 for first year
Current State Financing
* $30 for business hours; $40 non-business hours
** Or usual and customary fee, whichever is less.
FFS: Fee-for-service Medicaid enrollees
All: both managed care and fee-for-service Medicaid enrollees
State Enrollees Covered
Providers Covered
Who the State Pays Reimbursement Rate
Admin or Service
HI FFS FFS Lang. agencies $36/hr Service
ID FFS FFS Providers $7/hr Service
MA All Hospitals Hospitals Varies Admin
ME FFS FFS Providers $30-$40/hr* Service
MN FFS FFS Providers $50/hr** Admin
MT All Medicaid All Interpreters $6.25/15 minutes Admin
NH FFS FFS Interpreters $15/hr Admin
UT FFS FFS Lang. agencies $22 (phone)
$39 (in-person)
Service
WA FFS Public entities Public entities 50% expenses Admin
WA FFS FFS Brokers $28/hr Admin
Source: “Language Services Action Kit: Interpreter Services in Health Care Settings for People with Limited English Proficiency”
Ongoing Challenges in Health Care
Financial Reimbursement Medi-Cal and Healthy Families patients Uninsured patients
Changing Demographics Diversity of languages Indigenous languages
Workforce - Bilingual Providers and Interpreters Recruitment Retention
Lack of technical assistance resources and tools to assist in changing operations
Ongoing Challenges in Health Care
Trainings for interpreters, providers, and support staff Cost of training Opportunity cost of time away from clinic
Access to technology for remote interpretation Rural areas may lack adequate telecommunications
infrastructure
Confidentiality Especially for rare languages spoken by small
communities
Resources CPCA’s publication, “Providing Health Care to Limited
English Proficient Patients: A Manual of Promising Practices” at www.cpca.org.
AAPCHO’s publication, “A Functional Manual for Providing Linguistically Competent Health Care Services as Developed by a Community Health Center” at www.aapcho.org.
NHeLP’s publication “Providing Language Interpretation Services in Health Care Settings: Examples from the Field” at www.cmwf.org.
NHeLP and Access Project publication “Language Services Action Kit: Interpreter Services in Health Care Settings for People with Limited English Proficiency” at www.nhelp.org.
Questions?
Language Access Advocacy Project Contact Information
Asian Pacific American Legal CenterHemi Kim213-977-7500 x 215213-977-7595 [email protected]
Asian & Pacific Islander American Health Forum Alice Chen and Gem Daus415-954-9988 415-954-9999 [email protected] [email protected]
Language Access Advocacy Project Contact Information
California Pan-Ethnic Health NetworkEllen Wu and Martin Martinez510-832-1160510-832-1175 [email protected]@cpehn.org
California Primary Care AssociationVivian Huang916-440-8170 x 238916-440-8172 [email protected]
Language Access Advocacy Project Contact Information
Fresno Health Consumer CenterTeresa Alvarado and Sengthiene Bosavanh559-570-1205559-570-1253 [email protected]@centralcallegal.org
Latino Coalition for a Healthy California Lupe Alonzo-Diaz and Patty Diaz916-448-3234916-448-3248 [email protected]@lchc.org
Language Access Advocacy Project Contact Information
National Health Law ProgramDoreena Wong
310-204-6010 x3004
310-204-0891 Fax
Supported by The California Endowment
