Language Services as a Risk Reduction Strategy

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Language Services as a Risk

Reduction Strategy––What IT Needs

to Know

Presented by Elizabeth Swan & Eliana Lobo

Sponsored by InDemand Interpreting

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UNDERSTANDING THE COMPLIANCE REQUIREMENTS FOR LANGUAGE ACCESS AND LEGAL RISKS CREATED BY NOT USING QUALIFIED INTERPRETERS

+ OBJECTIVES

Sponsored by InDemand Interpreting

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Eliana LoboMA, BA

Elizabeth Swan RN, BSN, MBA, CPHRM

SPEAKERS

BANNER HEALTH

RN Risk Management Consultant

INDEMAND INTERPRETING

National Director of Interpreter Quality

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UNDERSTANDING THE LEP CHALLENGE, WHERE IT STANDS AND HOW IT WILL GROW

LEP: Limited English Proficiency

+ OBJECTIVES

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Bio

Eliana is a certified Trainer of Medical Interpreterswho studied at CultureSmart in Boston, MA. She recently joined InDemand Interpreting to oversee quality and train the language interpreters. Eliana led interpreter training and quality at Seattle's Harborview Medical Center for 6 years and was the Portuguese Division Chair for the International Medical Interpreters Association. Currently Eliana serves as the Chair of the Trainers Division at I.M.I.A. After completing her master's degree in Bilingual Education at Brown University she received a Fulbright Grant to conduct research in Brazil.

INTRODUCING

Eliana Lobo, MA, BA

INDEMAND INTERPRETING National Director of Interpreter Quality

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1980 2007 20131990 2000

23.1 M

31.8 M

55.4 M

61.6 M

47 M

People Speaking a Language

Other Than English

UNDERSTANDING THE LEP CHALLENGE

GROWTH FROM 1980 - 2013

Source: US Census Bureau

267%

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LEP Patients in the United States

61.6 Million people (1 in 5) Speak a Language Other than English in the Home

25.2 Million Are considered Limited English Proficiency (LEP)

300 Languages Spoken in the United States

W HY LANGUAGE ACCESS IS IMPORTANT

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W HY LANGUAGE ACCESS IS IMPORTANT

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Other common adverse events for LEP include:

• Medication errors

• Longer LOS (length of stay) in hospital as an in-patient for LEP

– Costs more for hospital to provide basic care

• Increased readmission rates

– Negatively impacts reimbursement rates to the hospital for Medicare and Medicaid patients

– Negatively impacts patient’s experience

• Overuse of the Emergency Room as a way to access primary care

– Literally, the most expensive way to treat a bad flu or cough

– Leads to lack of primary care physician for patient

LEP Patients are almost twice as likely to suffer adverse events in U.S. hospitals resulting in temporary harm or death.

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Harborview Medical Center

ABOUT

Licensed beds: >400

Employees: 4,700

Admissions: 18,00Emergency Department Visits:

66,000

Clinic Visits: 246,000

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Harborview Medical Center

Total Number of LEP Encounters

UNDERSTANDING THE LEP CHALLENGE: The Growth is Real

FY05-06

FY10-11

FY12-13

FY06-07

FY07-08

FY08-09

FY11-12

FY09-10

93,92197,854

107,660115,441

117,587121,637

126,596

102,569Jan-June 2014

134,757

FY13-14

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Partner with IT Upfront!UNDERSTANDING THE LEP CHALLENGE

• At Registration, ask patient for their preferred language

• Do NOT ask, “Do you speak English?”

• Ask instead, “What language would you prefer to use when discussing your medical concerns?”

• Make sure the preferred language is a stop field!

• Track your interpreter requests and compare them to the Registration numbers

• Discrepancies often mean inappropriate use of friends and family members

• Discrepancies can point to patients going without language access

• Know the number of requests for your top languages and track daily/monthly

• Facilitate the documentation on the EMR (electronic medical record) so providers can

accurately document the language and the fact that an interpreter was used!

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UNDERSTANDING THE COMPLIANCE REQUIREMENTS FOR LANGUAGE ACCESS AND LEGAL RISKS CREATED BY NOT USING QUALIFIED INTERPRETERS

+ OBJECTIVES

Sponsored by InDemand Interpreting

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Bio

Liz Swan is a RN Risk Management Consultant for Banner Health, a role she has held since 2005. As part of her loss prevention and claims management efforts she serves as the consultant to the Banner System Interpreter Program. She develops policy guidance on the provision of interpretation services and the implementation of Video Remote Interpreting, and supervises the System Interpreter Educator and System Translation coordinator. Still active, Liz Swan served as a Registered Nurse for 25 years, much of it specializing in hospice and home care.

Elizabeth Swan RN, MBA, CPHRM

BANNER HEALTH RN Risk Management Consultant

INTRODUCING

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Banner Health

ABOUT

25 Acute-Care Hospitals and Medical Centers in 7 States

with 39,000 Employees

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A WORD IS WORTH A MILLION DOLLARS

W HY LANGUAGE ACCESS IS IMPORTANT

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“Misinterpretation of a single Spanish word (intoxicado)

led to a $71 million dollar malpractice settlement

associated with a potentially preventable case of

quadriplegia”

Harsham P. A misinterpreted word worth $71 million. Med Econ. June 1984;61:289-292

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LEGAL IMPLICATIONS FOR HEALTHCARE PROVIDERS

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Compliance: Federal Regulations

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TITLE VI OF

THE CIVIL

RIGHTS ACT

OF 1964

"Health care organizations that receive Federal financial assistance have an obligation to help people who are unable to speak, read, write, or understand English well. These patients are called Limited English Proficient (LEP)”.

+ COMPLIANCE: Federal

Regulations

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"Health care organizations that

receive Federal financial assistance have an obligation to help people who

are unable to speak, read, write, or

understand English well…”

Title VI Also SaysCOMPLIANCE: Federal Regulations

42 U.S.C. § 2000d

"National origin" includes individuals with

Limited English Proficiency (LEP)

"No person in the United States shall, on

the ground of race, color, or national

origin, be excluded from participation in,

be denied the benefits of, or be

subjected to discrimination under any

program or activity receiving Federal

financial assistance."

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Provide language services at no cost, at all points of contact, in a timely manner during all hours of operation

Provide verbal and written notices informing patients of their right to receive language services

Assure competence of language services, family & friends should not be used to interpret

Signage and patient-related materials in languages of commonly encountered patients

CLAS StandardsCOMPLIANCE: Federal Regulations

Department of Health and Human Services Office

of Minority Health

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Obama administration is giving more attention to potential

National Origin Discrimination.

CLAS standards were updated

THE IMPACT

OF THE

AFFORDABLE

CARE ACT

COMPLIANCE: Federal

Regulations

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Compliance: Accreditations

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THE JOINT

COMMISSION

RI.01.01.01 –

The hospital prohibits discrimination based on age, race, ethnicity, religion, culture, language, physical or mental disability . . .

+ COMPLIANCE: Accreditations

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prohibits discrimination based on age,

race, ethnicity, religion, culture,

language, physical or mental

disability

The Joint CommissionCOMPLIANCE: Accreditation

RI.01.01.03 – The hospital provides language

interpreting and translation services.

PC.02.01.21 – The hospital identifies the patient’s

oral and written communication needs, including

the patient’s preferred language for discussing

health care.

HR.01.02.01 - The hospital defines staff

qualifications for those who provide interpretation

and translation.

RC.02.01.01 – The medical record contains the

patient’s communication needs, including

preferred language for discussing health care.

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Risk Management

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Clinical Risk of Not

Providing Language

Services

RISK MANAGEMENT

Incorrect diagnosis when the history and

symptoms are conveyed to the clinician

incorrectly

Patient making the wrong decision when

the risks and benefits are misunderstood

Unnecessary return visit to the emergency

department when the patient does not

understand the discharge instructions

Potential HIPAA violation when a family

member is used to interpret

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Potential Issues:

– Decreased access

– Delay in care

– Misdiagnosis

– Lack of informed consent

– More complications

Clinical Risk: Medical MalpracticeRISK MANAGEMENT

Standard of Care: adequate steps to be certain that the

clinician fully understands the patient’s complaints and the

patient understands the clinician’s instructions.

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BANNER HEALTH & LANGUAGE ACCESS

Can Technology Provide Effective Language Access Quickly And Economically?

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• Budget Constraints

• Standardizing Language Services

• Clinical Risks

• Compliance Issues

• Legal Risks

• Accreditations Risks

• Educating Staff to

– Recognize the Safety Issues

– Identify LEP Patients / ASL

Challenges Banner FacedLANGUAGE ACCESS

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Banner’s SolutionLANGUAGE ACCESS

What Choices Did Banner

Make and Why?

• Bilingual Staff

• Bedside Interpreters

• Language Assistants

• Video Remote Interpreting (VRI)

• Over-the-Phone Interpreting (OPI)

• Translation services

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Reduced risk of miscommunication

with patients and family

HOW HAS VRI HELPED?LANGUAGE ACCESS

• Qualified interpreters being used more

frequently through OPI, VRI and trained

staff

• Decreased expenses

• Improved satisfaction among patients,

staff and physicians

• Reduced risk of miscommunication with

patients and family

• Meeting Federal and Joint Commission

requirements

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• Works for ASL & LEP

• Effective Access

• Fast

• Economical

• Secure

Video Remote Interpreting Benefits

LANGUAGE ACCESS

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• Understand the importance of

Language Access for compliance

• Critical that you are engaged early

• Important that IT vet the vendor

The Importance of IT as a PartnerLANGUAGE ACCESS

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Q & A

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Thank You.

LANGUAGE SERVICES AS A RISK REDUCTION STRATEGY––What IT Needs to Know

Sponsored by InDemand Interpreting