Promising Practices in Healthcare Language Access Advocacy Project

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 California. Kids 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 Health. Care 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 lowincome 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 State Enrollees Covered Providers Covered Who the State Pays Reimbursement Rate Admin or Service HI FFS Lang. agencies $36/hr Service ID FFS Providers $7/hr Service MA All Hospitals Varies Admin ME FFS Providers $30 -$40/hr* Service MN FFS Providers $50/hr** Admin MT All Medicaid All Interpreters $6. 25/15 minutes Admin NH FFS Interpreters $15/hr Admin UT FFS Lang. agencies $22 (phone) Service $39 (in-person) WA FFS Public entities 50% expenses Admin WA FFS Brokers $28/hr Admin * $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 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. § NHe. LP’s publication “Providing Language Interpretation Services in Health Care Settings: Examples from the Field” at www. cmwf. org. § NHe. LP 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 Center Hemi Kim 213 -977 -7500 x 215 213 -977 -7595 Fax hkim@apalc. org § Asian & Pacific Islander American Health Forum Alice Chen and Gem Daus 415 -954 -9988 415 -954 -9999 Fax achen@apiahf. org gdaus@apiahf. org

Language Access Advocacy Project Contact Information § California Pan-Ethnic Health Network Ellen Wu and Martinez 510 -832 -1160 510 -832 -1175 Fax ewu@cpehn. org mmartinez@cpehn. org § California Primary Care Association Vivian Huang 916 -440 -8170 x 238 916 -440 -8172 Fax Vhuang@cpca. org

Language Access Advocacy Project Contact Information § Fresno Health Consumer Center Teresa Alvarado and Sengthiene Bosavanh 559 -570 -1205 559 -570 -1253 Fax talvarado@centralcallegal. org seng@centralcallegal. org § Latino Coalition for a Healthy California Lupe Alonzo-Diaz and Patty Diaz 916 -448 -3234 916 -448 -3248 Fax Lupe@lchc. org Pdiaz@lchc. org

Language Access Advocacy Project Contact Information § National Health Law Program Doreena Wong 310 -204 -6010 x 3004 310 -204 -0891 Fax wong@healthlaw. org Supported by The California Endowment