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1
Language Services as a Risk
Reduction Strategy––What IT Needs
to Know
Presented by Elizabeth Swan & Eliana Lobo
Sponsored by InDemand Interpreting
2
UNDERSTANDING THE COMPLIANCE REQUIREMENTS FOR LANGUAGE ACCESS AND LEGAL RISKS CREATED BY NOT USING QUALIFIED INTERPRETERS
+ OBJECTIVES
Sponsored by InDemand Interpreting
3
Eliana LoboMA, BA
Elizabeth Swan RN, BSN, MBA, CPHRM
SPEAKERS
BANNER HEALTH
RN Risk Management Consultant
INDEMAND INTERPRETING
National Director of Interpreter Quality
4
UNDERSTANDING THE LEP CHALLENGE, WHERE IT STANDS AND HOW IT WILL GROW
LEP: Limited English Proficiency
+ OBJECTIVES
Sponsored by InDemand Interpreting
5
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
6
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%
7
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
Sponsored by InDemand Interpreting
8
W HY LANGUAGE ACCESS IS IMPORTANT
Sponsored by InDemand Interpreting
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.
9
Harborview Medical Center
ABOUT
Licensed beds: >400
Employees: 4,700
Admissions: 18,00Emergency Department Visits:
66,000
Clinic Visits: 246,000
10
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
11
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!
Sponsored by InDemand Interpreting
12
UNDERSTANDING THE COMPLIANCE REQUIREMENTS FOR LANGUAGE ACCESS AND LEGAL RISKS CREATED BY NOT USING QUALIFIED INTERPRETERS
+ OBJECTIVES
Sponsored by InDemand Interpreting
13
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
14
Banner Health
ABOUT
25 Acute-Care Hospitals and Medical Centers in 7 States
with 39,000 Employees
16
A WORD IS WORTH A MILLION DOLLARS
W HY LANGUAGE ACCESS IS IMPORTANT
Sponsored by InDemand Interpreting
“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
19
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
20
"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."
21
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
Sponsored by InDemand Interpreting
22
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
24
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
25
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.
27
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
28
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.
Sponsored by InDemand Interpreting
29
BANNER HEALTH & LANGUAGE ACCESS
Can Technology Provide Effective Language Access Quickly And Economically?
Sponsored by InDemand Interpreting
30
• 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
31
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
32
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
33
• Works for ASL & LEP
• Effective Access
• Fast
• Economical
• Secure
Video Remote Interpreting Benefits
LANGUAGE ACCESS
34
• 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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