Transcript How: Overview - Hablamos Juntos

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
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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:
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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
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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 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 –
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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
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)
Service
$39 (in-person)
WA
FFS
Public entities
Public entities
50% expenses
Admin
WA
FFS
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.
 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 Center
Hemi Kim
213-977-7500 x 215
213-977-7595 Fax
[email protected]
 Asian & Pacific Islander American Health Forum
Alice Chen and Gem Daus
415-954-9988
415-954-9999 Fax
[email protected]
[email protected]
Language Access Advocacy Project
Contact Information
 California Pan-Ethnic Health Network
Ellen Wu and Martin Martinez
510-832-1160
510-832-1175 Fax
[email protected]
[email protected]
 California Primary Care Association
Vivian Huang
916-440-8170 x 238
916-440-8172 Fax
[email protected]
Language Access Advocacy Project
Contact Information
 Fresno Health Consumer Center
Teresa Alvarado and Sengthiene Bosavanh
559-570-1205
559-570-1253 Fax
[email protected]
[email protected]
 Latino Coalition for a Healthy California
Lupe Alonzo-Diaz and Patty Diaz
916-448-3234
916-448-3248 Fax
[email protected]
[email protected]
Language Access Advocacy Project
Contact Information
 National Health Law Program
Doreena Wong
310-204-6010 x3004
310-204-0891 Fax
[email protected]
Supported by The California Endowment