Interpreting: On-Site or Remote? A User Perspective

As we participate in the discussion about the value of different modes of delivery for interpreting services, the Interpreters Division (ID) is approaching stakeholders for their input regarding how they work with interpreters. Helen Eby, the ID Administrator, spoke with Stick Crosby, the Network and Health Equity Manager of All Care Health. Mr. Crosby is a member of the Oregon Council on Health Care Interpreters and sits on the Education and Training Committee.

We started with a simple question:

How do you engage with Certified and Qualified health care interpreters in Oregon?

Mr. Stick Crosby’s answer, for AllCare Health, involved discussing how his organization works with interpreters and more importantly, why.

HE: What is All Care?

SC: AllCare Health is a physician-led organization focused on improving healthcare for the people of Southern Oregon. We are headquartered in Grants Pass, Oregon and have been offering a wide range of quality health plans and services designed to meet the needs of our region’s diverse communities, while controlling costs for both patients and taxpayers since 1994. With the foundational ideas of Care, Coverage, and Compassion, we’re changing healthcare so it works for everyone.

HE: How do you integrate language access services in your work? I think we will see what that has to do with Care, Coverage, and Compassion as we go along.

SC: AllCare Health has truly adopted the motto “Changing healthcare to work for you” in all of our services. One of the ways we are addressing this is through Language Access Services provided in Southern Oregon. In 2015, AllCare partnered with So Health-E, a Regional Health Equity Coalition in Southern Oregon, to hold listening sessions with the local Latino community. The Limited English Speakers in attendance overwhelmingly stated that their number one priority was having access to trained, on-site medical interpreters.

HE: So you are saying that local potential patients wanted qualified on-site interpreters as a top priority? In a rural community it could be difficult. Why make the effort?

SC: Yes. Because this need for on-site medical interpreters is further supported by research comparing on-site interpretation versus telephonic or video interpretation. Telephonic and patient-supplied interpreters were associated with longer visit times, but full-time hospital interpreters were not (Fagan M, Diaz J, Reinert S, Sciamanna C.[1]). Additional studies report the positive benefits of professional interpreters on communication (errors and comprehension), utilization, clinical outcomes, and satisfaction with care (Karliner L, Jacobs E, Mutha S.[2]).

HE: So on-site interpreters not only improved patient satisfaction, but research shows they have better clinical outcomes! Where else does this matter?

SC: AllCare Health has an internal Health Equity and Inclusivity Action team that develops yearly strategic plans around Health Equity. Health equity is defined as: all people and communities having the opportunity to attain their full potential and highest level of health. This team looks at health care disparities and develops community engagement strategies through Multicultural Health Listening Sessions.

Multicultural communities often convey health information and knowledge qualitatively – through sharing stories – while professionals tend to rely more upon quantitative methods – such as data collection – to gather information. Storytelling and other qualitative methods can help professionals understand and determine the meaning behind the numbers, which is key to effective policy and program development. In addition, sharing a personal story can provide the added benefit of empowering the storyteller and, if applicable, help with his/her healing process. This is especially true when the story is heard by those in leadership positions who can influence positive changes that address elements shared within the story. (view https://www.youtube.com/watch?v=2lR_HVIjagE&feature=youtu.be). When AllCare holds listening sessions with limited English proficiency speakers, phone interpretation consistently receives poor ratings.

HE: We hear a lot about health equity, but you seem to take it seriously. Thanks for sharing your research and how you put it into practice. Have you been able to use on-site interpreters exclusively?

SC: To date, AllCare Health has not found a phone interpretation service that can sufficiently meet the Oregon Administrative Rule 333-002-0040 Eligibility Standards for Registry Enrollment, Certification and Qualification. The primary barrier being that the service cannot demonstrate certification of at least 60 hours of formal training as defined in OAR 333-002-0060.

HE: We found the list of requirements to be an Oregon Health Care Certified or Qualified interpreter. The national certification boards require 40 hours for certification. Oregon requires 20 more, and based on our research all interpreter certification bodies require at least 20 hours of CE credits for certification renewal.

Local potential patients wanted qualified on-site interpreters as a top priority

HE: How does All Care pay for these services?

SC: To support the use of on-site interpretation, AllCare Health has created financial incentives for providers who use on-site interpretation during medical visits. By creating financial incentives, AllCare is in alignment with the American Medical Association Commission to end health care disparities (Regenstein M, Andres E, Wynia MK[3]). As the access and utilization increases for these services, AllCare will be tracking health outcomes of these individuals receiving on-site interpretation versus those receiving telephonic interpretation.

HE: Thanks for letting us know that the AMA had a white paper about healthcare disparities! You are right, language access can be provided by interpreters and by service providers with sufficient level of language proficiency. We look forward to seeing the results of your comparison of health outcomes based on interpreting mode of delivery.

We know you have been training interpreters in Southern Oregon. You have been sending out fliers for people to attend your trainings. Not many medical providers do this. Why are you doing it?

SC: The development and support of the on-site medical interpreter workforce also creates a more diverse table of stakeholders moving toward achievement of the Triple Aim in Oregon:

• Improving the patient experience of care (including quality and satisfaction);
• Improving the health of populations; and
• Reducing the per capita cost of health care.

On-site interpreters are valuable advocates for the Limited English Proficient Community that can be made available for interactions within the facility and throughout the continuum of care.

The highest need for medical interpreters exists for specialty providers, where oftentimes the least amount of provider education is provided for medical interpreting. For example, using telephonic interpretation services during a physical therapy manipulation could be inconvenient to the patient and the  provider, as well as disrupting the treatment. An on-site interpreter would greatly assist in ease of communication during such procedures.

With Section 1557 of the Affordable Care Act, covered entities are prohibited from relying on unqualified staff or translators and from using low-quality video remote interpreting services when providing language assistance services. The covered entity (Federally or State funded health care programs, i.e. Medicare, Medicaid) is responsible for financial reimbursement for these services. This assists the provider with the financial barriers associated to interpretation. It has never been easier for providers wanting to provide high quality patient care and satisfaction for Limited English Speakers.

HE: Congratulations! It is good to see an organization that takes the federal Title VI and ACA Section 1557 mandates and applies them because they benefit the patients… and does whatever it takes to make it happen. You listened to your patients, implemented their requests, train interpreters, and did the research to know what would be most effective. You truly demonstrate Care, Coverage, and Compassion for your community.  Thank you Mr. Crosby!

References

1. Fagan M, Diaz J, Reinert S, Sciamanna C. Impact of interpretation method on clinic visit length. J Gen Intern Med. 2003;18:634–8. doi: 10.1046/j.1525-1497.2003.20701.x.
2. Karliner L, Jacobs E, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. HSR: Health Serv Res. 2007;42(2):727–54. doi: 10.1111/j.1475-6773.2006.00629.x.
3. Regenstein M, Andres E, Wynia MK, for the Commission to End Health Care Disparities. Promoting appropriate use of physicians’ non-English language skills in clinical care: A white paper of the Commission to End Health Care Disparities with recommendations for policymakers, organizations and clinicians. American Medical Association, Chicago IL 2013.

More on the topic of remote interpreting

California Courts News Release. Report: Video Remote Interpreting Effective for Court Users with Limited English Skills. Accessed March 18, 2019.

Executive Committee. “AIIC Position on Distance Interpreting“. aiic.net March 7, 2018. Accessed March 18, 2019.

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