Hospital interpretation and payment incentives

By | December 1, 2016

By ( [CC BY 4.0 (], via Wikimedia Commons to interpreters improves health care and is generally required by law. Why then, is interpretation access hard to come by in hospitals?

From a hospital staff perspective, appropriate policies may be in place, and hospital staff motivated to offer excellent patient care, but all the demands of providing medical care can lead to system breakdown.  Like other patient safety issues, when staff members have too many tasks vital to patient care, important items can be missed even with the best intentions.  Leaders in patient quality know this, and they is why they focus on better processes that make it easier for staff to do the right thing.

A recent study in Medical Care describes a scenario where the process for accessing interpretation was eased for one hospital floor. Instead of keeping a limited number of dual-handset interpreter telephones in a nursing station or locked cabinet, interpreter telephones were placed at every bedside, linking individuals with Limited English Proficiency (LEP) to qualified, certified interpreters. Coinciding with the improved process, use of interpreters increased and the readmission rate decreased, with estimated associated spending falling by more than $160,000 per month.

As Alexa Ortiz noted in a post last week, this study adds to existing evidence that better access to professional interpreters helps patient care.  From a hospital perspective, however, implementation may pose some challenges.  Hospitals want to improve patient care and comply with the law.  But interpreter services often are not reimbursed by insurers and other payers. Also, a decrease in hospital revenues due to reduced readmission rates can mean a decrease in hospital profits, especially if the hospital is largely paid per service or discharge.

The landscape of hospital payment is changing, which could provide incentives for hospitals to improve access to interpreter services. Hospitals are increasingly paid for value rather than per service or discharge.  Low readmission rates are a key quality indicator, used by several payers when determining payment rates.  In particular, CMS administers the Medicare Hospital Readmission Reduction Program, which penalizes hospitals for high readmission rates. As part of the Affordable Care Act, the Readmission Reduction Program may be vulnerable to repeal, but health care cost pressures will remain, and will influence some policy makers to continue pursuing value rather than volume in health care.

If the health care system increasingly rewards hospitals for improving quality and stemming health care costs, increased interpreter access could be included as a potential financial path forward.  Payers concerned with rising health care costs might be rewarded for taking a second look at reimbursing interpreter and other language services, as a way to improve quality and avoid costly hospital readmissions.

A note of caution is warranted here. Telephonic interpretation varies in quality and is not always the best option.  Face-to-face interpretation is probably better.  But despite these caveats, this study shows that a process improvement like bedside headsets can lead to better interpreter access and improved quality.

Next week we speak on law and order and how fighting a DUI in Utah and fighting a DUI in Florida can be a vastly different process.

Rachel Gershon

Rachel Gershon

Rachel Gershon JD MPH is a health policy attorney at the Center for Health Law and Economics at UMass Medical School. Her work focuses on the Affordable Care Act, health care affordability, and language access. Previously, Ms. Gershon advised and represented individuals who receive public benefits, including through Medicaid and Social Security. Ms. Gershon holds a law degree and a master's degree in public health from Harvard University, and a bachelor's degree in psychology from Whitworth University. Disclaimer: The views expressed are those of the author and do not necessarily reflect those of UMass Medical School.
Rachel Gershon
Rachel Gershon

Latest posts by Rachel Gershon (see all)