Standard 4: Qualified Language Assistance Services (mandate)

Telephone Interpreter Services
Although in-person interpreter services are the preferred approach in patient/clinician encounters involving diagnosis, treatment, and education, telephone interpretation may be necessary in some circumstances—eg, in decentralized facilities (independent physician networks) or those in which a large number of languages may be spoken. Situations where telephone interpretation may be appropriate include:

  • Nonclinical interactions
  • Emergencies where patient outcome may be compromised
  • Use of a rare language

Healthcare organizations should establish:

  • Written policies on when in-person interpretation is needed and when telephone services may be used
  • Standards for evaluating interpreter services
  • Evaluation criteria for the programs that recruit and train phone interpreters

Cost of Interpreter Services
The provision of language assistance services can entail additional expenses, often greater than the reimbursement provided by Medicare or Medicaid for an office visit. The costs of interpreter services may be a concern for both small clinics and large facilities—budgets are often tight, while the need may be great. No general description of reimbursement policies for interpretation services for non-English speaking patients by third-party payers can be made. Federal funding may be available for some Medicaid and other federal healthcare programs (eg, the State Child Health Insurance Program [SCHIP]); appropriate guidelines are available from the Centers for Medicare & Medicaid Services (CMS):

Although reimbursement for interpretation services may not be available, failure to provide such services may bring hidden costs, which could include:

  • Potential malpractice risks arising from inadequate communication
  • Expense of diverting highly paid professionals from clinical activities
  • Postponing surgical procedures when a patient has not clearly understood preoperative instructions
  • Providing emergency department care for patients who have become needier because they could not communicate with staff members in the primary care department

Cost-related concerns that led to agreements between the Office for Civil Rights and some healthcare organizations—resulting from Title VI discrimination complaints filed by LEP individuals—have been a primary motivation for the creation of most model programs of interpreter services across the United States. Although language services can become expensive with increasingly diverse communities, clinical staff who rely on them and are not willing to risk treating patients without them may strongly resist their reduction.





Howard University College of Medicine AIDS Education and Training Center - National Multicultural Center