Phone Interpreting for Hospitals (per ACA’s Section 1557)

Countries such as the United States with a significant immigrant population need to provide language services to different groups of people such as phone interpreting for hospitals and translation of information in healthcare facilities.

Modes of interpretation in healthcare

In healthcare, three modes of interpretations are commonly utilized. These are onsite interpreting, VRI or video remote interpreting and OPI or over-the-phone interpreting. Each one fills a different need in the provision of language services.

• Onsite interpreting. For delicate and sensitive discussions such as an end of life conversations, new diagnoses, informed consent and mental health, the appropriate choice is onsite interpreting. This mode of interpreting is also provided if the patient requests for it.
• Over-the-phone interpreting or OPI. In cases where many more languages are needed, including languages that are not commonly spoken, over-the-phone interpreting is vital. In OPI, the selection of languages is more extensive and often not provided in IVR and in person interpreter services. OPI is more common in situations that do not require visual cues such as follow up calls and appointment settings.
• Video remote interpreting or VRI. It is applicable in situations where visual cues are critical to the discussion and an interpreter is needed quickly.

In the healthcare industry particularly in the United States where a language access program is required, it is possible to combine the three types of phone interpreting for hospitals and other facilities that serve multilingual communities.

Patient Protection and Affordable Care Act – Section 1557

Before discussing the benefits of phone interpreting for hospitals and other healthcare facilities, it is vital to understand Section 1557 of the Patient Protection and Affordable Care Act. The first thing to know is that the language access program, such as accurate interpreting services, should be provided free of charge by the healthcare facility.

The Affordable Care Act or ACA has a nondiscrimination provision, which is called Section 1557. The section provides that intentional and unintentional discrimination be prohibited based on sex, age, color, race, national origin or disability in some health activities and programs.

Section 1557 extends the protection against discrimination from other laws on civil rights granted by the Federal government, such as Age Discrimination Act (1975), Title IX of the Education Amendments (1972), Title VI of the Civil Rights Act (1964) and Section 504 of the Rehabilitation Act (1973).

Section 1557 protects individuals participating in the following:

• Any healthcare activity or program that receives funding from the Health and Human Services (HHS) department of the United States, including hospitals, community health centers, nursing homes, physicians’ practices and health clinics.
• Any healthcare activity or programs administered by the HHS such as Medicaid, Medicare, tax-subsidies, credits and grants
• Health insurance marketplaces and the plans offered by insurers participating in the insurance marketplaces
• Section 1557 was enacted in 2010 and has been in implemented since then. It also protects against retaliation to persons or patients reporting discrimination.

Beginning October 16, 2016, the government required hospitals and other facilities providing healthcare to comply with Section 1557 under the conditions stated above strictly.

The ruling requires the provision of health care interpretation for patients with limited English proficiency (LEP). There have been many instances where culturally diverse patients and LEPs experience adverse issues when receiving healthcare. Many of these events include errors in the emergency department because the patient or relatives are not proficient in English and cannot describe the patient’s condition accurately. They may suffer errors in medication reconciliation, lack of understanding in the instructions for patient discharge, miscommunication about surgical procedures and uninformed consent.

Before the passing of the Affordable Care Act in 2010, there was already a law regarding the availability of interpreters for healthcare. However, the previous federal law only required that interpreters must be competent, which is taken to mean that anyone who speaks or understands a patient’s language may interpret for the patient.

Under Section 1557 of the ACA, the term being ‘competent’ was modified. Now, the healthcare interpreters must be ‘qualified.’ By this modification of the requirement, it is no longer possible for unqualified persons, such as family members, friends and even bilingual staff in a healthcare facility to act as the interpreter for the patient.

The law firmly states that the healthcare interpreter should have the proper cultural competency and interpreting skills to facilitate effective communication.

The covered health care institutions under ACA’s Section 1557 that comprise the majority of the hospitals and medical facilities in the United States must take the steps necessary to provide limited English proficient (LEP) patients with language assistance and follow other mandated requirements such as:

• Post notices of nondiscrimination within the facility in different languages. The language service available should be described properly. The provision instructs the facility to have language accessibility programs for the top 15 foreign languages spoken in the locality or state.
• Only qualified interpreters should be used in every healthcare situations. The interpreters must satisfy the standards stated by the HHS. They should also have physical proof that they have passed the testing process and are qualified to be medical interpreters. The criteria include proficiency in English and another language, ability to impartially and accurately make use of specific medical terminology and phrasing, and faithfully follow the ethical principles in health care, such as confidentiality of patient information. Caveat: When an interpreter is not available or if the patient explicitly requests it, a bilingual adult friend or patient’s family member may be allowed to act as interpreter. Minors may also be allowed to interpret during an emergency when a qualified interpreter is not available.
• The healthcare facility should provide a qualified interpreter for the spouse, partner or family of the patient even if the patient does not necessarily need an interpreter.

A healthcare institution that fails to meet the ruling of Section 1557 risks facing a lawsuit. It likewise grants the patient the right to sue a facility for discrimination for failure to provide language services.

The demographics in the U.S. are continually changing, and Section 1557 is a step to meet the needs of the patient population of the country, today and in the future. Based on the press release issued by the U.S. Census Bureau on September 2017, 21.6% of the population age 5 and older speak a language aside from English at home in 2016 (latest available data). It’s a massive leap from the 8% posted in 2015.

Spanish ranks first, with 40.5 million speakers, followed by Chinese (3.4 million) and Filipino (Tagalog) with 1.7 million speakers. These are just three of the 64 foreign languages commonly spoken around the United States, which are posted in the Centers for Medicare and Medicaid Services (CMS) website. The CMS is in charge of implementing Section 1557.

Using phone interpreting for hospitals

One of the most useful modes of interpretation service for hospitals is over-the-phone interpreting (OPI). Aside from immediate access to an interpreter, hospitals that provide language services can offer their diverse patients with access to qualified interpreters who can speak a variety of languages that are not typically available from on-site interpreters.

Hospitals follow guidelines in implementing OPI. Instructions include the number of LEPs in their service area, the frequency of doctor-LEP patient encounters, length of sessions for interpretation, preference of patients, and the nature of conversation needing phone interpretation and accessibility and immediacy.

With the latest data from the census bureau, hospitals across the U.S. would have a substantial increase in the encounters with LEP patients, and as seen in the data, there is an increase in the types of languages spoken, especially in areas that are favorite destinations of immigrants and in the resettlement areas for refugees.

When using an over-the-phone interpreter service, the patient can reach them by dedicated apps, mobile phones and the standard landlines, which are found in almost all healthcare facilities.

Hospitals that implement OPI typically provide a client ID and dedicated phone number to their staff. The user dials the number and gives the client ID and the required language after the prompt. The process connects the user to a qualified medical interpreter so the patient can converse properly.

Because a phone interpreter cannot see visual cues, they have extensive training in mental note taking and critical listening, which are essential to consecutive interpreting services.

Some healthcare facilities solely use OPI and other organizations provide the service as an alternative when on-site interpreting or video remote interpreting is not available for the requested language.

Benefits of phone interpreting

Phone interpreting is especially useful for hospitals that provide service to a community that speaks various languages that are less common.

• Over-the-phone interpreting is substantially lower in cost than on-site interpreting.
• Phone interpreting for hospitals and other healthcare settings allow patients who speak an uncommon language to receive healthcare treatment in a cost-efficient and timely manner.
• In-person medical interpreters for less common languages are difficult to find. The case is different with telephone interpreters, as there are more qualified over-the-phone interpreters and video remote interpreters.

Aside from bridging the language gap, telephone interpreting for hospitals offer patients access to language that would otherwise be non-existent and qualified persons who speak their language.

HIPAA-compliant translation company

Day Translations, Inc. is an HIPAA-compliant translation company. We can provide healthcare institutions with our teams of expert and highly trained medical phone interpreters who are native speakers of over 100 languages. They are linguists with proper training in the different fields of healthcare, ensuring that your patients will receive the most accurate phone interpreting and document translation services that your facility’s language access program requires. Call us at 1-800-969-6853 or send us an email at Contact us anytime. We are open 24/7 every day of the year so you can reach us at your convenience.