Have you ever had a text message conversation that came across totally wrong? Maybe the words in the message were in all the appropriate places, but the underlying tone was not conveyed as intended? Communication is complex, consisting not only of words, but also tone and body language. As nurse practitioners, we face even greater struggles getting the message across as we must communicate detailed medical concepts in a way that makes sense to those without a health education. The equation becomes even more complex when crossing cultural communication boundaries.
Recognizing the complexities of communication, and the critical nature of healthcare services, the federal government and most states have passed laws requiring that healthcare providers supply translation services to patients who lack English language proficiency. Although this is a requirement, many institutions and/or individual providers fall short when it comes to complying with these regulations. When are you required to use a translator as a nurse practitioner?
The Letter of the Law
Title VI of the Civil Rights Act of 1964 prohibits discrimination on the basis of race, color, or national origin. So, healthcare institutions or healthcare providers that receive federal funding must comply with this ruling. This means providing language access for non-English speakers. In the healthcare setting, these individuals are often referred to as LEP, or limited English proficient, patients.
Don’t think your facility receives federal funding? Think again. Facilities accepting Medicare and Medicaid technically receive government monies and therefore must comply with Title VI. If you don’t accept reimbursement from government payers, state laws may still require that you provide translation services to non-English speakers, although this varies across state lines.
Not only must nurse practitioners receiving federal funding in some form provide access to translation services for LEP patients, they may not bill or charge the patient for them. This presents financial hardship for some practices. The American Medical Association, for example, found that interpreter services often cost in the ballpark of $150, exceeding the provider’s payment for the patient visit.
Fortunately, there is help to cover these costs. Many states will reimburse providers directly for language services through Medicaid or other programs.
The Logistics: What Language Services Must I Provide?
The patient encounter involves not only verbal communication, but also written documentation. While state laws may vary when it comes to the details of what ‘language access’ looks like, this typically includes access to an in-person or video/phone translation service. It also involves the translation of common documents, forms, and instructions into the patient’s native language. Patients may opt to supply their own language services, such as a family or friend to interpret, however the provider cannot force the patient to use a family member or friend as an interpreter.
The HHS Office of Civil Rights (OCR) recognizes that not all healthcare facilities can supply, or should be expected to supply, the same level of translation services. A small clinic located in an area with a nearly nonexistent Chinese speaking population, for example, should not be required to maintain a supply of forms written in the Chinese language.
The OCR gives general guidance for healthcare providers when it comes to the extent of translation services made available to patients. In general, the regulatory body suggests healthcare providers look at the number and frequency of patients seen with language considerations as well of the nature of services provided. If the patient’s medical condition is emergent, or stands to worsen without proper translation, the facility is responsible for offering a greater breadth of language services. In contrast, patients with non-emergent conditions, for example, may be referred to another practice able to supply appropriate resources. The OCR takes these considerations into account when determining compliance with Title VI.
Offering language services in your practice as a nurse practitioner is costly and logistically difficult. Providing such services, however, ensures that your patients receive the best possible care and outcomes. Practices who cut corners when it comes to translating and providing culturally competent services risk even costlier malpractice mistakes, not to mention harm to their patients.
How often do you use an interpreter as a nurse practitioner or physician assistant?
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