New and revised Joint Commission requirements for language and interpretation standards took effect this month on a year-long pilot basis for healthcare providers nationwide. The aim is to improve patient-provider communication and ensure patient safety. Among the requirements: Proof of interpreter training and fluency competence, which is often difficult to produce as the number of spoken languages and dialects continues to grow.
Most healthcare providers use a combination of on-site and third-party over-the-phone interpreters for more than 170 languages as well as American Sign Language (ASL) for deaf and hard-of-hearing patients. Nearly every language service provider operates under a business model based on using independent contractors. By definition, contractors cannot be professionally trained, scheduled, supervised or monitored by the language service provider contracting with them. Many hospitals are likely to find no evidence of training processes or records for these contractors, nor will they find ongoing interpreter education provided by the company for which they work.
Through collaboration with multiple regulatory, healthcare provider and government stake holders, Language Line Services has developed a support program and tools to aid hospitals in their compliance with the new standards. The ultimate goal is to help hospitals guarantee their language service partners are able to provide the proof and documentation needed to ensure compliance with the new standards.
At a minimum, hospitals and healthcare organizations should be asking themselves: Do we have a clear understanding of the new and revised requirements as they relate to our organization? Have we identified our current level of readiness? Where are the gaps, and how serious are they? What could be done to close those gaps?
More specific questions from an exhaustive checklist about the new standards include: How many hours of training does the language service provider (LSP) furnish its interpreters? What does the training cover? Can the LSP describe how the processes used for training their contract vs. non-contract interpreters differ (if any)? How are the interpreters monitored? How is their performance evaluated? How often?
Healthcare organizations know that if they fall short on any Joint Commission standards they risk jeopardizing access to Medicare and Medicaid funds, as well as incurring added fees to resolve issues and reestablish compliance. Hospitals should be prepared to provide curriculum and credentials for both the interpreters and their trainers. Administrators may be asked to show proof of medical interpreters' competency, documentation for quality assurance, training and continuing education programs, and provide a copy of their most recent job recruitment description.
Documentation on criminal background checks could be requested as well, which again is complicated by the use of contractors where requirements and documentation are typically informal. It's important to note that contractors themselves are not the problem. They often are victims misclassified as contractors despite working as many or more hours as full-time employees, without the benefits of the same training, healthcare coverage, overtime pay or paid time off. Meanwhile, their organizations evade millions of dollars in unemployment insurance taxes, workers compensation premiums, social security contributions, administrative payroll costs and other U.S. Department of Labor regulations.
The new Joint Commission standards move out of the pilot phase and begin impacting accreditation decisions on January 1, 2012. Still, now is the time to ask the right questions and make sure healthcare providers throughout the country are prepared to handle the more stringent requirements.
Louis Provenzano, Jr. is President and Chief Operating Officer of Language Line Services, the world's leading and largest provider of healthcare language-based services.