Empowering Healthcare Leaders: The Business Case for Language Access_10.3.14
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Empowering Healthcare Leaders: The Business Case for Language Access provides a framework for calculating total potential encounters with limited English patients, the economic benefit and cost of not providing language access and a frame work to align the economic benefits with organizational goals under the Affordable Care Act.
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Empowering Healthcare Leaders: The Business Case for Language Access_10.3.14
- 1. Empowering Leaders: Building the Business Case for Language Access IMIA Tri-Symposia Oct. 3rd , 2014 Douglas E. Green © International Medical Interpreters Association
- 2. Why Healthcare Reform • Historical Challenges • Comparison • The ACA and Reimbursement The LEP Opportunity Under the ACA • Increasingly Diverse • Understanding the LEP patient experience • Ensuring Comprehensive Access Best Practices Aligning to Organizational Goals • Organizational Solutions • Community Solutions • Future Models
- 3. The Neurosurgeon and the sink basin1 •Dr. Guy Clifton, leading surgeon and chief of neurosurgery at a leading Texas Hospital. •Called upon administrators to address the safety concerns of his staff. •Not enough sink basins, drew up blue prints to fix 3x •Push to digitize x-rays to eliminate the need to perform duplicate x-rays, ‘No business case for’ •Core issue, disjointed culture and high turnover leading to post surgical complication, developed plan to address and was refused. •Study: $10,000 per patient per surgical complication 1 ‘Unaccountable’, Marty Makary, MD, pg 30-33, 2013 An example of a systemic flaw
- 4. The Case for Healthcare Reform • The Case for Healthcare Reform • Size of the healthcare industry • 17% of the Gross Domestic Product • .17 cents of every dollar produced in the US • Number of deaths per year • America's healthcare-system-induced deaths are the third leading cause of death in the U.S., after heart disease and cancer. • 12,000 deaths per year due to unnecessary surgery • 7,000 deaths per year due to medication errors • 20,000 deaths per year due to other errors in hospitals • 80,000 deaths per year due to infections in hospitals • 106,000 dues to negative effects of drugs • Global ranking(s) • The US Healthcare system is ranked 37th globally by the World Health Organization • 14th in preventable deaths • 24th in life expectancy • 72nd in level of health • 2nd in Total Health Expenditures as a percent of GDP
- 5. The Case for Healthcare Reform The Case for Healthcare Reform • Medical Errors Medical errors kill enough Americans to fill over 390 Boeing 747 Airplanes every year. • Poor communication The HC Industry loses 12B a year due to poor communication (about $1.2B for LEPs) • TJC Sentinel Events 3rd leading cause of all sentinel events is errors of poor communication, found as a root cause in 59% of all sentinel events • Willie Ramirez case The $72M word • Cost: The US HC system costs $8.2K a year per capita, 2.5Xs other developed nations
- 6. The Case for Healthcare Reform The Case for Healthcare Reform • Waste of the US healthcare System The US Healthcare system wastes over $750B a year, or 30% of all medical procedures on unnecessary and inefficient services. * 2012 Institute of Medicine Study 0 10 20 30 40 50 60 $26 billion $50 billion $30 billion $42 billion Opportunity: Language access eliminates waste
- 7. Before Healthcare Reform Language Access Was Seen as an Expense How does your organization view language access?
- 8. New Rules Under the ACA: Beyond Coverage • Greater resources and commitment to primary and preventive care • Greater focus on community health centers • Formation of ACO’s • 30-day readmission penalties • 2,217 Hospitals have been penalized $280 million in 20131 • Patient satisfaction and reimbursement bonuses • Focus on quality of care versus ‘amount’ of care The ultimate goal of the Affordable Care Act is to reduce healthcare costs by increasing the health and wellness of the US Population. 1 A Path Forward on Medicare Readmissions Karen E. Joynt, M.D., M.P.H., and Ashish K. Jha, M.D., M.P.H. N Engl J Med 2013; 368:1175-1177March 28, 2013
- 9. Readmissions Penalties Under the ACA Under the ACA hospitals will be penalized up to a 2% reduction in Medicare payments for all procedures for high 30 day re-admissions for Congestive Heart Failure, Heart Attacks, and Pneumonia (chronic Pulmonary Disease, and Hip Replacement 2015). In addition, CMS will not reimburse for the cost of the readmissions.1 169 Texas Hospitals penalized in 20132 1 Hospitals work to keep patients from being readmitted, USA Today, Shari Rudavsky, March 18th, 2013 2 Texas Tribune, Interactive: Hospitals Penalized for Readmission Rates, Becca Aaronson, August 16, 2013
- 10. Case Study: Readmissions at Memorial Healthcare 1 Hospitals work to keep patients from being readmitted, USA Today, Shari Rudavsky, March 18th, 2013 Example: Memorial Healthcare, Broward County, Florida 2011: •35% of patients spoke a language other than English in the home. •1,430 readmissions within 30 days •10,041 days of care that cost the system $114.8 million. •Average cost per episode was $80,279. •Readmissions ranked in the bottom quartile with a rate of 14% •Estimated penalty for 2014 at 2% would have been $3.8 million. •Total Loss: $118.6 million
- 11. Patient Satisfaction Penalties Under the ACA What affects Patient Satisfaction? 1 U.S. Ties Hospital Payments to Making Patients Happy, The Wall Street Journal, Janet Adamy, Oct. 14, 2012 Nearly $1 billion in payments to hospitals over the next year(2012) will be based in part on patient satisfaction, determined by a 27-question government survey administered to patients. Hospitals with high scores will get a bonus payment. Those with low ones will lose money.1
- 12. The HCAHPS Survey Topic Questions Involving Communication Total Questions Percent Nurse Care 2 4 50% Doctor Care 2 3 67% Hospital Environment 2 10 20% After You Left the Hospital 2 3 67% Overall Rating 0 2 0% Understanding Your Care 2 3 67% About You 3 7 43% Total 13 32 41% The intent of the HCAHPS initiative is to provide a standardized survey instrument and data collection methodology for measuring patients' perspectives on hospital care.1 1 www.hcahpsonline.org
- 13. Readmissions, Patient Satisfaction and LEPs 1. Heart disease is the leading cause of death among minorities in the United States, according to the U.S. Department of Health and Human Services' Office of Minority Health. Hispanics and Latinos are at greater risk. Due to: 1.High Blood Pressure 2.Obesity 3.Diabetes1 2. LEPs are going to have lower patient satisfaction scores than English speakers. 1 The American Heart Association English LEP Satisfied 71% 52% Would not return 9.50% 14% LEPs are 36% more likely to be dissatisfied with care and 47% more likely to not return. The study also showed that LEPs are more likely to report overall problems with care, communication, and testing.2
- 14. Why Healthcare Reform • Historical Challenges • Comparison • The ACA and Reimbursement The LEP Opportunity Under the ACA • Increasingly Diverse • Understanding the LEP patient experience • Ensuring Comprehensive Access Best Practices Aligning to Organizational Goals • Organizational Solutions • Community Solutions • Future Models
- 15. The Future of Healthcare: America in 2050 Increasing Diversity: The US in 2050* • 1 in 5 will be immigrants (1 in 12 2005) • Latino population will triple by 2050 and will be the largest ethnic group comprising 29% of the population (14% in 2005) • The non-Hispanic white population will be a minority at 47% in 2050 • Population growth will continue to occur in immigrant populations • The dependency ratio will increase from 59 children and adults per 100 adults of working age to 72 *Pew Research Projections: US Population Projections 2005 – 2050, February 11th , 2008
- 16. "My great-grandfather did not travel across four thousand miles of the Atlantic Ocean to see this nation overrun by immigrants," The US is Historically Diverse
- 17. What happens when LEPs enter the US HC system?
- 18. What Happens When LEPs Enter the HC System? Patient Safety, Quality, and Cost Drivers Quality and cost drivers are emerging in support of work in this area: • Longer length of hospital stays for LEP patients when professional interpreters were not used at admissions and/or discharge. • Greater risk of line infections, surgical infections, falls, and pressure ulcers due to LEP patients’ longer hospital stays compared to English-speaking patients with the same clinical condition. • Greater risk of surgical delays and readmission due to LEP patients’ greater difficulty understanding instructions, including how to prepare for a procedure, manage their condition, and take their medications, as well as which symptoms should prompt a return to care or when to follow up. • Greater chance of readmissions for certain chronic conditions among racial and ethnic minorities compared to their white counterparts. Improving Patient Safety Systems for Patients With Limited English Proficiency A Guide for Hospitals, AHRQ Publication No. 12-0041,September 2012
- 19. What Happens When LEPs Enter the HC System? Risk Management Risk management remains a critical concern . • Patient comprehension of medical condition, treatment plan, discharge instructions, complications, and follow up • Inaccurate and incomplete medical history; • Ineffective or improper use of medications or serious medication errors; • Improper preparation for tests and procedures; Improving Patient Safety Systems for Patients With Limited English Proficiency A Guide for Hospitals, AHRQ Publication No. 12-0041,September 2012
- 20. 20 Triage Registration MD Tests DischargeED Front Desk RN MDRegular Appt Triage Registration MD Surgical MD Anesthesia DischargeProcedure TechnicianTest MD Rounds RN 2 or 3X Admin of Medication Consults Discharge Inpatient/Med/ 1 day Front Desk Front Desk Mapping the Patient Experience Lulu Sanchez, Director Implementation Services, Languageline Solutions
- 21. 21 Mapping Patient Encounters Utilization Number of Encounters LEP % LEP Encounters Avg. Hospital Stay Avg. Encounters per day Total Encounters In-Patient 100,000 20% 20,000 5 4 400000 Out Patient 200,000 20% 40,000 1 4 160000 Emergency Department 30,000 20% 6,000 1 5 30000 590,000 NOTE: It is estimated that even the most advanced language access programs only meet about 20-30% of LEP encounters.
- 22. Interpreter needed For Patient Family Use SBAVRI Available? Use VRIUse Language Line YesNo SBA Available? LAS Interpreter Needed? LAS Interpreter Sent Call Dispatcher Language Line Not Available YesNo Interpreter needed for outpatient *Edgardo Garcia, Manager Language Access Services, Childrens Medical Center Dallas Out Patient Type Modality Encounters Front Desk SBA/VRI/OPI 40,000 RN SBA/VRI/OPI 40,000 MD SBA/VRI/OPI 40,000 Front Desk SBA/VRI/OPI 40,000
- 23. Interpreter Needed For Patient Family Call Dispatcher LAS Interpreter Available? Send LAS InterpreterVRI Available? Use VRIIUse Language Line Yes Yes No No Interpreter needed for inpatient *Edgardo Garcia, Manager Language Access Services, Childrens Medical Center Dallas In Patient Type Modality Encounters MD Rounds Staff/Video/OPI 100,000 RN SBA/VRI/OPI 100,000 Medication SBA/VRI/OPI 100,000 Consults Staff/Video/OPI 100,000
- 24. Interpreter Needed for Emergency/First Care/Arch ED Patient Family Interpreter Needed For Patient Family Call Dispatcher ER Interpreter Available? Send ER InterpreterOther Interpreter Available? Send Other InterpreterSBA Available? Use SBAVRI Available? Use VRIIUse Language Line Yes Yes Ye s Yes No No No No *Edgardo Garcia, Manager Language Access Services, Childrens Medical Center Dallas Emergency Department Triage Modality Encounters Registration SBA/Over the phone 6,000 MD Staff/Video/OPI 6,000 Tests Staff/Video/OPI 6,000 Front Desk SBA/Over the phone 6,000 Discharge Staff 6,000
- 25. Modalities by encounter type Outpatient In Patient Emergency Department Total SBA/Over the Phone 160,000 200,000 12,000 372,000 Staff/Video/OPI 0 200,000 12,000 212,000 Staff 0 0 6,000 6,000 Total 160,000 400,000 30,000 590,000 Outpatient In Patient Emergency Department Total SBA/Over the Phone 27% 34% 2% 63% Staff/Video/OPI 0% 34% 2% 36% Staff 0% 0% 1% 1% Total 27% 68% 5% 100%
- 26. Emergency Room Inpatient Outpatient Triage Typically no Paperwork Admitting Permission to Treat Admitting Permission to Treat Admitting Permission to Treat Insurance Insurance Insurance Notice of Patient Rights Notice of Patient Rights Notice of Patient Rights HIPAA Notification HIPAA Notification HIPAA Notification Financial Documents Financial Documents Financial Documents Rounds Disease Education/Treatment Testing Informational Brochures Testing Informational Brochures Rounds Medication Education Specific Consents Specific Consents Procedure Consent Form Consult Informed consent Consult Informed consent Discharge Discharge Instructions Referrals to aftercare Referrals to aftercare Medication Information Discharge Discharge Instructions Discharge Discharge Instructions Information for Transfer Medication Information Medication Information Patient Education Information for transfer Information for transfer Patient Education Patient Education
- 27. Localized marketing and support content -Web -Education campaigns Bilingual Staff -Fluency testing -Training - Medical interpreter testing - Call center monitoring Inbound LEP calls -Customized greeting -Call routing Over the phone interpreting -Language diversity -Data capture -speed of answer -connect time Video Remote Interpreting -Critical encounters -Quick connect -Smart phones, tablets, PC Translation Solutions -Vital documents -Consent forms -Discharge Instructions Onsite Interpretation -Extended critical encounters Comprehensive Language Access Solutions
- 28. Why Healthcare Reform • Historical Challenges • Comparison • The ACA and Reimbursement The LEP Opportunity Under the ACA • Increasingly Diverse • Understanding the LEP patient experience • Ensuring Comprehensive Access Best Practices Aligning to Organizational Goals • Organizational Solutions • Community Solutions • Future Models
- 29. © International Medical Interpreters Association dherence afety roductivity mage evenue xpense Aligning to Organizational Goals Organizational goals and priorities will shift based upon the environment in which we work. It is important to identify the focus of your internal champions. Position Area of concern Risk Management Safety/Adherence CNO Productivity/Safety Patient/Guest Services Image/Safety Manager/CFO Revenue/Expense CEO ASPIRE
- 30. 30 Organizational Initiative: Referral to primary care Historic Metric: Significant non-critical care being treated in the ER Resolution: During triage referred to primary care physician New Metric: Significant reduction in re-admissions, uncompensated care, and increases in efficiency and wait times. Organizational Solutions: Referral to Primary care Productivity and Expense
- 31. 31 Organizational Initiative: Reduce/eliminate no show appointments Historic Metric: $250 loss per no show Resolution: Proactive in language outbound campaign New Metric: Significant reduction in no-Shows Organizational solutions: Reduce/Eliminate no Show Appointments LEPs are perceived to have a higher rate of no shows to appointments due to a lack of understanding Productivity, Revenue, Expense
- 32. Organizational Initiative: Reduce discharge time Historic Metric: 1 hour 23 minutes Resolution: Integration into EPIC New Metric: 20 Minutes Organizational Solutions: Reducing Discharge Time NOTE: Translation of discharge materials seen as contributing to reduced readmissions and treatment plan compliance, but most hospitals only sight translate. Adherence, Safety, Productivity, Image, Revenue, Expense
- 33. Future Models of Healthcare: Texas Health Resources What other innovations are Health Care providers utilizing? Texas Health Resources: Meeting needs through education Image, Productivity, Revenue, and Expense
- 34. Future Models of Healthcare: Kaiser Permanente What other innovations are Health Care providers utilizing? Kaiser Permanente: Communicating through culture Image, Productivity, Revenue, and Expense
- 35. Representative Solution: St. Luke’s Episcopal Hospital 6 Hospitals (Acute + Specialty Acute) 5 Urgent Care or Freestanding ER 3 Clinic/Physicians-Primary Care 2 Disease Mgmt/Health Mgmt 2 Rehab/PT/sports Clinic ASPIRE
- 36. © International Medical Interpreters Association Questions?