ACP Member Physician Highlights Communication Needs of Limited English Proficient Individuals to Ensure Quality Health Care
(Washington, DC): Every patient with limited English proficiency deserves quality health care in his or her own language, said Kevin Larsen, MD, today at a congressional briefing on "Patient Centered Communication and Quality of Care for Limited English Proficient Individuals (LEP)." Dr. Larsen spoke on behalf of the American College of Physicians.
Dr. Larsen works at the Hennepin County Medical Center (HCMC) in Minneapolis, MN, as part of a group of 13 general internists with an inpatient and an outpatient practice. He has served on the Minnesota State Department of Health Immigrant Health Task Force devoted to, among other things, the challenge of ensuring access to language services.
"We have many patients of multiple language and ethnic groups for which we provide care—I would estimate 25 to 30 percent are of limited-English proficiency," said Dr. Larsen.
Due to the large number of LEP patients, Hennepin County Medical Center has established a department of interpreter services with 40 full time interpreters. Last year the interpreter department had over 123,000 patient encounters in 53 languages.
Dr. Larsen outlined a number of issues related to the lack of recognition and adequate reimbursement for the extra resources physicians must spend to provide quality care to LEP patients.
Research shows that caring for LEP patients often entails increased utilization of expensive tests. If physicians can't understand what a patient is saying, they may order a cat scan or other extra tests to avoid missing anything. They admit they would not have used these tests if the communication had been better.
It typically takes Dr. Larsen at least twice as long to provide care to a non-English speaking patient. Since most private and public reimbursements are not adjusted to reflect the extra time he spends with these patients, he can actually lose money on these encounters.
"If there is no interpreter, I spend a long time trying to communicate by any means possible, talking to family members, using phone interpreters or simply repeating myself in many different ways," said Dr. Larsen. This time factor renders the standard patient care reimbursement fee inadequate.
Dr. Larsen outlined some "best-practices" employed by HCMC and the state of Minnesota for treating LEP patients, including:
A large full-time interpreter staff.
Language phone lines staffed by interpreters to access any part of the health system
Language specific multi-disciplinary clinics to organize care around interpreters and cultural brokers.
A city-wide health consortium across practices that shares language materials translated into multiple languages over the Web so that each system can avoid the cost of translating its own materials.
Clinic signage in multiple languages.
Development of language specific videotapes for LEP patients with low literacy in their own language.
Training of medical students in how to work with interpreters.
Compensation for interpreter fees through Medicaid managed care plans.
The briefing was sponsored by a coalition of groups which advocate for improved funding and policies to increase access to health care for LEP individuals.
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include more than 116,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illness in adults.