Reducing Hospital Readmission Rates for LEP Patients

How do language barriers affect hospital readmissions rates? More than 60 million Americans speak a language other than English at home, and 41% of this population (8% of the total U.S. population) have limited English proficiency (LEP). The increase in LEP patients in the U.S. can present communication barriers for healthcare systems to overcome in order to provide a high-quality patient experience. Studies have shown that LEP populations are more vulnerable to higher readmission rates.  In this post, we’ll be looking at how comprehensive language access programs can reduce readmission rates for healthcare systems.

 

The Importance of Reducing Readmission Rates in Health Care Systems

 

Hospital readmissions are associated with unfavorable patient outcomes and high financial costs. Reducing hospital readmission rates have increasingly been used as a measure in health services as a quality benchmark for health systems.

Defining Readmissions: When patients return for treatment for the same issue within 30 days of initial release.

Hospital readmission rates can be a financial risk for health care systems, who may receive penalties for excessive readmission rates. In addition to penalties, readmission rates can significantly impact hospital CMS star rating, accounting for 22% of overall score.

 

The Affordable Care Act (ACA) and Hospital Readmission Reduction Program (HRRP)

 

Section 3025 of the Affordable Care Act added section 1886(q) to the Social Security Act establishing the Hospital Readmissions Reduction Program, which requires CMS to reduce payments to IPPS hospitals with excess readmissions.

In 2015, Medicare fined a record 2,610 hospitals with readmission penalties.

 

Medicare Readmissions Penalties by Hospital (Year 3)

 
*Chart below. Source: Kaiser Health News. Medicare will apply these readmissions penalties to reimbursements from Oct. 1, 2014, through Sept. 30, 2015. This chart shows the penalties for all three years of the program. Maryland hospitals were not penalized because the state has a unique reimbursement arrangement with Medicare. Also exempt are certain cancer hospitals, critical access hospitals as well as hospitals dedicated to psychiatry, rehabilitation, long‐term care and veterans. Medicare also excluded hospitals that had too few cases to be fairly evaluated.

 

State	Percent of All Hospitals Penalized	Average Hospital Penalty	Number of Hospitals Penalized
Alabama	76	0.63	71
Alaska	24	0.83	5
Arizona	62	0.58	48
Arkansas	47	1.02	37
California	64	0.41	223
Colorado	34	0.33	27
Connecticut	88	0.65	28
Delaware	86	0.22	6
District of Columbia	78	1	7
Florida	79	0.58	148
Georgia	65	0.51	89
Hawaii	56	0.2	10
Idaho	12	0.62	5
Illinois	65	0.78	118
Indiana	53	0.62	68
Iowa	19	0.68	23
Kansas	26	0.44	34
Kentucky	66	1.21	63
Louisiana	59	0.71	72
Maine	41	0.31	15
Maryland*	n/a	n/a	n/a
Massachusetts	80	0.78	55
Michigan	52	0.64	71
Minnesota	27	0.4	36
Mississippi	56	0.7	55
Missouri	61	0.67	66
Montana	9	0.44	5
Nebraska	14	0.33	13
Nevada	56	0.76	20
New Hampshire	35	0.41	9
New Jersey	98	0.82	63
New Mexico	45	0.35	19
New York	80	0.73	148
North Carolina	65	0.47	74
North Dakota	4	0.18	2
Ohio	63	0.73	107
Oklahoma	52	0.57	66
Oregon	30	0.14	18
Pennsylvania	72	0.63	126
Rhode Island	67	0.67	8
South Carolina	71	0.61	44
South Dakota	15	0.27	8
Tennessee	72	0.75	83
Texas	56	0.52	213
Utah	30	0.66	14
Vermont	27	0.1	4
Virginia	76	0.97	66
Washington	37	0.5	34
West Virginia	56	0.96	30
Wisconsin	37	0.43	47
Wyoming	31	0.38	9

 

 

Hospital Readmission Rates and the LEP Patient Experience

 

The Centers for Medicare and Medicaid Services (CMS) reports that in addition to high readmission rates, racial and ethnic minorities (including LEP patients) also present a higher degree of certain health-related concerns, including:

 

• An increased risk of longer stays at the hospital
• Higher rates of anxiety and depression
• Less access to primary care providers
• Inadequate follow-up care after discharge
• Multiple co-morbidities
• Socioeconomic pressure (e.g. underinsurance, social isolation, housing and food security issues, lack of access to transportation, lack of employment opportunities)

 

Language barriers in hospital settings can contribute to avoidable readmissions, including lower rates of outpatient follow-up, use of preventive services, medication adherence, and understanding discharge diagnosis and instructions. The CMS Guide to Reducing Disparities in Readmissions recommends the following for reducing readmission rates for LEP patients.
 

• Ensure that patients with limited English proficiency are aware of and have access to
  professional medical interpreter services during inpatient stays, during discharge, and when
  accessing post-hospital care.

• Communicate discharge instructions in the patient’s preferred language. Provide written
  materials at an appropriate literacy level (5th grade or lower, as recommended by the Joint
  Commission) and in the preferred language of the patient and/or caregiver. Simply translating
  written instructions may be insufficient to ensure patient understanding.

• Include family members and/or caregivers in care as appropriate, work with members of the
  extended care team (such as community health workers), and coordinate with traditional
  healers to help facilitate culturally competent care for patients with limited English proficiency

 

Reducing Hospital Readmission Rates for Limited English Proficient Populations

Among hospitalized patients, language barriers can lead to higher readmission rates and longer hospitalizations. Studies show that access to qualified interpreters in hospitals decreases readmission rates and hospital expenditures for LEP patients.

Comprehensive language support for LEP patients in critical at every step of the patient journey in order to provide quality patient care and in reducing readmission rates for LEP patients, including:

 

Admissions: Professional translation and medical interpretation at admission leads to a more efficient and effective process, and can increase the LEP patient comfort level and overall satisfaction.

Consent & Prior to Procedure: Obtaining patient informed consent before a procedure should be provided in the language preferred by the LEP patient to ensure the patient understands, and reduce miscommunication errors that can lead to patient safety events.

Checkups and Procedure: Staff and doctors should use qualified interpreters to communicate with LEP patients.

Discharge & Post-Discharge: Aftercare instructions provided in the patient’s preferred language – translated, and through an interpreter – helps with patient understanding and adherence, which can lead to reduced readmission rates and greater health outcomes.

 

5 Things to Consider When Selecting a Hospital Language Services Provider:

Dedicated Support: Your hospital language service provider should implement quality training, cultural awareness training, and provide support materials to help staff communicate effectively with LEP populations and interpreters.

Ease of Use: Connecting to a qualified medical interpreter, whether remotely, or to schedule an on-site interpreter, should be easy, and reliable.

Speed of Services: When language barriers arise in health care settings, you don’t have time to wait on hold. In order to provide the highest quality of patient-centered care, staff should only have to wait, on average, a few seconds to be connected to a remote interpreter.

Quality of Services:  Interpreters should be certified medical interpreters, with specific knowledge of medical terminology and experience in interpreting in health care settings to provide high-quality interpretations that reduce communication errors.

Compliance: Be sure that your hospital language services partner provides services that can help your facility achieve or maintain regulatory compliance.

 

Having dependable access to language services allows health systems to reduce risk of penalties by reducing hospital readmission rates for LEP patients, helps achieve and maintain regulatory compliance and standards, can positively impact CMS Star Rating, reimbursement, community reputation, and overall patient satisfaction. Comprehensive language access programs are associated with a high quality of patient care and better health outcomes. It will also save time so your hospital and your staff can be more productive when communicating through an interpreter with limited-English proficient patients.

Want to learn more about how to improve patient communication and satisfaction? Optimize star rating? Reduce hospital readmission rates for LEP patients? Need help achieving or maintain compliance with government standards? Download the free eBook to understanding language access in healthcare!
 

The Healthcare Interpretation Guide: Language Access for a Better Patient Experience [Download Your Free Copy]

 
Reducing Hospital Readmission Rates for LEP Patients is a critical component for providing patient-centered care. Communicating through an interpreter in healthcare settings doesn’t have to be difficult. Telelanguage has been providing professional medical interpreters for healthcare organizations since 1991, and over 70% of our current clients are healthcare entities. Our team of 5,000+ certified interpreters is ready to speak in over 300 languages. We offer complete language service solutions, including telephonic interpretation, on-site interpretation, video remote interpretation, and translation services for hospitals and health care systems.
 
No matter what language your patients speak, Telelanguage can help. Superior language support when you need it — available 24/7, 365 days a year. Have questions? Chat with us live or contact us for more information.

 

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