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Cultural competence and multilingual communications are increasingly important for the nation’s hospitals because of changing demographics. According to U.S. Census data, the percentage of individuals with limited English proficiency (i.e., speak English "less than very well") grew from 8.1 percent in 2000 to 8.7 percent in 2007, and remained at 8.7 percent in 2011. In addition, many new immigrants are settling in states (e.g., Georgia, Nevada, South Carolina) that have not historically had large immigrant populations (see exhibit below).
Many individuals with limited English are newly eligible for healthcare coverage from state Medicaid expansions or health insurance marketplaces, but language and cultural barriers may make it difficult for them to access coverage or the financial assistance they need.
“Just because someone appears to not want to provide you with information, it doesn’t mean they have something to hide,” says Sheldon Rock, Lutheran Medical Center’s vice president, patient accounts. “They just might not understand you. You need to go that extra step to reach that person, either with a document in their language or another person who can speak to them in their language.”
Lutheran Medical Center is located in Brooklyn’s Sunset Park neighborhood, where 49 percent of residents are foreign-born. About 50 percent of residents are Latino, and 25 percent are of Asian heritage. To ensure accurate communications about financial matters, Lutheran Medical Center ensures that patients who have limited English proficiency get one-on-one help from a staff member who speaks the same language, as well as translations of important documents.
See related sidebar: Translating Patient Financial Documents
This tactic has paid off. One measure: The denial rates for Medicaid applications at Lutheran Medical Center and Lutheran Family Health Centers, the system’s network of federally qualified health centers, are “almost non-existent because patients with limited English-language proficiency have assistance in completing the paperwork,” Rock says.
The Affordable Care Act (ACA) requires that healthcare professionals provide information to patients in plain language, which is defined as “language that the intended audience, including individuals with limited English proficiency, can readily understand and use…”
The ACA does not specify that written documents must be translated into a language other than English if a certain percentage of patients use that language, although some states have such requirements. In New York, for example, written documents must be translated if 1 percent of patients primarily use a certain language.
Lutheran Medical Center provides written documents, including financial assistance applications, in Spanish, Creole, Arabic, Russian, Mandarin, and other languages when the need arises.
“I don’t know how many of our patients need language assistance,” Rock says, adding that the hospital does not track the percentage of patients who need a specific language translation. His main concern is the ability to communicate with any patient who seeks care at the hospital. “What I do know is that, if one patient comes in and speaks a different language, then we can communicate in that language.”
In addition to the translated documents, Rock ensures that patients have access to a revenue cycle staff member who shares their native language. He does so by hiring employees who live in Lutheran Medical Center’s primary service area. “We try to hire as many employees as possible from within our diverse community, so our employees have the same cultural mix as our patients,” he says.
“It makes financial sense to have somebody who speaks the language,” says Virginia Tong, Lutheran Medical Center’s vice president for cultural competence. “Language shouldn’t be an obstacle to getting the necessary information to send a bill and collect payment for services your organization has provided.”
The hospital mandates that every staff member participate in annual cultural competence training, and Rock recommends more for his staff. He wants someone from the patient accounts staff to attend every cultural competence training opportunity offered in the hospital, and that person is expected to share the information with the entire department.
Beyond that, Rock invites presenters to his department to reinforce cultural competency skills and an appreciation for the diversity among his staff members. “The cultural training is not only between employees and patients, it’s among ourselves,” he says. “The patient accounts department is so diverse that we have to be respectful of each other. And if we can’t be respectful of each other, how are we going to be respectful of our patients? So we work at it.”
Communicating effectively with people from different cultures eases the process of finding payment sources for Lutheran Medical Center’s patients, Rock says.
For example, some patients with limited English struggle to communicate in English because they think it is required. Lutheran Medical Center staff are trained to recognize when that is happening and seek translation assistance from a staff member who speaks the patient’s native language.
“Once you provide that service, you’re going to make someone a lot more comfortable. And when you provide the documentation—a financial assistance summary or financial assistance application in their language—the fear that you’re going to do something to them goes away,” he says. “We get better information and we spend less time capturing the information because we have developed a rapport with the patient by trying to communicate in the best way possible.”
The patient accounts staff is trained to write letters to employers or landlords seeking documentation that will help with financial assistance applications. Furthermore, Lutheran Medical Center adjusts its policies to accommodate cultural differences.
For example, when Rock attended a community meeting, he heard members of the Arabic community say they did not want to provide a lot of financial information. He told the group that Lutheran Medical Center will accept a letter from an employer or even a self-attestation of employment to help patients seek assistance or insurance. “My goal is to help the patients get the services they need and get paid for those services,” he says. “And if I can do that by helping them get approved for Medicaid, Health Plus Amerigroup [another public insurance program in New York], or any other insurance, then I think we can all win.”
Lutheran HealthCare, the medical center’s parent organization, supports the patient-friendly bilingual services with hospital signs posted in up to six languages and patient education materials available in five languages. In addition, Chinese, Arabic, and Orthodox Jewish community liaisons are assigned to help patients navigate the healthcare system.
Chinese, Latino, and Arab advisory committees also work with Lutheran HealthCare executives to make decisions of significance to their cultural communities. For example, Kosher and Halal meals are available for Jewish and Muslim patients, and the hospital has an interfaith chapel, a mosque, and a mediation and support room for Jewish families.
This complete package of culturally competent practices serves Lutheran HealthCare’s diverse population and positions the health system to adapt its services, policies, and procedures to meet cultural changes in the community down the road.
Lola Butcher is a freelance writer and editor based in Missouri.
Quoted in this article:
Sheldon Rock is vice president, patient accounts, Lutheran Medical Center, Brooklyn, N.Y.
Virginia S. Tong is vice president, cultural competence, at Lutheran HealthCare, Brooklyn, N.Y.
Related sidebar: Translating Patient Financial Documents
Publication Date: Monday, November 18, 2013
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