CCHAP Newsletter Three
Contents:
- Reimbursement for Medicaid Versus Commercial Health Insurance -
- Work Effectively With Interpreters -
- Medicaid Families That Miss Appointments -
- Resources for Children With Special Needs -
- Announcements -
- We Want Your Feedback -
Compare: Reimbursement for Medicaid Versus Commercial Health Insurance
Versus Office Expenses
This table compares Medicaid reimbursement for common pediatric visit and procedure codes with the average reimbursement from commercial health insurance companies for the codes. This table was developed with Colorado data provided by the American Academy of Pediatrics and the pediatric practices that work with CCHAP. The table also compares Medicaid reimbursement with Medicare reimbursement for the same codes. We opted to make this comparison, because for many codes 100% of Medicare rates roughly equals the actual, total direct and indirect expenses incurred by the average Denver metro pediatric practice as it provides the service for that code. One exception is the Medicare rate for 99213, intermediate office visit for established patient, which is still at 70% of total expenses.
The Colorado Department of Health Care Policy and Financing (HCPF), which oversees state Medicaid, after receiving input from the Colorado Chapter of the AAP and other provider organizations, decided in July, 2006 to use the 2-3% increase they received to provide dramatic increases in certain commonly used primary care codes (like those for preventive care visits for infants and young children and for some office visits for established patients). They gave good increases for some codes instead of small increases for all codes. Also, note in the table the good reimbursement for developmental screening (an article on this topic will appear in our February newsletter) and for completing an individual care plan (see the article in our November newsletter).
(click on the table to download a larger .pdf file)
Colorado Medicaid Program 2007 HCPCS Codes Bulletins
2007 Immunization Update
http://www.chcpf.state.co.us/ACS/Pdf_Bin/Immunizations_B0600222.pdf
2007 Practitioner HCPCS
http://www.chcpf.state.co.us/ACS/Pdf_Bin/07Practitioner_B0600223.pdf
Effectively Working With a Trained Interpreter in Your Practice
In our last newsletter, we described the literature on health care for children with a parent who has limited English proficiency (LEP). Using untrained family members, volunteers or staff can result in poor clinical outcomes. The most cost-efficient method to address this problem is to have bilingual staff, who are trained in medical Spanish and who use the methods used by professional interpreters. CCHAP now offers this type of training (see announcement in this newsletter). This newsletter describes how providers can most effectively work with trained interpreters in practice.
Clinicians working effectively with interpreters
1. Permission and confidentiality
Be sure to ask for permission from the patient/family to use the interpreter you have selected and, when feasible, inquire about whether there may be things they would not want to discuss in front of this person. If in doubt, trust your instincts and choose to use a phone language line for sensitive issues .
2. Pre-interview
Prior to entering the exam room, briefly discuss with interpreter: the general reason for the visit, known issues, and the goals for the encounter without breaking confidentiality.
3. Role of the interpreter
In the pre-interview, discuss with the interpreter the roles you want her/him to take. Do you want the interpreter to simply interpret the words or do you want the interpreter to assist in better understanding barriers or needs of a cultural nature.
4. Starting
Ask the interpreter how to say an appropriate, professional greeting in the family’s native language and use the greeting to begin the visit. Most of us feel awkward about talking through an interpreter. Feel free to say so and encourage the parent to let you know if it is not working well for any reason.
5. Etiquette
When possible, try to arrange for you to face the patient, with the interpreter on the side. Ask the interpreter about the family’s cultural preferences regarding eye contact, closeness of sitting proximity, touching, etc. Talk directly to the patient and parent, in the first person, as you would normally do.
6. The Dialogue
Try to use single questions and short phrasing. Attend to the interpreters need to interpret what you are saying, and break long statements and questions down to shorter segments. Periodically check whether the parent/patient understands by asking them to repeat their understanding. If you wonder about the meaning or length of response, ask the patient and interpreter to clarify. Be patient, some phrases in English may require longer sentences in other languages to have the same meaning.
7. The Story
In many cultures, there is a tradition of “telling the whole story.” So, the parent may talk for several minutes and the translator may give you a much shorter interpretation. But, it may well be that the parent will want you to know the whole story and the degree to which you hear the whole story may influence their level of trust and compliance later. So, spend them time up-front. Ask the translator to tell you the story, show interest.
8. Barriers
Be sure to ask the interpreter to explore whether there are barriers that might interfere with treatment: monetary, transportation, attitudes, concerns, beliefs or other cultural barriers, as you would with any patient.
9. Adequate understanding
In this setting, there is obviously greater chance that the parent will not have a complete understanding. Allow ample time for questions and specifically ask whether they have gotten all of their questions answered. It is particularly encouraging if you learn the word for “question” in the parent’s language.
10. Debriefing
Before leaving the room, ask the patient/parent to provide feedback through the translator. Also ask the interpreter for any feedback the interpreter has regarding potential barriers or concerns about the parent’s understanding or ability/willingness to follow through.
Using Casual Interpreters (family members or volunteers)
In some instances, you may not have a formal interpreter available or telephonic voice interpreting. In that case, you may have to use a “casual” or an “ad-hoc” interpreter. This might include a co-worker, a family member or community volunteer, but never a child. Some states, like California, are already working on legislation to prohibit using a child as an interpreter.
Be aware that when using ad-hoc interpreters, there is a higher risk for errors than when using trained interpreters. But there are times when it cannot be avoided. You should be much more cautious and double check important issues. Remember that, when using family or a friend, confidentiality may become an issue and/or embarrassment. If you sense this may be an issue, get a trained translator or use a phone language line.
In some families, the child may be expected to “take care of” the parent who does not speak English well. So, be sure to reassure the family that it is not anything against them personally, but that medical, as well as Federal, guidelines require an older person to translate.
Acknowledge the importance of the perspective of the ad hoc interpreter (family member or friend) and talk with him/her enough to understand that perspective. And then emphasize the importance of getting information as directly and precisely as possible from the patient.
Trust your senses: if the responses seem inadequately translated, or the history is confusing, insist on getting a trained interpreter or use the AT+T translation line.
And, of course, in the context of domestic violence, spouses or partners should not be used as interpreters.
A Resource for Families
That Repeatedly Miss Appointments
Announcements
Spanish Interpretation Training for Pediatric Practices
CCHAP offers a convenient, time-efficient, cost-efficient medical Spanish interpretation training program for pediatric office staff and providers. It is provided as a telephone conference, during practice office hours at lunch time
Training in medical Spanish interpretation includes:
Medical (pediatric) terminology
The subtle differences in the two languages in word selection and grammar
Culturally appropriate communication skills
Professionalism and etiquette of interpretation
Confidentiality and HIPPA issues
Who: This program is for people in the practice who already speak Spanish and English
How: The sessions will be conducted via telephone, using handout materials and the Internet, and will also include role-playing.
When: Wednesdays from 12:15 to 1PM
Starting: January 24, 2007
How long: 45 minute sessions
How long: 6 weeks
Registration - Each individual can register using the registration form, which will be sent to each practice administrator and be available in the CCHAP Newsletter. Each class participant will fill out the form and send it in by emailing it to ilssoto@aol.com.
Price: $10 per session. Please send check for $60, payable to International Language Services, 12572 West Brandt Place, Littleton CO 80127.
An assessment of each individual’s skill level will be done during a 5-10 minute phone call prior to first telephone conference/class – during lunch hour. Schedule this initial individual telephone call during the week of January 15th to 19th during the lunch hour via email at ilssoto@aol.com.
A certificate of completion will be given after completion of all 6 sessions.
The faculty is Maria Soto, a certified Spanish Interpreter and trainer, with International Language Services.
To register for the Spanish Interpretation Training for Pediatric Practice, please forward this completed form by email to ilssoto@aol.com. Simply copy and paste the text below into an email. To send by postal mail download the form by clicking the like below. Then mail to: International Language Services, 12572 West Brandt Place, Littleton CO 80127, along with a check.
Name of student:
Job title:
Pediatric practice name:
Work phone number:
Home phone number:
Is your first language English or Spanish?
If Spanish is your second language, how long have you been speaking it?
What time is your usual lunch hour?
What is your goal in enrolling in this class?
Next Practice Liaison Teleconference
Thursday, January 25th
12:30 PM
Topics:
Common Issues In The Office
In Providing Care for Minority Families
(bring Your Own Difficult Cases)
RSVP:
Joanie Muzzulin
Muzzulin.Joan@tchden.org
303-861-6309
- contents - newsletter archive - home -
Feedback
We want to hear from you. What topics would you like to hear more on?
What problems do you face that you would like to hear what others do to handle?
Are there tips you would like to share with others?
Send your suggestions, topic, thoughts, tips to:
Poole.Steven@tchden.org
Contents:
- Reimbursement for Medicaid Versus Commercial Health Insurance -
- Work Effectively With Interpreters -
- Medicaid Families That Miss Appointments -
- Resources for Children With Special Needs -
- Announcements -
- We Want Your Feedback -
- newsletter archive - home -
