Wednesday, April 24, 2024

Improve patient outcomes by speaking their language

Patients with limited English proficiency (LEP) face poorer health outcomes due to low health literacy and language barriers.

In a recent systematic review, 75% of studies showed that LEP patients experienced better outcomes when they spoke the same language as their providers.Written translation also supports connection. In a recent study 91% of Spanish-speaking parents preferred to receive translated copies of their children’s written discharge instructions to improve comprehension.

How can health care professionals build the trust they need to successfully treat culturally and linguistically diverse patients? A language access plan offers a roadmap to help practitioners build cultural competence to connect with patients. Planning ahead allows for efficient use of resources and effective communication.

Here's how to create an effective, patient-centered language access plan for your practice.


Assess community needs


The first step is to understand the population you serve. To determine which languages are spoken in your community, refer to the U.S. Census Bureau’s language tables. For greater precision, artificial intelligence tools can fill in missing data based on the known demographics in your practice area. Once you understand your patients’ needs and preferences, you can begin to meet those with communications that connect.

Keep in mind which points of contact these patients are likely to have with your practice team. Whether they’re telephoning, using an online portal, or visiting the office for an appointment, ensure that your team is offering meaningful language access at each touchpoint.


Create your connection toolkit


Next, create a comprehensive language services toolkit. Consider the following questions when creating your plan:

Which types of interpreting will you offer? A review by the Wellesley Institute found that providing trained interpreters improved health outcomes and increased preventative care.

There are several ways to provide this service, and your practice will probably want to offer a mix of options. On-site interpreting and video remote interpreting (VRI) both offer face-to-face interaction for improved communication, allowing both the patient and interpreter to respond to important non-verbal cues like facial expressions and body language. VRI may provide a quicker, more cost-effective way to provide access to an interpreter in a patient’s preferred language, allowing you to provide service to more communities.

Over-the-phone interpreting is the best fit for follow-ups or non-emergency situations when there isn't enough time to arrange for an on-site interpreter.

Remote simultaneous interpreting (RSI) is rapidly gaining popularity due to the recent increase in remote care. RSI is concurrent, which means the interpreter interprets while the other patient speaks, so there's no delay.

With RSI, the interpreter is in another location, so communication is handled through video and headsets. Although the interpreter is not in the room, patients often find the immediacy of RSI reassuring. Children’s hospitals have used It to assess children in a global clinical trial. There’s also evidence that RSI is the most effective interpreting method for reducing the rate of clinically significant medical errors.

How will you translate documents? Providing professionally translated documents helps ensure that patients fully understand their health care, insurance, and billing options. This is not only practical but also a matter of compliance: regulations like Section 1557 of the Affordable Care Act require specific documents to be available in the patient's preferred language.

But truly meaningful access requires not only making translated material available but going beyond minimum compliance mandates. A culturally competent approach to communication promotes equity and patient satisfaction by ensuring your patients understand their health status and treatment plan.

Machine translation technology can speed up the process, but only in tandem with specialist translators who understand the medical field and thus avoid translation errors that could harm patients or lead to frustration.

Some patients may have difficulty with written information, even when it's written in their home language or at or below the recommended fifth-grade reading level. A medical interpreter may be required to read the written documents to the patient and assist you with any follow-up questions.


Provide training


Train your staff so that everyone understands their specific role in implementing the plan. This includes training in both cultural competence and the technology used to provide language access to patients.

Cultural competence in health care goes beyond language to include skills such as fostering health literacy for diverse patient populations and navigating social and cultural differences in communication. To promote consistency in training and procedures, appoint one person on your team to the role of language access coordinator.

When everyone in your office can confidently handle requests for language access, patients will feel more confident in the care you provide.


Build community awareness


Now it’s time to let your community know that language isn't a barrier to getting care at your practice through an awareness campaign that includes the major marketing channels your patients use.

With growing diverse populations, your practice needs a plan that supports equal access to care. A language services provider has the expertise to assist with translation, language asset management and navigating regulations. This partnership increases accuracy, compliance and overall efficiencies.

The good news is that more language access tools than ever are at your team’s disposal. Using these tools to connect with patients can ensure everyone in your diverse community gets the care they need to improve their health in a culturally relevant way.


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Tuesday, April 23, 2024

EHR upgrades and patient care

Each time my EHR is upgraded, I am informed on the new functionality and the wonderful tools it will encompass to make charting more efficient and patient care better. Improvement features with interoffice staff communication, improved coding features, and data sharing all seem to be a necessity with upgrades but why don’t I see improved efficiency and less screen time as a result?

Unfortunately, to the contrary, often with upgrades functionality changes, colors and format differ, and I find myself having to relearn EHR processes all over again. I usually don’t find the upgrade to be that much different than the version from the year prior, and personally I haven’t been mesmerized by the improved aspects of patient care as a result. What changes, however, is the logistical flow. As clinicians, we are taught on structure. Medicine uses tradition such as how we obtain a history starting with the chief complaint. There is a flow to medical notes, from taking a history to presenting a case. We are trained this way and medical school basic doctoring courses still teach the cadence of performing an exam with this style of flow. We organize our thoughts and communicate our presentations both orally and written in this manner. However, the EHR organizational structure is seemingly constructed with countless variations. The construct seems to ignore the legacy of how we are trained. We try to be flexible with the EHR flows and constant inflow of changes to colors, icons, functionality placement, etc.Why does it always have to change with every upgrade? Most recently, an upgrade to the EHR included emojis. Really?

Why EHR companies change color formats, icons, and sometimes location of functions is beyond me. The changes do make the upgrade readily apparent, but do the changes aid in patient care and safety? Is my job more efficient as a result? Functionality may indeed improve, but my overall arching question is why must all the icons, the colors, the locations of such tabs change as well? The Greek philosopher Heraclitus is credited with the idea that the only constant in life is change but with the frequency of “needed” upgrades, it is nearly mandatory we are forced to change every few months. Acclimatizing to our EHRs seems to be in competition with keeping up with newest medical advances in disease management -- a statement which I never thought I would have to make.

Respectfully, I do understand that EHRs may help to improve accuracy, help with clinical decision-making, have tools for medication interaction review, and search features to retrieve needed information in a sea of medical records hidden in specific tabs within the EHR, and in some instances help with medical legal defense. Conversely, I find efficiency of the patient examination, and the satisfaction of delivering care less so because of the complexity and task-oriented functions of the EHR. In many instances, I find myself feeling like a data entry clerk rather than a clinician.

Clinicians, now more than ever, have many data entry duties. The clinical encounter’s efficiency is dictated by the ease of the EHR. I would suspect that most clinicians do not feel that their efficiency and clinical duties ease because of such upgrades. The National Academy of Medicine stated that nurses and doctors spend 50% of their workday looking at a computer screen, not the patient, and the increased EHR demands contribute to provider burnout.

The “upgrades” seem like a barrage of changes like a video game that my kids play. The marketing of new features, colors, and graphics make computer games fun. I wish I had the same positive outlook as my kids do when I hear an upgrade is coming to my EHR. The EHR often seems like a video game in and of itself. It has many nuances and features that often seem hidden and depending on the training and skill of the user, can then be unlocked for clinical use. Developing such skill and adaptability takes work, time, effort, and practice -- but then may quickly fade once the newest upgrade is placed into motion.

If I had a wish, I would ask computer informaticists who assist with such upgrades to ask me if I even need an upgrade and at a bare minimum, keep the same icons, colors, and fundamental basics without significant change. The hours spent on meetings, emails, and videos about the impending new and improved upgrade could potentially be better spent on patient care. Until then, I will have to continue to get used to EHR upgrades and learning the new format and inefficiencies of such.

I wonder when Madden 2025 comes out…


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Monday, April 22, 2024

Denials, coding, prior auths, and your revenue cycle

Denials management, coding, and prior authorizations are the revenue cycle tasks that require the most subject matter expertise, according to a survey from AKASA, a developer of artificial intelligence for health care operations.

More than 550 health care financial and revenue cycle leaders were asked: Which revenue cycle tasks require the most subject matter expertise? They could select up to five out of a list of 15 tasks. The top choices were:78.7% said denials management
50.1% said coding
49.7% said prior authorization

Denials management not only requires the most subject matter expertise, but it’s also the most time-consuming task within revenue cycle management — followed by prior authorization and insurance follow-up.

As health systems and hospitals continue to experience major staffing gaps, advanced automation driven by artificial intelligence (AI) and machine learning (ML) can help streamline these complex tasks and save providers valuable time and revenue.

“Revenue cycle leaders are being challenged to do more with less as they’re strapped for resources, while also experiencing higher volumes of claims,” said Amy Raymond, vice president of revenue cycle operations at AKASA. “To continue to improve yields and meet revenue goals in this environment, leaders must leverage automation and AI-driven solutions that help reduce burnout for existing employees and ensure workflows still get done reliably.”

To make the biggest impact, health systems and hospitals should consider automating repetitive work (such as claim status checks) so teams can focus their time and attention where it’s needed most: tasks that require human judgement and revenue cycle expertise. The ideal automation tool can handle both the mundane and the more nuanced, complex tasks to provide the support RCM teams need — while ensuring processes are more streamlined and efficient.

“Experienced revenue cycle staff is hard to find. Deploying automation for more repetitive work can be a key retention strategy for training up junior staff, giving them an opportunity to build their areas of expertise, while allowing experienced staff to focus on the more challenging claims that return more value to the organization,” said Raymond. “This creates an environment where individuals feel the organization is invested in their career development and success while also improving the bottom line.”

Commissioned by AKASA, the survey fielded responses from 556 chief financial officers and revenue cycle leaders at hospitals and health systems across the United States through the Healthcare Financial Management Association’s Pulse Survey program between July 8, 2022, and August 2, 2022. The national survey was designed to assess revenue cycle challenges at hospitals and health systems across the U.S.


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