Medical interpreters face high demand, low reimbursement

For patients who speak more common languages such as Spanish, Arabic, Mandarin or Vietnamese, finding medical interpreters to facilitate communication with providers is typically achievable.

Looking for professionals to translate in lesser-known languages like Tigrinya, Pashto, Krahn or Ojibwe becomes tricky. 

The importance of medical interpreters has grown during the COVID-19 pandemic, when isolation policies meant patients couldn’t bring family members to help translate during doctor’s visits.  

Approximately 8.3% of the U.S. population, more than 27.5 million people, have limited English-language proficiency, according to the U.S. Census Bureau. Roughly 15% of adults—more than 37.5 million people—have some difficulty hearing, the National Center for Health Statistics found.

While the practice of healthcare interpretation has grown over the past couple decades with advances in technology and certification programs, the field still faces significant challenges related to the availability of language services and the reimbursement of those services by insurers.

Almost 19,800 medical interpreters are employed in the U.S., according to Zippia, an online recruitment service platform, which looks at job openings and data from the Bureau of Labor Statistics. The number of medical interpreter jobs is projected to increase by 20% between 2021 and 2031, according to data from the Bureau of Labor Statistics. 

The most difficult part of recruiting and training medical interpreters is identifying skilled individuals in a wide range of languages who have the necessary experience or certification to teach, said Lisa Morris, director of Cross Cultural Initiatives at Commonwealth Medicine, a division of the University of Massachusetts Chan Medical School.

Commonwealth Medicine works closely with community-based organizations and other interpretive agencies to understand the language needs of patients, she said. 

“I see an increase in the demand and not enough supply,” Morris said. “I get calls from institutions all the time asking, ‘Do you have any graduates in this language or that language? Are you training people in this language? We really need it.’”

The profession is interconnected with issues of social justice and immigration and is crucial to helping patients understand their prognosis, treatment and care instructions, said Natalya Mytareva, executive director of the Certification Commission for Healthcare Interpreters.

“Interpreting is done in many settings, but in healthcare, it's the most important part of expressing your symptoms if you are sick and providing care if you are the provider, because any provider is only as good as they are interpreted,” Mytareva said. 

Developments in technology have facilitated greater flexibility and capabilities for interpreters in the medical field, said Jacobia Solomon, president of language services at AMN Healthcare, a staffing company. Medical interpretations of American Sign Language in particular have been delivered remotely via video since the late 1990s and early 2000s, allowing patients to have greater access to services.

Initially, AMN offered virtual interpreter services using standalone devices like iPads or TVs. Now, the organization has an app that patients can use to access an interpreter in their chosen language to translate during any healthcare interaction, whether it is a telehealth session, hospital-at-home care or a conversation at a reception desk, Solomon said. 

AMN employs around 3,700 interpreters and in 2022, its interpreters were involved in 15 million patient sessions nationwide, offering services in more than 350 languages. 

Rather than employing their own interpreters, more hospitals are beginning to contract with companies like AMN to supply them with full-time and part-time interpreter staff.

At Akron Children's Hospital in Ohio, staff work to promote health equity, literacy and quality by encouraging families to take advantage of interpretive services so they have an easier time making appointments and connecting to resources, said Roula Braidy, the hospital's manager of language and special access services.

"Akron is actually a resettlement area, where we see a lot of families and refugees from [Myanmar], from Congo, from the Middle East—Iraq and Syria, Afghanistan, Pakistan," she said. "We usually work with the agencies that we have a contract with and they try to recruit more interpreters to match our needs."

If patients aren't able to see an interpreter face-to-face, they can access an interpreter virtually in more than 250 languages, she said. In a single month, the hospital typically provides more than 40,000 minutes of interpretive services via video and 20,000 minutes over the phone.

To ensure patients have access to an interpreter when they need one, staff at Northwestern Memorial Hospital in Chicago attempt to schedule appointments weeks in advance, said Eileen Johnson, the hospital's manager of patient relations and interpretation services. For patients who come in sick without an appointment, it can take the hospital a matter of minutes to access an interpreter via digital device, she said. 

Before working as an interpreter, individuals must complete thorough training and certification processes, which can be difficult to accomplish in languages that aren’t as common and have fewer expert educators. 

At Commonwealth Medicine, students undergo a 60-hour program on the fundamentals of medical interpretation, learning anatomy and physiology.

Another issue to resolve is payment.  

Although health systems receiving federal funds are required to provide free interpreter services for Limited English Proficiency patients under Title VI of the Civil Rights Act and Executive Order 13166, neither Medicare nor Medicaid are required to reimburse providers for the services.

As a result, healthcare entities are often responsible for covering the full cost of medical interpreter services.

In the 15 states that offer some reimbursement for language services for Medicaid patients as part of the underlying cost of the direct medical service, providers can claim up to a 75% match on translation and interpretation as administrative expenses. 

Akron Children's Hospital doesn't receive any reimbursement for its use of medical interpreters and can pay up to $1.2 million annually for these services, Braidy said. Each year the hospital has to plan for this cost, often budgeting a small percentage for the expansion of interpretive services, she said.

Due to the myriad challenges, healthcare organizations should think about the resources they need to be able to provide patients with 24/7 access to interpretive services, said Dr. Komal Bajaj, chief quality officer for NYC Health + Hospitals' Jacobi/North Central Bronx. 

It could include conducting an assessment to understand the populations served by a health system and the types of interpretive services necessary, as well as a roundup of available technology, funds and medical interpreters. 

“It's a patient's right to have access to these services free of charge,” she said. “Health entities need to do a better job of letting people know that. It’s important to empower our communities so they know this is available to them.”