AMA seeks federal funding of medical interpreters

Honolulu -- Doctors fed up with being stuck with interpreter bills that sometimes exceed reimbursement for patient visits are "redoubling" their efforts to get some financial relief from what they view as an unfunded federal mandate.

Although the government in August 2003 made the guidelines for accommodating patients who don't speak English more flexible, physicians say much more needs to be done. The rules, released by the Dept. of Health and Human Services' Office for Civil Rights, apply to doctors and facilities that accept patients in programs funded by federal money, including Medicare, Medicaid and the State Children's Health Insurance Program. Acceptance of Medicare Part B pay alone does not trigger the interpreter rule.

At the AMA Interim Meeting in December 2003, physicians directed the Association to:

• Continue trying to get federal funds for medical interpreter services.
• Consider the feasibility of a legal solution to the interpreter services funding problem.
• Work with government officials and other organizations to make interpreter services a covered benefit for all health plans, which are "in a superior position to pass on the cost of these federally mandated services as a business expense."
• Urge the Bush administration to reconsider its interpretation of Title VI of the Civil Rights Act of 1964 that medical interpreter services be provided without reimbursement.

The Office of Management and Budget says physicians in 2002 paid $156.9 million of the $267.6 million spent on medical interpreter services.

"A small business has a difficult time absorbing costs," said AMA delegate William L. Hamilton, MD, an anesthesiologist from Salt Lake City.

Steven Miller, MD, an otolaryngologist from Salt Lake City and AMA delegate, said his office sees a number of deaf patients who need face-to-face interpreters. It costs $60 for an office visit, but Medicare reimburses only $35.

"The physician offices are the ones paying for this," Dr. Miller said.

In August 2003, HHS said the reasonable steps a physician must take to provide services is a gray area. The guidelines state that physicians should consider four factors when deciding how to serve their patients: The number or proportion of patients with limited English skills, the frequency of visits by such patients, the importance of the service provided and the resources available.

For example, the government said a small practice that encounters very few patients who don't speak English would not be required to offer the same level of service as a large, urban emergency department that regularly encounters non-English speakers.

While this might be a more flexible stand than in the past, doctors want to see even more changes because the bulk of the responsibility -- particularly financial -- still rests on them.

"We don't think physicians should be responsible for translation," said David L. Cohen, MD, AMA delegate and an orthopedic surgeon from York, Pa. "At some point you have to expect patients to take responsibility."