You’re the office manager of a growing group practice. Bethany is your only deaf patient, and you’ve been able to schedule an American Sign Language (ASL) interpreter for each of Bethany’s prior visits. Her health plan has reimbursed a portion of the fees paid to the interpreter by your practice.
On the last visit, however, the scheduled ASL interpreter was an hour late for his appointment with Bethany, who communicates via ASL and knows basic written English. Bethany ultimately became frustrated and demanded to be seen immediately. You explain that the interpreter was late and offered to reschedule her for another appointment if she wanted. She refused. Finally, you get a call from the interpreter’s wife informing you that her husband was in an accident and unable to make the appointment.
You have no backup ASL interpreter and find out that the next available ASL interpreter won’t be available until the next morning. Upset that no interpreter was provided to her, Bethany leaves the practice and communicates her anger to you before leaving.
This scenario is one of many that can cause patients like Bethany to leave a practice, pursue legal action or retaliate online. In addition to scheduling in-person or on-site ASL interpreters, many hospitals and facilities have a Video Remote Interpreting (VRI) service that is used on-demand to communicate with patients like Bethany when an on-site interpreter is unavailable or is not practical. Yet, practices don’t always know what options they have when it comes to procuring VRI service, or they don’t know where to start.
What is VRI?
VRI is a fee-based service – similar to video chat applications like FaceTime – that uses video conferencing technology to access an off-site interpreter. VRI is generally less expensive than having on-site interpreters. VRI is an accepted auxiliary aid under most state and federal regulations, but to be an effective choice, the VRI device (often an iPad or tablet) should be capable of the following standards:
- Real-time, full-motion video and audio over a dedicated high-speed, wide bandwidth video connection or wireless connection that delivers high-quality video images that do not produce lags, choppy, blurry, or grainy images, or irregular pauses in communication;
- Sharply delineated image that is large enough to display the interpreter’s face, arms, hands, and fingers, and the face, arms, hands and fingers of the person using sign language, regardless of his or her body position;
- Clear, audible transmission of voices;
- Adequate staff training to ensure quick, efficient set-up and proper operation.
When using a VRI device, the patient should be able to view the screen at any angle, especially if the patient is lying down and needs to communicate with the provider. The VRI device should work seamlessly in areas where patients typically need interpreting services, such as the exam rooms. Testing the VRI devices in these areas, especially if a wireless connection is used, helps reduce a delay in treatment.
What to look for in a VRI Vendor?
VRI vendors typically have software that can be installed on a mobile device that allows the practice or physician to connect with one of the vendor’s off-site interpreters. These interpreters follow a script and are ready to translate as soon as they are connected. Hence, many patients appreciate VRI as an option for communicating with their physician or healthcare provider.
In addition to the performance standards above, here are five things to consider when vetting a VRI vendor.
- Ask about languages other than ASL. VRI is a service that allows remote, live interpreters to translate between the provider and the patient via an electronic device such as an iPad or laptop computer. In addition to ASL translation, VRI vendors may offer other common languages such as Spanish or Vietnamese in audio only or video translation methods.
- Ask about the billing method (and cost). Many billing structures exist among VRI vendors. Some VRI vendors offer a low monthly subscription fee with a per-minute charge for every minute the interpreter is online. Some require annual contracts and others do not. A practice that may not have any deaf patients may want to consider a VRI vendor with no monthly or annual fees even if the per usage cost is higher. A practice that sees several deaf patients annually may be able to negotiate a better rate.
- Ask about the contracting and implementation process (and sign a BAA). Covered entities must enter into business associate agreements (BAA) with third parties that have access to protected health information. VRI service vendors directly interact with a patient, and hence a business associate agreement (BAA) is necessary. Consult with your attorney about what to include in your BAA with the VRI vendor. Additionally, ask about how long it will take for the vendor to set up the service for your practice.
- Ask your hospital affiliate (if any). Hospitals receive discounted rates because of their higher usage volume. Some may recommend reputable vendors or offer solutions to your practice.
- Ask as many other questions as needed to get you comfortable with the vendor. VRI vendors know that not all physicians and practices understand what VRI is or how to get started. A good vendor representative will offer resources and take the time to explain everything you need to know. Some questions to consider:
- Can you provide any materials for us to review?
- How does your service work and on which devices?
- How are your interpreters qualified to provide healthcare interpretation?
- Generally, where are your interpreters physically located?
- Can you offer free or discounted devices, e.g., an iPad, for my practice?
- What are your security standards and performance statistics?
- Can I chose my interpreter’s gender based on my patient’s request?
- What is your average downtime? What if I cannot access your service?
- If we choose your service, what will contracting and implementation look like? How long before I can start using your service?
- Will you provide training for my office staff?
- Can I terminate the service at any time?
- How can I get a better price?
Once a VRI vendor is selected, ensure your staff are properly trained on how to use the devices and where to find them. Properly document procedures for the use of VRI and the training provided to ensure reasonably prompt service to patients.
LAMMICO is putting together even more resources to help you vet VRI vendors. These resources will be available in the coming months in the Practice Solutions section of the website. LAMMICO insureds may access these resources free of charge by logging in as a Member at lammico.com/login. For more information, contact the LAMMICO Risk Management & Patient Safety Department at 504.841.5211.