Interpreter rule still costly: Doctors with non-English-speaking patients bear burden

Changes to federal rules for treating patients with limited English skills could help doctors, but the government fails to lift the financial burden.

Editorial. Nov. 10, 2003.

All doctors want to be able to communicate easily and effectively with their patients. That holds true for all patients, including those who have limited English language skills.

A recent revision of strict federal requirements on physicians' interactions with such patients could help doctors reach this goal while working within the practical realities of most medical offices. But the government's failure to remove physicians' responsibility for carrying the cost of this unfunded mandate means that good communication will continue to be a hardship.

The rules require physicians who accept even one patient in Medicaid or the State Children's Health Insurance Program to provide interpreter services to all patients who need help with English -- at the physician's expense.

That is not only unfair to physicians but a good way to discourage doctors from taking Medicaid and SCHIP patients.

The federal guidance, first issued by the Dept. of Health and Human Services Office of Civil Rights in 2000, lumped physician practices, even the smallest ones, in the same category as hospitals and other institutions that have much greater resources to provide interpreter services. Given that Medicaid rates often do not cover the cost of medical services, let alone an interpreter, physicians understandably regarded the rule as a burden.

Since the guidance was issued, the AMA and other physician groups have steadfastly argued for modifications. It seems as if the federal government got some of the message. In August, an update of the guidance was released in an effort to bring HHS standards in line with those of other government agencies. In some respects, it appears to give physicians some much needed flexibility.