Video Remote Interpreting or, VRI is one of three delivery methods of interpretation that have a valuable role in health care. A well-rounded language access plan should include Video Remote Interpreting along with in-person (onsite) and OPI (Over-the-Phone Interpreting), but there is danger in assuming VRI should be the default method for interpreting services and the cost/benefits of doing so are often oversimplified and overestimated. In addition, there have been several legal complaints from patients who were refused face-to-face interpreting by institutions which thought they were being fully compliant by offering only Video Remote Interpreting and Over the Phone Interpreting services.
From a patient satisfaction, reliability, and accuracy perspective, the value of each service from most effective to least effective is:
- In-Person Interpreting – Highest rated
- Video Remote Interpreting – A great option for many circumstances
- Over-the-Phone Interpreting – A great option for a few situations in health care
Switching around the order of preference of the above list is tantamount to lowering the quality of service and patient satisfaction. In-person interpreters typically visit the same hospitals frequently and have a much deeper understanding of the policies and culture of these institutions, something that interpreters working remotely cannot take advantage of.
What about the costs?
Buyers beware! Service providers sometimes advertise potential savings in a way that may be misleading. Conducting an extensive ROI requires factoring in more than a simple 1:1 formula when comparing services.
Many health care institutions have visiting interpreters available for more than one patient per visit. With a two-hour minimum, the institution can request an in-person interpreter stay for the entire time, interpreting for multiple patients at no additional cost while providing the best service to both hospital staff and patients. At MasterWord, this is part of what we call Smart Scheduling, maximizing the use of in-person interpreters who are already scheduled to be on site.
Is your cost for Video Remote Interpreting really an average $18 to $20 per patient as some claim?
Companies tend to calculate this by considering each call as a separate patient, but how many calls are made for the very same patient? Who is interpreting for the patient during in-take, at the nursing station, with the specialist, in radiology, with the social worker, and so on? If each patient has several video remote calls, the cost per patient will be significantly higher — much higher than simply having an in-person interpreter on hand.
An onsite interpreter can be with a patient, maintaining continuity throughout the entire process and will typically interpret in at least 4 contact points per patient such as those listed in the above paragraph. Thus, one patient would require multiple Video Remote Interpreting calls, all likely handled by different interpreters, bringing the price up and the continuity down. (Four VRI calls for one patient at an average of $19.00 per call would add up to $76.00.) This being considered, VRI may be the more expensive route for many kinds of patient visits.
Additional Video Remote Interpreting associated costs also apply:
- Cost of technology including individual devices, cameras, speakers, microphones, additional wireless routers
- Cost of integration/upgrading
- Cost of maintenance, both with local IT personnel and offsite vendor personnel
Indirect VRI-associated costs:
- Lowered patient satisfaction by reduction in onsite interpreting leads to lower ratings on CMS scoring which can contribute to lower reimbursement from CMS and potential penalties.
- Increased legal and financial risks to those who inappropriately use Video Remote Interpreting when in-person interpreting is either preferred by the patient or is logistically problematic.
In what circumstances is it best to avoid Video Remote Interpreting?
The most conservative position on the use of Video Remote Interpreting is that of the National Association of the Deaf (NAD): “NAD strongly believes that VRI services should be provided only if on-site interpreter services are unavailable” (National Association for the Deaf, 2008). Most experts recommend limiting the use of VRI in situations that make using the technology difficult for patients. This would include deaf patients who are unable to see the screen due to restricted movement and those with physical impairments that make hearing or seeing the device difficult. In the case of patients receiving “bad news,” such as a terminal or life-changing diagnosis, and those visiting mental health facilities, trained on-site interpreters should be used.
Again, while Video Remote Interpreting is a very important tool to have in your toolbox, using it in place of in-person interpreting when in-person is the more appropriate choice is like using a screwdriver when a hammer is needed.