CG 11.1 Scope
CG 11.1.1 This Costing guideline outlines an approach to cost interpreter services.
CG 11.1.2 This Costing guideline also provides practical steps and examples to guide staff on the patient costing process for this activity.
Interpreter service scope
CG 11.1.3 The use of accredited interpreters allows health professionals to fulfil their duty of care, including obtaining valid and informed consent.
CG 11.1.4 An accredited interpreter is also engaged when the information to be communicated to the patient is significant for health and/or health outcomes, is requested by the patient or a family member, or the patients English skills are assessed to be inadequate for messages to be conveyed.
CG 11.1.5 Interpreter services can be performed in a number of other areas within the hospital. Expenses can generally be found within Culturally and Linguistically Diverse departmental cost centres or within Allied Health cost centres.
CG 11.1.6 Interpreter usage is a resource consumed by patients and should be patient level costed as they add to the cost of production.
CG 11.2 Objective
CG 11.2.1 The objective of this Costing guideline is to guide costing practitioners on the end to end steps required to ensure that where an interpreter is engaged within the hospital; the objective of this Costing guideline is to guide costing practitioners on the end to end steps required to ensure that all interpreter service activity is costed and matched to final products as they contribute to the full cost of production.
CG 11.3 Costing guideline
Step 1: Identify scope of activities and stakeholders
CG 11.3.1 Costing practitioners should obtain their jurisdictional policy with regards to the use of interpreters to define the services offered by interpreters.
CG 11.3.2 Costing practitioners should identify where these interpreter directorates reside within the hospital. For example, these services may fall within the auspices of allied health, patient liaison or defined specialist departments providing services to culturally and linguistically diverse patient populations.
CG 11.3.3 Costing practitioners should meet with the appropriate hospital interpreter stakeholders and Finance stakeholders. The agenda of this meeting should include an overview of the interpreter model being used by the hospital. For example, it may be more economically feasible for the hospital to contract interpreters from a third party on a fee for service basis as their Low English Proficiency (LEP) patient cohort requiring these services have arrived from multiple international origins. In some cases, it may be a mixed model, where a number of interpreters are employed by the hospital as it has defined a fixed percentage of its cohort requiring interpreter service of a particular nature, whilst also contracting with third parties for other interpreters on a needs basis.
Step 2: Align expense to the Interpreter service department and define overhead and direct expenses, including overhead allocation methods
CG 11.3.4 Costing practitioners should work with interpreter services stakeholders to define the expense (as per their interpreter service model) to be allocated to final products.
CG 11.3.5 Interpreter services expenses are generally defined within its own cost centre and map directly to a final cost centre for costing purposes. However, there may be instances where interpreter services may hold the expense for interpreters, but that interpreter is engaged directly in another department. For example, as interpreter services encompass services for the hearing impaired, it may be the case that a hospital employed interpreter for this patient cohort may reside within the audiology department of the hospital on a daily basis, but expenses held in the interpreter cost centre. In this case, costing practitioners should work with interpreter services stakeholders to define and agree on the methods and assumptions to be used to transfer that expense to other products.
CG 11.3.6 Costing practitioners should (within the patient costing system) use stakeholder insights to transfer expense appropriately to the interpreter final cost centre and other relevant final cost centres.
CG 11.3.7 Costing practitioners should utilise the costing system or another medium to record:
- the interpreter expense and relevant mapping to the interpreter and other final cost centres;
- the stakeholders met with;
- the date of the meeting; and
- a date for future review of interpreter services alignment.
Step 3: Identify Interpreter activity and feeder data and perform quality assurance checks
CG 11.3.8 Costing practitioners should with their interpreter services stakeholders define the type of activity captured with their department. The level of activity detail captured will influence the costing methodology for interpreter services products.
CG 11.3.9 Ideally, the interpreter feeder system will include some or all of the following fields:
- The patient’s unique identifier;
- The patient unique episode identifier;
- The unit where the service was requested (for example, outpatient clinic A, Ward B);
- The date of service;
- The type or category of the interpreter service provided (for example language interpreter, Auslan interpreter);
- Interpreter delivered - a flag to demonstrate if the patient actually met with the interpreter; and
- the time of the interpreter consultation
CG 11.3.10 Where interpreter services are unable to provide detail of interpreter activity at patient level (such as interpreter booked), costing practitioners should also seek the ‘Interpreter Required’ or ‘Preferred Language’ field from the hospital Patient Administration System (PAS) or outpatient booking system to help define the LEP cohort.
CG 11.3.11 Costing practitioners should perform quality assurance checks on the interpreter feeder activity file prior to the costing process. For example, checks should be made on the date of service (to test reliability to remove error dates and ensure dates are relevant to the period being costed).
CG 11.3.12 If the hospital is reliant on the interpreter required field as the trigger for identifying interpreter activity, costing practitioners should seek advice on the reliability of this field as an identifier for interpreter activity and its use for costing purposes. Costing practitioners should be aware that this field:
- may be populated, but only represents that the patient or encounter required an interpreter
- does not account for the volume or frequency of interpreter interaction at patient or encounter level (as it is a Yes/No field)
- will require further checks as it may be collected in an ad-hoc manner
- may not be captured across all care settings, hence underestimate the activity at final product level.
Step 4: Creating and mapping Interpreter service costing products or intermediate products
CG 11.3.13 The application of interpreter services to costing products will depend on how the costing practitioner establishes the final cost centre in the costing system as either an overhead or final cost centre.
CG 11.3.14 If interpreter services are treated as an overhead (as the costing practitioner and relevant stakeholders are unable to decipher the frequency of interpreter services by activity), the costing practitioner should assign the most appropriate overhead statistic to distribute these expenses. For example, the interpreter required field might be used to ensure interpreter expenses are only spread to activity where this service was reported. In this case the costing practitioner should inform relevant stakeholders that the methodology does not factor in frequency.
CG 11.3.15 If interpreter services are treated as a final cost centre, the costing practitioner should obtain the required detail from the feeder as a means of allocating costs. For example, the costing practitioner might use the type or category of interpreter service and volume of services as a cost driver.
CG 11.3.16 Where the category/type or interpreter service is used for cost allocation, intermediate products will need to be created in the costing system and mapped to the interpreter service final cost centre. An example of such a product is: ‘Interpreter_Language A’, where ‘Interpreter’ is derived from the unit code field, and ‘Language A’ is derived from the Interpreter category/type field of the interpreter service feeder file and describes the service provided (including language spoken). The same would be undertaken for Auslan services where the product would be defined as ‘Interpreter_ Auslan’. Once the product codes are created, costing practitioners will be required to map this in the costing system to the interpreter service cost centre.
Step 5: Apply Relative Value Units
CG 11.3.17 Relative Value Units should be determined in consultation with the interpreter service stakeholders. For example, where interpreter services are provided by a third party, the costing practitioner might consider the charge of the service levied by the third party as the appropriate RVU, as it may be considered a cost proxy or represent the value of effort or workflow.
Step 6: Create intermediate product costs in final cost centres
CG 11.3.18 Two allocation processes are performed:
- When overhead costs are allocated to the Production Cost Centre (using an appropriate allocation statistic)
- When the Production Cost Centre costs (overhead and direct) are allocated to the intermediate products.
Step 7: Match intermediate products and their costs to patient activity
CG 11.3.19 Where interpreter services are deemed as final care areas, the intermediate products derived such as ‘Interpreter_Language A’ and ‘Interpreter_Auslan’ are matched to the appropriate patient episode or encounter using the appropriate matching criteria.
Step 8: Report costs
CG 11.3.20 Costing practitioners should perform the required steps to consolidate and report costs at patient or encounter level
Step 9: Cost data review with Interpreter services stakeholders
CG 11.3.21 Costing practitioners should meet with their interpreter services stakeholders to report on the costs calculated.
CG 11.3.22 Cost data should be reviewed for amongst other checks, the number of costed interpreter interactions against activity collected by interpreter services, such as the number of interpreter interventions to test the reasonableness of the matching criteria collected by the service. The cost relativity per interpreter intervention should also be reviewed.