Ep. 45 | Advancing Language Access: Compliance, Technology, and Equitable Care
In this episode of Elevate Care, Eric Martino, Brand Manager for Language Services at AMN Healthcare, breaks down the current state of the language services landscape—spanning regulatory clarity under Section 1557, evolving interpreter supply models, and the practical realities of delivering equitable care for limited English proficient (LEP) patients. Eric explains how hospitals are doubling down on language access despite perceived regulatory ambiguity and highlights the technologies—like EHR integrations, video remote interpretation (VRI), and telehealth interpretation—that strengthen outcomes, reduce readmissions, and improve patient experience. He also shares a behind-the-scenes look at consulting on HBO’s medical drama, The Pitt, to portray language access accurately.
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Timestamps
00:00 – Introduction and Eric’s background
02:30 – Why demand for language services is growing
03:40 – Language access as a pillar of equitable care
05:35 – Regulatory clarity: Section 1557, Title VI, and state laws
08:00 – What changed vs. what didn’t: Provider obligations today
10:00 – Proving impact with data: EHR integrations and outcomes
12:30 – Modality best practices: In-person, VRI, audio, telehealth
15:30 – Interpreter supplier models: Contractors vs. employed
18:00 – Beyond price-per-minute: Quality, connection time, session length
20:00 – Expanding access beyond bedside + media portrayal (“The Pitt”)
About Eric Martino
Eric Martino is the Brand Manager for Language Services at AMN Healthcare and has a background in healthcare technology with a specialty focus on compliance for language access. He collaborates with healthcare leaders, legal experts, and operations teams to help hospitals design clear, practical compliance programs that align with civil rights protections and evolving regulations. Eric advocates for data-driven language access strategies that improve outcomes, reduce disparities, and restore joy to care.
About Kerry Perez
Kerry Perez leads the design and development of enterprise strategy in addition to overseeing Marketing, Corporate Communications, and Creative Services. Ms. Perez joined AMN Healthcare in 2007 and has held various roles during her tenure, including recruitment, marketing, innovation, strategy, and M&A. She most recently served as the company’s Vice President of Enterprise Strategy. She also stood up AMN Healthcare's Diligence and Integration Management Office, which led the strategic and functional integration of new acquisitions to drive synergy. She was named among Staffing Industry Analyst’s Top 40 Under 40 in 2021, and she hosts the AMN Healthcare podcast, Elevate Care.
Ms. Perez maintains the guiding principles of being customer-obsessed, thinking big, and delivering results. She has a passion for mentoring emerging leaders and building effective teams. Ms. Perez holds a Bachelor of Arts degree in Business Economics and a Bachelor of Arts degree in Communication from the University of California at Santa Barbara. For more than four years, she has served on the board of Dallas-based nonprofit CitySquare, which focuses on fighting the causes and effects of poverty. Connect with Kerry.
Transcript
Speaker 2 (00:00.066)
Welcome to Elevate Care. I'm your host, Keri Perez, and today we're doing our own little state of the union on language services industry. I am thrilled to have here Eric Martino, who is the brand manager for language services at AMN and also resident expert on all things compliance content. Eric, welcome to the show.
Thank you, it's good to be here.
Okay, before we jump into some of the topics, would you mind giving us a little bit more of an intro?
Yeah, I'd be happy to. So I'm Eric Martino. I've had the pleasure to be here at Amon Healthcare for about two years. Prior to that, I have long history in medical and healthcare technologies. And so I found a great opportunity to come and be a part of the Language Services team. Most especially recently in the past two years, I've enjoyed diving into all things compliance.
which there's a lot of, especially for language access and when it deals with the civil rights of patients. And so I've had the wonderful opportunity to dive in and be part of conversations with other healthcare leaders, legal experts, operations consultants about how healthcare teams are putting together their own compliance plans to navigate these constant regulatory changes that are happening.
Speaker 2 (01:19.746)
Well, who knew compliance could be so fun?
Honestly, that's what I've been asking myself too. I never knew I'd find a passion for it, but here we are.
Excellent. So let's jump right in. So tell me a little bit about what's going on with language services industry today from a macro perspective. Lots of changes, some regulatory things, some things in flux. What's your sort of overview?
Yeah, absolutely. I think the first thing that needs to be said is that language services continues to have strong growth as a need for patients and as an industry. And if anything, the recent COVID-19 pandemic and also just other issues that are surrounding healthcare in general have increased the need for language services. And so we've seen a very steady growth above 5 % almost every year.
for the past several years and it continues to look that way.
Speaker 2 (02:12.782)
All right, let's touch on that a little bit more when we talk about some of the factors that are causing that increase. What are a few things that are coming to mind?
Yeah, absolutely. So I'll tackle that in two ways. One, obviously it's our population as a country continues to grow. And we continue to have patients who become more and more educated as to the resources that are available to them as they seek care. And so as we've seen hospitals begin to consolidate, some hospitals begin to close as a result.
We find that there are these populations of limited English proficient or LEP patients begin to seek care at new locations. A second thing that we're beginning to see as well is that the regulatory landscape centered around language access is beginning to clarify and condense. We've had several iterations as administrations have changed.
But in the end, the overall trajectory of the regulations is more protecting civil rights and protecting a pathway to care that people who don't speak English very well have.
So why is language access such that critical component of delivering equitable care today?
Speaker 1 (03:39.47)
Yeah. So in as, well, let me talk, let me speak to that from a general standpoint first, um, in general, and this has always been the case, but we're seeing this more and more because more patients are seeking care is that when a person who doesn't speak English is in a country where everyone else speaks English, um, every daily encounter that they have is a little nerve wracking.
And when you layer those nerves on top of now I'm needing to seek care for my body, for my health, you can just crank that nerves anxiety rating up to 10. And so we're seeing that as patients become more aware of, of the resources, their rights, but also, you know, in the different ways they can seek care. We're getting.
more more LEP patients or limited English proficient patients coming to hospitals. And on top of that, what I have seen in my personal conversations with some of these healthcare leaders is that this, providing that care in a way where they can communicate with someone who is nervous and anxious and they can provide that safety, it's a joyous experience.
So it really is bringing back some of the joy in healthcare and leaving everyone with a safer and more positive experience.
So you mentioned that, you know, there's been some regulatory changes. Yes. Yeah. And, you know, from your compliance lens, you know, just kind of stating the facts. What was it before? Maybe what is it today? And what does that mean for either people providing language services or patients looking to access language services?
Speaker 1 (05:33.934)
Absolutely. This is such a great question because, you know, for those on the compliance side of the world, it's been action heavy for the past two years. So, you know, the biggest one was probably an addition or changes to the Affordable Care Act. And so this is in Section 1557. And it's had a couple of iterations over the years, but the most recently, most recently last year, they came out with a final ruling of what Section 55.
57 means for people and what that entails and essentially boiled down. It was instead of having these loose plans or just having plans out there, we now require that specific procedures and policies be written down and that everyone is trained on those procedures and policies by certain times, you know, since, you know, from their implementation. And we also see, you know, some definitions get clarified, but
and the roles of certain individuals who are required to own these processes and procedures have also been laid out and clarified. So that's been really helpful and a really great forwarded step for those wanting a landscape that's clear and one that plays to LEP patients finding safe care. So that's a big one. Now, like moving up to this year, one of the big...
atmosphere shakers, so to speak, was a recent executive order making English the official language. Now, what, you know, the technical what this does was the technical piece of what this did was that it repealed an earlier executive order upon which a lot of federal agency guidance to hospitals was issued on the basis of a previous executive order. And so what it did not do
was changed the requirement to provide language services for those patients. But sometimes when you read it at first, you're not sure. like, so what does this exactly mean to folks? And so what we've been very happy to share with other folks and what we've been happy to partner with various healthcare leaders and legal experts to share is essentially this doesn't change anything that's happening from a healthcare
Speaker 1 (07:59.99)
language services perspective. Everyone still who goes seeking care, who doesn't speak English, still needs to be provided with language services.
So that's very helpful, thank you. So those hospital systems who were already in compliance, is it, hey, continue as is? Is it turbo boosted? Is there any difference from what they, know, anything that was in limbo that now isn't that they can move forward with any plans? How does that sort of clarification and solidifying of what it means alter what people are doing today?
Yeah, that's an excellent question. And I think what we've seen from people is, with whenever there's regulatory ambiguity or perceived ambiguity, it's very telling to see what some of the industry leaders are doing with their health systems. And I've recently had the opportunity to be on a couple webinars and a couple joint presentations with other healthcare leaders from.
prominent healthcare systems in the U S and it was so gratifying, a little surprising, but gratifying to hear that even though they were navigating this regulatory uncertainty for a little bit, that every single one of them has decided to double down on providing language services. you know, we have people sharing stories with me that they've needed to, because on a given day,
their labor and delivery ward, they'll have 13 patients all speaking different languages that require these services. And so it was gratifying to see that a lot of them, regardless of whatever the regular regulation, excuse me, regardless of what the regulation required, that it was so ingrained with their values and their strategy in general to just provide the best level of care.
Speaker 1 (10:06.798)
that they were committed to providing more language services, more devices that helped interpret more staff who can help navigate that for patients. And so that was wonderful to see. Now, as far as like changes in general, Title VI is still there. so Section 1557, while it did clarify some of the requirements, know, Title VI has always been
has always been a North star. And in addition, there are still state laws that are still very much in place. And so what we've seen is more of a, we're clarifying some things for people. So section 5057 helped clarify some of those things and these other executive orders have prompted community discussion, which in the end has led to a positive step.
Excellent. Okay, Eric, resources. What are some resources that are currently available to healthcare providers to ensure compliance with regulations while they're still maintaining that equitable care?
Yeah, this has been a big ask from a lot of hospitals around, you know, due to all the action that's happening into the regulatory space. And I think we we read that the Health and Human Services website is always a great place to be and great place to start. They have a lot of guidance that's listed on there for those who are looking for some more specific guided material, maybe some templates and things like that. Amon Health Care does have a compliance toolkit.
that includes some templates and some other things on there as well. I think another really important piece, especially since we just spoke about state laws, is the healthlaw.org. They have a breakdown of all the state laws that apply to everyone, regardless of what the federal state of affairs is with regulation. So I would absolutely recommend those places. I think also there are...
Speaker 1 (12:06.246)
Most language services vendors would have some type of webinar series or resource page that they could visit. And we have a relatively in-depth one as well that people could share. It has about six hours worth of detailed guidance.
Sounds like a lot of available resources and we've got some, I'm sure we can even link it in this episode. So you also mentioned kind of tools and the proliferation of tools in the previous response. Tools, technology, virtual, there's lots of things that aid in language services. How are hospitals integrating technology like remote interpretation or AI tools to fill gaps in maybe whatever service delivery there is? Previously you were mentioning.
a lot of hospital consolidation, is giving an influx of patients that now need more help. Yeah, talk to me a little bit more about those tools.
Absolutely. I'm going to highlight a challenge that's leading people to seek out these tools first. And then I'll share some of those technologies. think one of the challenges that, is occurring with a lot of those who work in language services is on paper, justifying numbers and expenditures, especially in a world where there's so much consolidation happening and sometimes financial struggle. And so
One of the tools that they're reaching out to, to help navigate that area is integrations with their current technology landscape. So if someone is looking to utilize language services, but they're also looking to get some analytics and get metrics that help prove, Hey, readmission rates have decreased due to our patients, our LEP patients, understanding their take-home instructions.
Speaker 1 (13:54.926)
by integrating an EHR with the language services platform has been immensely helpful. And so I have a number of colleagues who are in the middle of their own personal studies within their own hospital to prove those points with them when before what was only available were a few secondary sources of resource that were conducted on a national level or from other countries or things like that. So
So EHR integrations, a major one. think also what we're seeing is, know, VRI or video remote interpretation continues to be a pillar that people are beginning to lean on more and more for their interpretation encounters because they're seeing that the quality of that interpretation counter is directly affecting.
the readmission rates of these individuals and how long they stay at the hospitals. And so they're definitely utilizing a lot more video remote interpretation than before.
A little bit off script, but I know there's a few different types of interpretation. There's in-person, there's video, and then there's over the phone. You were just mentioning about the benefits of video. Maybe, can you tell me a little bit about, you know, I'm sure all three serve its purpose, but between phone and video, what are some of the use cases for both?
Absolutely. I'm going to add to, to that. So in-person interpretation is still alive and very, very well. And in many cases preferred by, by the patients. And those are going to be in, in, in like group sessions or, interpretation sessions that involve difficult information or, or anything that involves a child in person is, very much preferred. Video remote is the next best thing for, for in-person.
Speaker 1 (15:54.294)
and preferred in many areas because it's on demand. Whenever you involve in person and the hospital doesn't have the luxury of having on staff interpreters in that language, you need to rely on something that can connect you to an interpreter remotely because then that interpreter can cover many more hospitals and many more areas. And having it be video provides not only the basic
understanding that's required for interaction, but also a presence of someone who understands. So definitely a, an atmosphere of safety and understanding for that person. Audio has its role. Now I said video is great for that, but there aren't as many video remote interpreters as there are audio interpreters. And so a great, great advantage from audio is every hospital room has a phone. And so it's, it's pretty easy to implement.
In addition, rare languages like Zofay or anything else like that is easier to connect with via audio because you can contact anyone, any interpreter in the world and they don't need to have an at home video setup. They can just hop on the phone and they're there and ready to do that. And again, at any odd hour of the day, it's not typical office...
hours or not typical hours, but it's an emergent situation. Audio is often used as well. And the last piece I will mention that's definitely emerging is telehealth interpretation. so as these limited English proficient patients are beginning to come into the modern healthcare medical journey and seeking care at
other areas besides major emergency departments, because that is something that we've seen is that with people who don't speak English, sometimes they will not go to the most efficient or appropriate level of care for their injury or for their problem, but they'll go to what they know will have language services, which sometimes is the hospital. But now we see that as providers are beginning to have the capability,
Speaker 1 (18:10.168)
to bring interpreters into telehealth encounters because they integrate with whatever telehealth platform they have. That limited English proficient patients are beginning to be able to participate in that modern healthcare journey. And that's really great to see.
Great. So when you're looking ahead, how do you see the intersection of language services and healthcare evolving, especially in terms of improving health outcomes and reducing disparities?
I think the biggest thing that I'm seeing right now on, on how we're evolving is we're beginning to see all of the applications that language services can have in a hospital stay or in any type of healthcare encounter. I think before, when the availability of these services were somewhat limited or not known about, we saw very basic clinical encounters where it was
doctor or nurse and patient. But what I've been grateful to see more and more is that language services are starting to be utilized for the non-clinical encounters that still increase their patient experience and increase their adherence to instruction from the doctors. So for example, I know one of our colleagues and clients is using
interpretation services for outbound calls to patients. And so this is like surgical prep, know, questions about their medication, making sure that they're going to get there. So we're, we're decreasing missed appointments for things like that. One particular poignant example is, is that that was shared with me by an interpreter colleague was when they were on a call with a mother of a
Speaker 1 (20:02.496)
of a child who was in the NICU. And despite all the wonderful efforts of this mother, this baby wasn't growing as the doctors had projected. And through the encounter with the interpreter, the interpreter was able to pause and see that the patient wasn't understanding as well. And so they asked a few clarifying questions like, here are the instructions the doctor gave you. Is this what's happening? And she said, yeah, absolutely. I have a...
cup of formula that I give to my baby every day, just like the doctor said. And the interpreter asked, well, what does the cup have on it? And she says, it has a one slash two. And so what everyone was then finding out was that it wasn't a cup, it was only half a cup. so that little things like that are able to be corrected and people are seeing that. So we're seeing language services being done in...
and pharmacy encounters and encounters with nutrition and again outbound calls and telehealth. And because of that, the LEP patient is experiencing healthcare just like English patients are supposed to as well. And so we're not all the way there yet. Obviously the adoption is not 100%, but we're getting there. And I think it's only been a benefit to the patient and as hospitals are seeing a benefit to the hospital systems themselves.
I think that's so important that it is growing beyond just at the point of care. is the pre-procedures, the post-procedures, which is just as important, you know, to follow those instructions. So I think that's really great that we're seeing that adoption. Eric, anything that we haven't chatted about that you want to mention?
Yeah, thank you. So back when we were talking about changes in industry as a whole, I had briefly touched on like consolidation among some of the language services providers. Something that we've seen that's been attached to that is a general change in interpreter supplier model. So this is how people and language service providers find interpreters to be able to use. And something that we have seen is a shift in seeking out interpreter contractors.
Speaker 1 (22:14.318)
And interpreter contractors are great for a lot of reasons. They very much help. It gives the interpreter a lot of freedom and how they want to work and things like that, which is great. It also allows us to staff areas in which maybe a time of day is hard to get a language interpreter in a certain language. So the contractor model can be very helpful in those ways. I think though with that, what we have seen is with
fully employed interpreters, especially in AMN Healthcare's case where they're medical only, there's a specialization that occurs there that becomes specifically beneficial to the healthcare industry that might get lost on an over-reliance or over-reliance on the interpreter-contractor model. Because when you have an employee and contractor, there's an ecosystem of support there that goes with an employee interpreter.
And so one of the things that we see sometimes is that a contractor who does work for schools and government, which are absolutely necessary and the LEP patients need that support in those areas as well. Sometimes those interpreter contractors are then required to shift gears when they're hopping on a healthcare encounter where they have to start talking about appendix removal or any other complex medical term.
What we've seen is that as these vendors have consolidated and switched supplier models, they've been able to drop a price per minute, which at face value looks wonderful. but on the backend, some of the full story that begins to emerge is that, without some of the ecosystem support, we do begin to see that connection time getting connected to an interpreter who's a contractor.
can be a little more difficult because there's not an expectation of availability. And the session duration of that interpretation session begins to lengthen. And so in vendors that strike a balance between contractors and full-time employees, they've been able to cover the rare occasional bases, but then the everyday bases a lot quicker. And so we've seen the value come back.
Speaker 1 (24:36.866)
where even though maybe at face value that price per minute was lower with those who have a high percentage of independent contractor, the quality of the experience means the session duration and the patient experience begin to give its own value to the point where not only are you not waiting around, the doctors aren't waiting, the nurses aren't waiting for that time and they're not able to do anything else because we have a longer interpretation session.
But also the direct cost of language services as a whole also can come down because the session durations are just shorter.
Yeah, that makes sense. So what I'm hearing from this first segment, from a macro standpoint, there's been, you know, regulatory changes, but there's also been some clarification on Section 1557. And what that has actually done is like continued everybody on the trajectory of language services is required, needed, and, you know, becoming even more and more adopted. There's been consolidation both in providers as well as hospital systems that
has the landscape changing and becoming more complex, furthering the need for interpretation. From that, we've gotten different models that is inclusive of both contractor and full-time employees that has a sort of kind of trade-offs and that ultimately, you know, we're still looking at the human aspect of the importance of getting that care, both at the point of care and before and after that creates that sort of equitable
access for our LEP patients. Okay, great. Awesome. So, you know, one of the things that you mentioned moving into kind of this other segment, which is fun for us to talk about is, you know, that it is getting more adopted. And I think a great example is sometimes things that we see in mainstream media. I know as a brand manager at AMN for language services, you had a big hand in
Speaker 1 (26:17.93)
Absolutely, I think that was a great summary.
Speaker 2 (26:40.674)
helping with getting our green machines on the hit show, The Pit. So would if you could maybe give us a little bit of behind the scenes inside scoop there, kind of how that came to be and that process that might be a little interesting for our list.
Yeah.
Speaker 1 (26:55.21)
Yeah, absolutely. for those at home, our green machine refers to our video remote interpreting platform, which is basically a type of tablet smart device on wheels. And so we had one of our clients be the recipient of several WB prop masters and executives to come and search out their hospital to kind of get ideas for how they will build their set. And of course, our video remote interpretation machine is
bright green and so everyone could see it. And it just so happened that they had a story beat that the head writer, Dr. Joe Sachs on that show, wanted to include in the story of someone who didn't speak English being severely injured and needing quick care. And so they saw that there and they thought that was a great idea to include. And so they talked to the hospital who then talked to us and
we reached out and we had a conversation and we were honored to be able to consult with them on how patient encounters happen with language services, when language services are needed. And it was great to see that come out in episodes two, three and four of The Pit on season one.
And so did you feel that it was a pretty accurate representation of how you had described how this process works with patients and interpreters?
yeah, the pit and all the people over there were great in the fact that they were very, very careful in saying, is this how this goes? Do you have any suggestions for us? You we really want to simulate how your device looks in the real world. So can you help us with that? And so, and I applaud them for that effort. I know that was something that has, you know, that they have been trying to do is they wanted to be the most accurate medical drama.
Speaker 1 (28:50.528)
in history and from a language access standpoint, I definitely feel that they achieved that and we were grateful to be a part of it.
Well, I'm looking forward to season two.
Yeah, as it so happens, we got a call from the pit and they want us to continue to work with them in Season 2. So we're excited to see that.
Excellent. Eric, thank you so much for joining us today.
Thank you, it's been a pleasure.
Speaker 2 (29:14.424)
Thanks for joining us on Elevate Care and we'll see you next time. Thank you for joining us today on Elevate Care. If you found this episode valuable, please consider sharing it with a colleague and subscribing to our show on your favorite podcast platform. You can learn more about this episode and our show on our website at amnhelfcare.com and follow us on social media to stay updated on new episodes and the ever-changing world of healthcare.
