1. Your LEP Patients and Members Are Not Engaging With Preventive Care
Preventive care depends on communication that patients can understand and act on. For patients with limited English proficiency (LEP), this means qualified interpreters, translated materials, and culturally relevant messaging. When organizations are not reaching their LEP patients and members effectively, we often see
the same issues across the data: lower preventative care use, including colorectal cancer screening, fewer follow-up visits, lower digital patient portal adoption, and worse
chronic disease management outcomes over time.
For hospital systems, you will see this gap in Healthcare Effectiveness Data and Information Set (HEDIS) preventive measure performance. For health plans, you will see it in member outreach response rates, plan ratings, and the equity-focused measures inside the Health Equity Index. You may also see the same pattern reflected in specific service lines. Older adults with LEP face
oral and dental health disparities at
1.68 to 3.47 times the rate of English-proficient adults.
Some of the friction is operational. One analysis of Spanish-speaking calls to federally qualified health centers found that
roughly 20 percent of calls were dropped before the patient could complete the call. Repeated across thousands of interactions, small failures like that determine whether your LEP population engages at all.
Some of the friction is cultural. A screening reminder that assumes a Western model of preventive care, or discharge instructions built around dietary norms that do not reflect how a patient actually eats, can seem irrelevant and be disregarded as a result, even when the translation itself is accurate. Patients disengage not because they cannot read the material, but because the material was not written with them in mind.
As Susan Amarino, President of Liaison Multilingual, puts it, “A document can be translated accurately and still fail to connect with the patient. For example, a consent form may be linguistically correct but use complex medical jargon or unfamiliar phrasing, leaving the patient confused about what they are agreeing to.”
2. Your LEP Patients Are Coming Back as Readmissions
When discharge communication does not work for LEP patients, readmission rates in that group are often higher than your overall numbers would suggest.
For example, studies have found that
LEP cancer patients are 27 percent more likely to be readmitted than English-speaking patients, and LEP patients with heart failure and chronic obstructive pulmonary disease (COPD) face significantly higher
30-day and 90-day readmission rates as well.
Many of those readmissions begin with discharge education that the patient could not fully process. Patients may leave with written instructions they cannot read, because they were poorly translated or not translated at all. Or, they may not realize follow-up appointments are necessary. Medication instructions that lose even small distinctions in translation can change whether a patient takes a drug correctly.
Under Medicare's Hospital Readmissions Reduction Program, hospitals with excess readmission rates face payment reductions of up to 3 percent across all their Medicare cases. For health plans, those readmissions show up as higher medical loss ratios and lower Star Ratings.
3. Your LEP Patients Are Experiencing More Adverse Events and Medication Errors
A
study of six Joint Commission-accredited hospitals found that among LEP patients, 52.4 percent of adverse events were linked to communication errors, compared with 35.9 percent among English-speaking patients. Research on pediatric inpatient care found that when families had limited English fluency, the likelihood of a medical error, such as administering a medication to a child with a known documented allergy, was roughly double that seen in English-speaking families.
Many medical translation errors come from ad hoc interpretation. For example, a family member or a bilingual colleague is utilized without the expertise of a professional interpreter. Or a teenage sibling might translate a medication dose at the bedside. Medical terms are translated or interpreted using industry terminology. Professional medical interpreters have special training and certification to translate medical instructions. Fluent laypeople do not.
4. Your Staff Are Bypassing the Interpreter System
When getting an interpreter takes too long, staff find workarounds: bilingual colleagues, utilizing an app on a phone, or simply moving forward without language support.
These are understandable responses to a system that is not fast or accessible enough to keep up with the actual pace of care, but that does not make them safe. Federal nondiscrimination law requires qualified language assistance across healthcare settings, and the Joint Commission's 2026 standards now require documented medical linguistic competency for any bilingual staff acting as interpreters.
One way to check is to compare how often interpreters are used with how many LEP patients you serve. If there's a significant gap, language support likely isn't reaching patients who need it. This is not uncommon. For example, a
2024 study of LEP surgical patients found that while most had interpreter use documented at some point during their stay, only 12 percent received language-concordant discharge forms, the documents patients take home and rely on after they leave.
5. Your LEP Patient and Member Satisfaction Scores Are Lagging
When it comes to your patient and member satisfaction scores, language access could be part of the problem.
A large-scale HCAHPS analysis covering more than 5.4 million patients across 4,517 hospitals found that within every racial and ethnic group, non-English-preferring patients reported worse experiences than their English-preferring counterparts, with the largest gap in Care Coordination.
For health plans, you might see lower plan ratings, members who misunderstand their coverage, and gaps in coverage for needed services. If your Star Ratings, HEDIS performance, or Health Equity Index measures are lagging in ways you cannot fully explain, stratifying by language preference may reveal part of the answer.
Where to Start
None of these problems require a full program overhaul to begin addressing. Most of these steps start with data you already have.
Audit how consistently your EHR or member enrollment system captures and updates language preference. A 2025 multi-hospital study found that electronic health records correctly identified non-English language preference in only 69 percent of patients. When language preference is missing or wrong, LEP patients and members may not receive language services at all, or face delays while the staff determine whether support is needed. If your data is undercounting, every metric you track by language preference is understating the gap.
Stratify your readmission rates, CAHPS or HCAHPS scores, adverse event reviews, and HEDIS preventive measures by preferred language. These gaps may impact your aggregate numbers, but they will be most visible in segmented data.
Track interpreter utilization rates by department, shift, or contracted site. Any gap between utilization and LEP patient or member volume is worth investigating, because it usually means staff are finding workarounds.
Verify medical linguistic competency for any bilingual staff acting as interpreters. Under the Joint Commission's 2026 standards, conversational fluency no longer meets the requirement.
Compare your translated vital documents and member communications against the actual language profile of your patient and member population. Start with the highest-volume languages.
Audit your patient education materials and member communications for cultural appropriateness, not just translation accuracy. Qualified medical interpreters provide cultural mediation alongside language conversion, and your written materials should reflect that same standard.
Our Approach to Language Access in Healthcare
Liaison Multilingual has spent 29 years working with healthcare organizations that take language access seriously. Every translated consent form gets a second-linguist review. Every interpreter we place meets documented competency requirements. Our president, Susan Amarino, chairs the ASTM F43.05 subcommittee on Quality Assurance in Language Services.
The healthcare organizations we work with come to us for different reasons. Some need on-demand interpretation available around the clock, wherever care is being delivered, or members have questions about their health plans. Leading organizations also trust LMS to translate policies, plan documents, consent forms, and patient and member education at high volume, ensuring every document is accurate, consistent, and ready for real-world use. Most need both.
If you are looking for a language services partner whose work reflects what is actually at stake for the people who depend on it, please feel free to get in touch. We would love to hear about what you are working on, your needs, and how we can help.
