What is Early Intervention?
Insurance companies managed by MDMC have been recommending a policy called “Early Intervention” for early resolution of adverse outcomes for some time. Early Intervention is a risk management program element designed to “make the patient whole again” subsequent to an untoward, unanticipated or unpleasant outcome arising out of medical treatment, the omission of a medical treatment, or a medical/surgical procedure.

The underlying objectives of Early Intervention are to provide the patient with the best medical care possible and to maintain a good patient/physician relationship, even when things don’t go as planned.

Early Intervention in no way implies an admission of “guilt” or the acceptance of “blame” on the part of the treating physician. Early Intervention is a real and measurable way of saying to the patient:

• “I’m sorry – and we are sorry - this happened to you.”


• “How has this event affected you?” i.e., what inconvenience or expense have you, the patient, experienced as a result of the event.


• “This is what we all can do to help.”

Some examples of situations where Early Intervention can be applied are:

• A medical procedure is unsuccessful or incomplete. Example: A circumcision is performed on a newborn. Weeks later it is determined that the procedure needs to be redone. The physician could “Early Intervene” in the incident by offering 1) to reimburse the parents for any out-of-pocket expenses incurred by the first procedure, and 2) waive the fee for the second procedure. If the parents opt to have another physician perform the second circumcision, an offer could be made to pay for that procedure.


• Known complication arising out of a surgical procedure. Example: The patient suffers a perforation during a surgical procedure. The perforation is properly diagnosed and treated, but the complication prolongs the patient’s recovery time. One might “Early Intervene” this incident by 1) offering to reimburse the patient for missed income due to the prolonged recovery, 2) offering to pay for home health care, if some is needed, and/or 3) offer to reimburse the patient for out-of-pocket expenses associated with the surgery and complication.

There are many other situations where Early Intervention can be used, i.e., wrong breast lump is removed; successful surgery, but there is a retained object (sponge); patient believes that an alleged delay in diagnosis caused them harm; and in the case of surgeons, the wrong organ, limb or appendage was removed. The key to successful implementation of Early Intervention is a good patient/physician relationship.

If you have any situation whatsoever with one of your patients that Early Intervention might conceivably help resolve, call us at 305 666-6709 or 1-866-633-2900, explain the circumstances, and we will guide you through the process.

How Does an Insured Implement Early Intervention?
It is imperative that as soon as a physician insured is aware of an unanticipated outcome, he or she begins the Early Intervention process by:

• Calling the insurance company office, reporting the incident and filling out the Incident Report that will be provided to you.


• If the patient is unaware of the outcome (missed lab results, failed tubal ligation) speak to the patient immediately to advise them of the problem (disclosure)


• Offer the patient your sincere apology


• At the same time offer them a solution (at no cost to them)


• Do not send the patient a bill for any medical expenses related to the incident


• Make it clear to the patient that they will not receive an invoice for any medical services


• If the patient contacts you first, immediately offer your apology and tell them you will work with them to “fix” whatever went wrong. After you have spoken to the patient, immediately call us so we can take you through the Early Intervention process. If this is one of the rare instances where the physician does not have a good relationship with the patient (for example, the patient is angry or non-communicative), you may still be able to implement Early Intervention by working with us. An apology and a speedy solution to the problem can often diffuse the patient’s anger.

It is important to note that an insured should not independently implement Early Intervention. The process must be done in concert with the insurance company staff.

What is an Incident Report?
Insurance companies managed by MDMC require that insureds fill out an incident report whenever there is an unplanned or adverse outcome. All new insureds are provided with a copy of the incident report form, the form is mailed monthly in each member’s monthly information packet, and additional copies are available immediately by fax or on the insurance company’s website. Incident reports are not “held against” the insured and are not part of the underwriting or renewal pricing process. On the contrary, insurance companies managed by MDMC appreciate being kept informed of all adverse outcomes—regardless of whether or not the incident is appropriate for Early Intervention.

The management report is an important tool to help the insurance companies assess their potential risk/liability and to alert the MDMC staff as to when Early Intervention is appropriate.

How Does The Insured Get Reinbursed?
Insurance companies managed by MDMC will reimburse insureds for their out-of-pocket expenses associated with Early Intervention. However, for audit purposes, documentation is required. You may be asked to send a copy of a cancelled check (front and back) and the supporting documentation (invoices, letter from the patient establishing amount of lost wages) to the office. Upon receipt of the cancelled check and supporting documentation, the company will reimburse the insured.

Please note that companies do not reimburse for the insured physician’s “fee for service.” We ask that you waive your fee and do not bill the patient. However, if there are related physician fees from other physicians, subsequent to the event in question, and the fees are not covered by the patient’s healthcare insurance, then the company will reimburse the insured for these fees.

Will The Patient Sign a Release?
The need for a signed release of liability is dependent on the situation. In most cases, when the physician is reimbursing the patient for out-of-pocket medical expenses (those not covered by the patient’s healthcare insurance), there is no need for a release, and asking the patient to sign a release may cause harm to furthering a trusting physician/patient relationship.

However, if the patient is asking to be compensated for “pain and suffering” as opposed to actual expenses, it is usually wise to obtain a Full Release to prevent future claims. If a release is needed, the company will provide the physician insured with the document and advise the insured how to have it executed.

If I use Early Intervention, Can I Be Sure The Patient Won't Sue?
Absent a Full Release and Covenant not to Sue, there are no guarantees that a patient won’t file suit or initiate a binding arbitration action. It is far more likely that a patient will not bring any legal action against you with a binding arbitration agreement in place.

However, there is nothing to lose - and much potential for goodwill to be gained - by apologizing and offering to correct the error—even if the patient does not sign a Release. In the insurance companies managed by MDMC, in our experience it is very rare that a patient files suit following the use of Early Intervention when a binding arbitration agreement is in place.

Early Intervention is, first and foremost, in the best interests of the patient, and secondarily in the best interests of the insured. Our insurance companies firmly believes that Early Intervention greatly reduces the number of claims, which helps control defense costs and loss payments – and ultimately the rates the insurance companies may charge physicians for professional liability coverage.

Early Intervention, especially in the context of a binding arbitration agreement, is one of the very best tools the insurance companies managed by MDMC have to continue to offer affordable medical malpractice premiums to insureds.