Disclosure and early intervention programs help preserve the physician-patient relationship and foster ongoing communication after an adverse outcome.
As the first private sector early intervention program in the country, Copic's 3Rs (Recognize, Respond, and Resolve) Program has gleamed many lessons learned about the unique blend of emotional and financial support necessary after an unanticipated medical outcome occurs. The 3Rs program is an early intervention program that focuses on supporting and preserving the physician-patient relationship through the disclosure process and often provides reimbursement for the patient’s out-of-pocket medical expenses related to an unanticipated outcome. So what can we learn from Copic's early intervention program?
An early intervention program may assist with the disclosure process and reimbursement for the patient’s out-of-pocket medical expenses related to the unanticipated portion of their care. At Copic, this process is overseen by a team of nurses and physicians who assess a case, apply any exclusions, coach the disclosure and communication with the patient, and reimburse the patient in a timely manner. Copic was not only a pioneer in disclosure and reimbursement programs, it remains heavily resourced to timely assist patients, providers, and the systems they work in.
3Rs case example: A 47-year-old male with rectal cancer underwent an uneventful low anterior resection. Subsequently, the patient developed an anastomotic leak necessitating a return to the OR for exploratory lap, loop ileostomy, and drainage of abscess. The 3Rs Program facilitated physician-patient communication and reimbursed unanticipated out-of-pocket medical expenses for ER, infectious disease, hospital, radiology, and anesthesiology services associated with the care needed for the anastomotic leak. Additionally, travel expenses were reimbursed and the patient’s extended recovery period was recognized.
When working with a physician and their patient, a significant amount of time is spent dealing with the reimbursement aspect of the case. Through experience over time, we have found that 3Rs cases are usually multifaceted. While the reimbursement of out-of-pocket medical expenses is an objective tool in meeting the financial needs of the patient, it is also important to recognize that there are often times other aspects of resolution. These aspects are more subjective and yet can be just as important.
The emotional piece of the unexpected outcome is not as tangible as a bill, a receipt, or extended recovery, but still may require time and support.
Patients are not the only ones who experience an emotional toll when an unexpected outcome happens. Physicians can also receive support from an early intervention program and coaching to help get through the difficult conversations with the patient. There are times when an unexpected outcome that occurred with the patient leaves the physician feeling upset or frustrated. Copic's 3Rs nurse specialists can offer suggestions on how to handle these situations or refer those physicians to peers who are risk managers and can provide support.
Additionally, Copic has found that patients involved in a 3Rs case are less likely to pursue legal action. And while patients retain the right to pursue legal action after participating in the Copic's 3Rs program, of the cases that are paid, less than 5% pursue legal action.
Information in this article is for general educational purposes and is not intended to establish practice guidelines or provide legal advice.
Article originally published in 4Q24 Copiscope as "What You Need to Know About Copic's 3Rs Program."
