Australasian Dentist Magazine Sept-Oct 2021

Category Australasian Dentist 125 Please see above the Australian Society of Orthodontists’ (ASO) Guidelines for the transfer of an orthodontic patient during treatment. I do feel that this would be overall the fairest way to perform any calculations with regards to an active orthodontic patient transferring in or transferring or out of a practice. Q3 Dear Geoff, I really appreciate your Clinician’s Corner and I have been having significant discussions with my staff members, as to when should we obtain a deposit for doing aligner patients. Should we obtain the deposit at the time of doing the scan, even though the patient may not have agreed to treatment, or should we just wait until the day we commence aligner therapy? Dr CW, South Australia Response 3 Dear CW, Another fantastic question, and probably more of a practice management decision. We have all been burnt on many occasions and as one gets older and more experienced in the area of orthodontics and dentistry, we make sure we cover our costs. Hence, in our practice, any treatment that requires a laboratory fee of any sort, a deposit must be paid before we send the impression or STL files to a dental laboratory. In other words, whether we’re doing an indirect bonding, or any appliance based treatment, e.g. fabrication of a functional appliance , Nance appliance etc – these patients are required to pay a deposit prior to sending the impressions or STL files to the laboratory. There is no difference with regards to aligner therapy. In our practice we organise a small payment to cover our time and expertise for doing the ‘ClinCheck’ or digital set up. Once we show the patient the set up, and they approve the treatment, we then ask for the remaining deposit. We then approve the case on the aligner site and aligner fabrication commences once the final deposit is paid. The initial fee of approximately $700 covers our time to perform the digital set up / Clincheck and if the patient proceeds with treatment, the practice credits the $700 from the total aligner treatment fee. However, if the patient doesn’t proceed with treatment we have been compensated for our time. I also find that if a patient is unwilling to pay the $700 for our diagnostic knowledge – then it is exceptionally unlikely they will commit to an investment of $8,000 for aligner therapy. In other words, this approach provides a great filter to ensure that we’re only investing our valuable time for patients who are willing to come on board in our practice. I am sure if you utilise this system, you will reduce your issues with patients and in fact increase your conversion rate and ensure that your valuable time is spent in the most efficient manner. u Dr Geoff Hall, Specialist orthodontist Founder and Director of OrthoED, Smilefast And CAPS Ph 03 9108 0475 email geoff@orthoed.com.au ASO Patient Transfer Protocol Protocol for Determining Transfer Patient Fees The Australian Society of Orthodontists recommends the following formula as an equitable method of allocation of fees when a patient transfers during treatment. Records, treatment planning and fixed appliance placement 25% Active treatment adjustments 60% Deband, retainer provision, post treatment records, supervision 15% Practical Use: 1. If the original fee charged is $7500 and the patient transfers after 12 months of active treatment of an 18-month treatment plan, the fee remaining would be: Active treatment adjustments remaining……………….6/18 x $7500 x 60% = $1500 Deband, retainers, records and supervision………….$7500 x 15% = $1125 Fee remaining to collect on transfer of patient………$1500 + $1125 = $2625 2. If the patient transfers only four months into a 24-month estimated treatment plan with a quoted fee of $7500, the fee remaining would be: ($7500 x 20/24 x 60% = $3750) + ($7500 x 15% = $1125) = $4875 As there is no recommended fee, the receiving orthodontist is not constrained by the original quote and the patient may be required to re-negotiate fees for the completion of treatment. The receiving orthodontist will calculate their fee based on their estimate of treatment time remaining, irrespective of how long the patient has already been in treatment. Direct communication with the original orthodontist is encouraged if there is a significant discrepancy in order to find an amicable patient-centric solution. If the transferring patient is entitled to a refund from the original orthodontist, this should be paid directly to the patient rather than to the receiving orthodontist. Where there is a significant laboratory fee associated with the treatment (for example, sequential plastic aligner treatment or use of customised wires and/or brackets), this fee should be recovered only by the original orthodontist. The suggested protocol is: Records, treatment planning, commencement of treatment Lab fee + 25% total fee Active treatment adjustments/visits: 60% of (total fee – lab fee) Treatment completion, records, retention and supervision 15% of (total fee – lab fee) Patient Transfer Protocol This protocol should be used as a guide only; it can’t possibly cover all nuances of a patient transfer. It is not binding but it helps reach common ground. Generally: • Any exchange of money should be between the orthodontist and the patient, not orthodontist to orthodontist. • Records should also be given/emailed directly to the patient together with a transfer letter outlining initial diagnosis, treatment objectives, estimated treatment time, fee, bracket type/slot size and cooperation (oral hygiene, elastics, frequent breakages). As the orthodontist transferring the patient: • It is a good idea to ask the patient to let you know when they have contacted their new orthodontist. This is an opportunity for you to speak directly to the new orthodontist about any sensitive issues. As the orthodontist accepting the transfer patient: • It is important to understand what the initial objectives for treatment were and have a frank discussion with the patient about what still needs to be done, for how long and for what fee. • If there are problems with the case, be careful not to denigrate the work of the previous orthodontist – there are often a multitude of factors at play and the patient doesn’t always recount these accurately. • In clearly difficult cases it is always best to communicate directly with the previous orthodontist. Our primary objective should be to provide continuity of excellent care for the patient. It is in the best interest of our specialty to make the transfer as smooth as possible. columnists