Dealing with Transfers Into the Practice

By Dr. Dean C. Bellavia

I was talking to a Super Practice doctor today about a complicated situation regarding a transfer patient into his practice. The case and situation is difficult and he wanted to discuss the best way to approach the patient/family at their upcoming consult visit. In discussing this case, it became obvious to me that what every orthodontist needs a consistent way to “view” transfer-in cases. What I mean by view is the view I have when discussing such cases from “outside the box”, which is different from the view most doctors have from “inside the box”. Inside the box is where the details of each case are viewed and outside the box is the manner in which all cases MUST be viewed.

Most doctors view a transfer-in case as “a continuation of the previous orthodontist’s treatment”, which is impossible since you are not them—only they can continue their treatment. You can only provide your treatment, based on what you find in the mouth, using your unique philosophies and mechanics (yes, I can assure you that every doctor is unique). Thus, you have a choice between thinking in terms of “continuing their treatment” or in terms of “providing your treatment”.

The pitfalls of “continuing their treatment” are that:

· You continue with their diagnosis (extraction or non-extraction, surgical or non-surgical, single or multiple phase, etc.) instead of your own.

· You continue with their mechanics as best you can or make modifications in the strap-up.

· You continue with their timetable, although it typically is increased due to loss of treatment time, etc.

· You continue with their fees, although they usually overpay the previous orthodontist and even though you recalculate the fee as you are supposed to, you usually give them a substantial break.

· In essence, you continue treatment on their patient, instead of your own patient.

The satisfaction of “providing your treatment” is that:

· You provide your diagnosis, which you are comfortable with and can base a sound treatment plan on.

· You provide your mechanics, which you are comfortable with and know what it will do, even if you have to redo some or all of their strap-up.

· You provide your timetable, which you can accurately predict, even if it is much more or less time than the previous orthodontist’s.

· You calculate your fees, based on the work you will do, which is fair to all involved.

· In essence, it is your new patient and not someone else’s.

There is one more level of thinking that must be addressed, that of professional courtesy. If your treatment differs substantially from previous doctors, it has nothing to do with you or them; you have your way of doing things and they have theirs, neither is right or wrong, only different. This must be communicated to the patient or else they will feel taken advantage of by either you or the previous doctor. Addressing the previous doctor overpayment is difficult and is best avoided.

A final comment is that the patient ultimately decides what to do since you can only provide them with options. In the case that prompted this article, the patient wanted to transfer to the Supers practice because they now had insurance that the Supers practice accepted and the previous practice didn’t. It also turned out that the case was being treated non-extraction and the Supers doctor diagnosed a 30-month full blown skeletal class-II requiring extractions/surgery and a new strap-up. This fact did not make the previous orthodontist wrong; he may well have suggested extractions/surgery with the family accepting a compromised treatment to avoid it. The patient thus has a choice to: 1) accept a 30-month skeletal treatment at a full fee with some insurance coverage, 2) go to another practice that has insurance coverage and possibly be treated non-extraction, or, 3) continue with their present orthodontist and not receive insurance benefits.

I hope that this article helps you to view your transfer-in patients in a better light.