Winter 1999 Practice Management Diary:

When your patient goes off to college or boarding school, do you transfer treatment responsibility to an orthodontist near the school? In our Berkeley, Calif., practice we have developed a protocol of continuing our supervision of the treatment while the patient is attending school out of town.

Why keep the patient in your practice?

• Appointment intervals in our practice are typically six to eight weeks. This means that if you see the patient in August, the next visit is in early October. If an orthodontist near the school can do that visit, we can do the following adjustments during the Thanksgiving and December vacations.

In the spring, many schools have two breaks, and the school-side orthodontist may need to see the patient only in February and possibly in May. We can usually prepare the treatment stages so that the cooperating orthodontist needs to make routine adjustments during those few visits.

• The financial arrangements are kept in place. The family continues the regular payments to our office, and the school-side orthodontist bills us for any adjustment appointments done. This is a great relief to all involved, especially if the patient has insurance benefits. Insurance companies are often inefficient at transferring providers.

• The treatment plan remains consistent, the treatment time estimate is more likely to be met, and the appliance does not require major changes.

As Jack Webb would say, ‘What’s the M.O.?’

When we first hear that a patient will leave our practice for the school year, we immediately evaluate the patient’s status to see how the school schedule will coordinate with our treatment schedule. For example, if we have begun treatment with the lower appliance and a biteplane, should we get the upper appliance on before the patient leaves for school? This would probably avoid delays, since we don’t want to have the school-side orthodontist placing any appliances. We also will ask patients if they will be home for school breaks and summer vacation, because if they don’t plan to return, we would rather transfer the treatment responsibility out of our office.

The second step is to contact an orthodontist near the school and discuss the arrangement. We want to locate someone who is comfortable with cooperative treatment, who is willing to bill us fairly, and who will communicate freely. After pursuing this system for several years, we now have connections with orthodontists in the major university areas. We have even handled ortho-gnathic surgery cases in this way.

One of us will make a personal call to the orthodontist and propose cooperative treatment. explaining that when the patient leaves for school, we will send a report of the current treatment status and propose an adjustment for the next (October) visit. We do the same after the winter holidays. We ask for a letter or phone call after the school-side visit to advise us of the details of the adjustments accomplished. We ask that they bill us for a typical monthly payment or higher as they see fit. If the orthodontist agrees to participate, we prepare the following copies of the records:

• Headfilm tracing
• Digital photos of the pretreatment panogram and cephalogram
• Pre-treatment intra- and extra-oral digital photos
• Digital photos of the models
• A letter outlining the diagnosis, goals, treatment plan, and treatment history.

The letter also briefly delineates the cooperative treatment protocol. These records are sent immediately after the first phone call to the orthodontist. We invite him or her to look over the records and let us know if there are any problems with the arrangement.

Final Comment

If you do the initial ground work and communicate regularly while the patient moves back and forth from home to school, I believe that this system provides more efficient and trouble-free treatment for the patient.

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