Wednesday, June 10, 2009

Invisalign....Ghost writer

Hey all,
I hope you are having a good week.
I have a ghost writer who has a soap box that he wants to stand on.
It is a bit long so I will not write anything about me.
Except GO MAGIC (I went to the game last night. I will tell you about it on Friday).

Here is a scenario; an major implant company representative walks into your office and smiles. He/She proceed to inform you that they have great news and have instituted a few new policies to make you and the implants you place better! Sounds great right, well here comes the kicker. They proceed to tell you that you will have to attend place and/or restore ten implants a year or they will no longer let you buy their products!

Why stop there, how about the endo rotary file representative that tells you that to continue to be able to purchase their files you must submit endo cases that you have completed with their system on a yearly basis to continue to purchase their system.

How well would that go over in your office? This is preposterous scenario and would never happen correct! Think Again!

Essentially, that is what Align Technologies, parent company of Invisalign has done. They sent out and placed a letter (see their web site) requiring 10 cases to be completed per year and 10 Invisalign approved CE classes a year in order to maintain your Invisalign account in an active status.

This has all been done under the disguise that it is to better the doctor and assure that the patient is protected and has a well trained provider. You must first take the Clear Essentials certification course prior to being certified and this “supposedly” made you trained enough to treat cases. This has been the only certification process to begin Invisalign for some time now. I guess they have now determined I am not “trained” or “qualified enough” to treat patients. I “feel horrible” (wink wink) now for all this time putting my patients at risk not knowing what I was doing. I have been told in the past by others (4-5 years ago) that all it took was letting the Invisalign representative buy you lunch and you were certified. Oh how things have changed.

I am a member of the AGD and do not get me wrong I am all for continuing to improve yourself and your skills via continuing education but to have a company mandate what I have to do seems a little extreme.

The last time I recall having clinical requirements was in residency and dental school. I checked in my home state and once you have met the requirements for a dental license you do not have to do clinical requirements except for continuing education. One of my local oral surgeon buddies commented that once he has meet the initial requirements (clinical) cases for IV sedation he did not have to continue to submit cases after other than anesthesia CE. I would think the complications and risks involved with IV sedation far out weigh the risks with Invisalign.

The goals Align are seeking could and should be achieved via CE and hands on CE. Continuing education is acceptable enough for every other phase of dentistry and to maintain a state dental lisc. then why not for Invisalign.

My suspicion is that during a down economy this is an attempt to force practitioners (general and specialist) to “sell” more cases to patients. Based on my experience with Align I would be shocked if they had not run statistics on how much increased profit they would achieve by forcing ten cases per provider and factor in how many providers would be pushed out of the company. Align has had requirements for case submissions in order to be listed on their web site to encourage doctors’ to complete cases. This latest round of requirements is just another poor attempt to push and promote Invisalign.

Others have said that this is in collaboration with orthodontist specialist interest groups to limit the general dentist’s role in orthodontics. This could be possible, but from my experience local orthodontist have encouraged my use of Invisalign. They have been more than happy to help if I had any questions with the cases I was treating.

I understand that Align is a company and reserves the right to limit their product to whom they chose and impose rules on whom they provide it to. However, with Align currently the only provider of this system it is unfortunate they have taken this stance. We as dentists also have the right to let Align know that we disagree with the requirements.

What about the small offices and dentist in remote isolated areas that want to provide this service to their patients but might not have the patient flow to meet Invisalign requirements. I guess Align is telling them tough luck you will just have to refer everything out even if that is not convenient for the patient.

I believe that the biggest and most important thing a provider can do is know their limits and select cases based on comfort level and training. I do non complex and simple cases. That is all I want to do. If I want to increase my knowledge and do more challenging cases then great but right now I have treated several patients and have had few issues and all were minor and have enjoyed treating the patients with Invisalign. Invisalign is just a small part of my practice and was never intended to be a large role in my practice.

I strongly feel that this was not done primarily for the patients benefit and the doctors’ improvement and more for the increase in profits and benefit of the share holders.

This is a poor decision that if successful could encourage more companies in dentistry to follow suite seriously jeopardizing dentist autonomy to provide care.

Very well done ghost writer.
I have an opinion and I am sure you do lets hear it.
If I get enough comments maybe I will post them all on Friday.
Have a great hump day.


Anonymous said...

Soooooo.......Let's all use the Red, White and Blue alignment system instead. Since Invisilign sued them for "copying" it must be very similar (Invisalign lost) and they have no "minimum" requirement. Stupid move on Align's part in my opinion

Anonymous said...

Soooooo.......Let's all use the Red, White and Blue alignment system instead. Since Invisilign sued them for "copying" it must be very similar (Invisalign lost) and they have no "minimum" requirement. Stupid move on Align's part in my opinion

Anonymous said...

Well I Couldn't Agree with you more.
I wrote my Rep and told him the same thing basically and I told him to forward it to his superior.

Get this, he did offer to come in and train us how sell more cases. Their new thing is hygiene. Tell your Hygienist to sell the patients that straightening the front 6 teeth will solve all their perio problems. The office that are doing this are starting one new case a day. Let me come in and teach you how to do this.

I told no I was done with them and I hoped a class action suit was coming against them or they would go out of business for simply being GREEDY.

Barry Raphael said...

Don't think the specialists are behind this. As a specialist, I've been using the Align lab since the beginning, have treated numerous cases to completion, some very complex including extractions, elastic traction and canine impactions. Yet since I've only one case submitted this year, my head is on the chopping block as well. And guess what - they have no right to tell me what is best for my patients. Nor do they have a right to judge me.
As a laboratory, they are excellent. As a company, they are a disgrace to our profession.

Dr. C. said...

I ama specialist too and I definitely think this whole thing is CHUTZPAH! I'm not usually a vindictive sort of person but I do hope they go down for this. I'm planning to take the "clear correct" course as soon as its in town.

Anonymous said...

If ADA had done a fair bit more than simply collecting the membership dues from member dentists years over years they would have been able to take care of two issues that have been pestering dentists: 1) mandatory collection of patient co-pays and deductibles (that the doctor’s are often forced to let go as the patients do not want to pay) directly by insurance companies and not by dentists so the dentist could truly serve as caretakers without having to worry about the business element related to collection of fees and 2) all vendors, merchants, laboratory etc., wanting to do business with the dentists follow strict guidelines mandated by ADA or be forced out of business. Well, for whatever reason ADA has gotten ( themselves) to a point of being a puppet association without any teeth and nails, so the dentist suffer at hands of monopolies like Invisalign.

The proficiency requirement from Invisalign is yet another loose-loose policy that will eventually backfire in several ways such as but not limited to a whole generation of new dentist not willing to/capable of providing Invisalign treatment, class action law suites from both dentists and patients, a competitor such as ClearCorrect becoming strong by being a viable and only other alternative, severe reduction in patients due to decline in advertising for Invisalign otherwise primarily done by provider dentists and of course negative propaganda the dentist could and would initiate once they are/can be no longer Invisalign providers. The other loose-loose and rather discriminatory policy Invisalign has is of not displaying dentists as providers on their website until a minimum number of cases are performed by the dentists and of showing dentists with different levels of Invisalign experience. Well, that has two negative impacts on patients and for dentists and Invisalign alike: 1) patients do not see a whole of dentists flooding the search map which could make them think that the Invisalign process is not very popular and 2) new dentists who would form the next generation of Invisalign providers are left out by patients as Invisalign indirectly tells them to select dentists based on their level of experience.

The shareholders of Invisalign are failing to see the upcoming disaster as they are blinded by the wall-street like short-term mentality of the Invisalign executives (we all know ell what the short-term mentality did to the economy), who do not care as long as they get their fat bonuses based on short-term profits before getting fired eventually. What really happening at Invisalign is bad for patients, dentists and shareholders, but it will continue to happen unless prevented by some legal means as it is good for the executives.

Anonymous said...

My lawyer told me that it would not be worth the cost to persue this directly. If there is a class action I want to be included.

jdog said...

I am an orthodontic specialist and I must say this new policy is a shocker. Now they are backing off a bit, because so many of us will fail to meet the requirements by the end of they year....they say they have listened to the upset professionals and have decided that since they started this new policy in the middle of the year, that they will give us another six months to push their product on the public.

I have taken the CE courses, and lets face it......the quality of the results is not the same when you look at the complicated cases that the people are showing.....there are cephs, superimpositions, and models that are missing in the records. The photographs are of poor quality, and some of them almost appear enhanced or altered. Likely many patients (Cl II corrections with protrusive incisors (adults), and crowding, corrected magically by 1.5 to 2.5 mm of so-called molar distalization...are you kidding me?) have a large slide or a dual bite. It really makes me angry when the representative tries to convince me I can do these types of cases....and has the power to put me at a disadvantage if I do not comply with their production minimum.

I will also say to those using their elite super pooper provider status as a way to project themselves as providing superior out. This is walking a fine line in the ethics department. I personally would not allow a family member to obtain treatment from these types of practices!!!

gatordmd said...

Invisalign opened up this can and I don't think it is over. In six months they are going to have a bunch of ticked off dentists.
You do carry a lot of credibility because you are an orthodotist and I appreciate your comments.
I hope you like the blog and keep reading.

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