The following is a letter from Eric Chong, co-founder of ReferralRight, which runs pre-treatment dental coordination with hospital cancer programs. He can be reached at eric@hsfm.co.
There are patients in this county whose cancer treatment is waiting on a dentist.
Before head and neck radiation, and before many transplants and cardiac surgeries, the mouth has to be examined and any infection resolved. Treatment does not start until it happens, and the oncologist cannot do it.
The programs we work with have these patients now and not enough dentists to send them to. Most are working with one dentist, or none. A hospital routes to a single office, so what arrives is a line of patients that keeps coming, and once a program has someone who handles it well, that holds for years. When nobody answers, the patient waits. In Los Angeles, that wait has been running about six months.
There are plenty of dentists who could do the work. What runs short is dentists in a relationship that holds, and these break in the same places every time.
Nobody owns the case. The referral arrives with no clinical question attached, so the dentist does not know what is being asked. The patient does not show and nobody notices for two weeks while the medical team waits. The findings go back in a form the team cannot use, sometimes saying the patient is “cleared,” which is not a thing a dentist can say and not a thing anyone should write. Nobody settled who pays. And once the report goes back, usually nothing comes the other way.
Then there is the one that ends it quietly. A practice takes two of these, absorbs the coordination itself, and stops answering the third call. Nobody decides to stop. A hospital program is not two cases, and a front desk that can carry two cannot carry twenty.
Where those hold, the physician sends the next patient. Where they fail, the practice gets one referral and never hears from them again. We have watched it go both ways and cannot promise which one you get.
The referral relationship stays the dentist’s, and it should. What we take is the coordination: chasing the missing clinical question, tracking whether the patient came, and putting the findings back in the form the medical team reads.
That last one is where most arrangements fall down. The return has to happen and it has to be documented, and usually it falls to whoever remembers. We track every return and tell the practice when the loop closed, so the dentist knows the work landed and the record shows it did.
The network we run for this is free, and it stays that way. Referrals cannot be bought or sold.
One more thing worth knowing, because most dentists never hear it. This work is not paid for out of a dental plan and it is not a fee schedule anyone negotiates. Since 2023, federal coverage rules have treated dental care that is “inextricably linked to, and substantially related and integral to the clinical success of” a covered medical treatment as part of that treatment, in the regulation’s own words. The categories are at 42 CFR 411.15(i)(3)(i). Whether a given case qualifies comes down to the clinical picture and what gets documented, which no citation will settle for you, and that is most of the work.
Contact Eric Chong for more information. He can be reached at eric@hsfm.co