Are you ready to elevate your orthodontic practice while sidestepping legal pitfalls? Curious about harnessing AI ethically or managing patient challenges with confidence? Dive into this episode of The Golden Age of Orthodontics with hosts Dr. Leon Klempner and Amy Epstein, joined by Trey Lawrence, CEO of the AAO. We explore essential strategies for today’s orthodontists: navigating the complexities of social media to avoid HIPAA violations, crafting airtight informed consent processes to shield against malpractice, and responding to negative reviews without escalating risks. Trey shares critical advice for new grads on spotting contract red flags, like misleading non-compete clauses, and offers best practices for dismissing disruptive patients while protecting your staff and practice. Plus, we tackle the ethical and legal questions surrounding AI’s growing role in diagnosis, treatment planning, and marketing. There’s never been a better time to be an orthodontist—tune in to stay informed and thrive!

IN THIS EPISODE: 

• (00:00) Protecting your practice isn't optional, it's essential
• (07:27) Discussion of being an introvert and the impact that has on professionals
• (12:35) Common legal blind spots for orthodontists are HIPAA violations and Social Media Litigation
• (17:38) Trey Lawrence advises new grads or young associates on interviewing and job offers
• (20:39) HIPAA laws on negative reviews, malpractice and informed consent
• (30:38) Should you dismiss a patient, and if so, what is the best practice
• (35:52) What legal and ethical questions should orthodontists consider regarding AI

KEY TAKEAWAYS: 

• Orthodontists often overlook HIPAA violations on social media, such as disclosing patient information without consent, like naming patients or showing them in posts without proper authorization.
• Young orthodontists should avoid mislabeled independent contractor agreements and unclear non-compete clauses, especially in multi-location practices, and seek affordable legal review before signing.
• Avoid defending yourself online to prevent HIPAA violations; instead, use a curated response like, "There's been a misunderstanding, please contact our office," to begin an offline conversation.
• Ensure informed consent involves direct doctor-patient interaction or at least an offer to discuss with the doctor, and document this process to strengthen legal defense against malpractice claims.

RESOURCE LINKS

People + Practice  - Website 

Leon - Email

Amy - Email

People + Practice - Email

AAO - Website

Trey Lawrence - The Orthattorney - Instagram

GUEST BIO: 

The AAO is thrilled to announce Trey Lawrence's appointment as its new Chief Executive Officer, effective March 1, 2024. Mr. Lawrence, a proven executive at the AAO, has successfully led the association’s advocacy and legal efforts and is poised to lead the organization to its next chapter of growth and innovation. 

“Trey Lawrence was a clear choice, and we are thrilled to have him take on the role as CEO,” said Myron Guymon, DDS, MS, AAO President. “We are confident that he is the perfect leader to guide the AAO into the future,” continued Dr. Guymon. “His strategic vision, strong leadership skills, and a commitment to collaboration will play an instrumental role in advancing our strategic plan and ensuring the continued success of the orthodontic specialty.” 

Mr. Lawrence has a distinguished career spanning nearly 25 years in law practice and advocacy. Most recently, he served as vice president and general counsel for the AAO, where he led the AAO’s advocacy program to unprecedented successes in the AAO’s history, in addition to leading the AAO’s legal team. For the past five years, Mr. Lawrence has represented the AAO before members of Congress, federal regulatory agencies, state legislatures, state dental boards, state attorneys general, and other organizations throughout dentistry and healthcare.  Throughout his career, Mr. Lawrence has demonstrated a strong commitment to zealous advocacy for clients and, for the last five years, on behalf of AAO members and their patients, making him a perfect fit for the AAO’s mission.  

“I am honored to be appointed as the new CEO of the AAO,” said Mr. Lawrence. “I am passionate about the field of orthodontics and firmly believe in the AAO’s mission to advance the art and science of orthodontics through education, advocacy, and research. The last five years have been the highlight of my career working closely with the AAO community, including our dedicated members, Board of Trustees, and staff, and I look forward to continuing this work to further strengthen the association and ensure its continued success in the role of CEO.” 

KEYWORDS: Golden Age of Orthodontics, Orthodontics, Orthodontic Practice, elevate your orthodontic practice, AI in Orthodontics, American Association of Orthodontics, AAO, Trey Lawrence, TheOrthAttorney, Legal Pitfalls, patient challenges, Dr. Leon Klempner, Amy Epstein, Practice Strategies, HIPAA, HIPAA Violations, consent processes, harnessing AI ethically, AI Diagnostics, AI treatment planning, AI Marketing, stay informed, Introverts, proper authorization, legal review, young associates, contract red flags, non-compete clauses, legal pitfalls, HIPAA laws, independent contractor agreements, best practice, offline conversation, document this process, prevent HIPAA violations, strengthen legal defense,  malpractice claims, patient information, legal and ethical questions, patient challenges, Social Media Litigation, Malpractice, Patient Information, Consent Issues, Non-Compete Clauses, Independent Contractor, Contract Review, Legal Blind Spots, Online Reviews, Negative Reviews, Curated Response, Offline Communication, Informed Consent, Malpractice Defense, Doctor-Patient Interaction, Documentation, Patient Dismissal, Disruptive Behavior, Staff Protection, Ai Ethics

GAOO Ep 72 - Trey Lawrence, CEO, American Association of Orthodontists

[00:00:23] The Orth attorney, that's orth attorney. Uh, this is one episode you wanna take notes on, so stay tuned. Our Golden Age of Orthodontics podcast sponsors make it possible for us to bring you new episodes. KL Owen is revolutionizing orthodontics by turning the chaos of conventional braces into custom control, their custom digital solution.

[00:01:13] Created by an orthodontist grin is redefining remote monitoring with a cost-effective solution. That boosts practice efficiency while delivering personalized care for each patient. Grin provides you with dedicated assistance, enabling you to focus on providing exceptional care, all while saving valuable time for you and your patients.

[00:01:53] Narrator: The future of orthodontics is evolving and changing every day, but although the way to achieve practice growth has [00:02:00] changed, there's never been a better time to be an orthodontist.

[00:02:22] Join your host, Dr. Leon Klempner and Amy Epstein each month as they bring you insights, tips, and guest interviews focused on helping you capitalize on the opportunities for practice growth. And now welcome to the Golden Age of Orthodontics with the co-founders of People and practice, Dr. Leon Klempner and Amy Epstein.

[00:03:05] And today, as usual, I'm joined by my daughter and my partner Amy, and I must say that, uh, I feel really blessed. To be working with my daughter. We have a lot of clients, uh, that work with us that are also, uh, family, uh, uh, kids working with their dads, brothers, sisters, legacy, um, practices. So, uh, you guys all know, uh, what it means for those that you, that don't.

[00:03:41] Amy Epstein: I'm doing well. We're fresh off the a a o. So we heard a lot of those stories and met a lot of parent child, uh, you know, ortho practices and was telling the story to some somebody that we met, I think. But you know, my. I have two sisters, and, uh, you tried [00:04:00] to pitch being an orthodontist, like over, over and over, almost caught one of us almost.

[00:04:18] Dr. Leon Klempner: you know, it, it, the only thing that, uh, got in the way was organic chemistry.

[00:04:29] Gone on. I know. Yeah, I know. I wasn't, I wasn't about to do that. I mean, there you have to, it takes a special person. You have to have a lot of skills in a lot of different areas and, um, you know, the, the people person and the kid person and then the technical skills. And you gotta be at the top of your dental school class.

[00:05:03] Dr. Leon Klempner: you caught me.

[00:05:08] Amy Epstein: I, I know an opportunity when I see one.

[00:05:10] Amy Epstein: Um, yes. I'm Amy Epstein. I am the first daughter of Dr. Leon Klempner and also of. Career marketer, um, spent some time outside of the industry of orthodontics and spent about 15 years inside the industry of orthodontics, bringing some of the tenets of marketing over to the industry of orthodontics because marketing, the framework of marketing, although changing a lot of the core pillars of marketing are the same.

[00:06:02] Um, you know, Trey, he's the CEO of the a a o, and he has had a long and distinguished career in law and advocacy. Uh, he's been on the show before and we've asked him all the questions and we're gonna ask him some, some different ones again because we know that they're always top of mind. He's been a pivotal figure, uh, in guiding orthodontists through complex legal and regulatory landscapes.

[00:06:51] So, and that, um, you know. I think is a great way to, it illustrates Trey's commitment to making the legal [00:07:00] information that he has both accessible but also actionable for orthodontists. Um, and so we're excited to talk about his insights and the evolving challenges that we're facing today. Trey, thank you for being here.

[00:07:17] Amy Epstein: we're not, you're not new to our podcast and we know you do. So Yeah. You don't have anything to work worry about. But I wanna say one thing before we talk about all the, the questions that we have for you.

[00:08:09] And it can sometimes, I've gotten this feedback before. In my professional career, in in public relations as being like a little aloof and for by others that are more extroverted. And if you spend enough time with introverts like us, you realize that we're really paying attention to all the details. And so I wanted to say thank you for that.

[00:08:41] Trey Lawrence, CEO of AAO: Yeah, no, absolutely. It, it influences everything you do. And I, I'll start with, you are not alone in feeling heard by that. So that post did better than I, you know, not a huge. Uh, presence on LinkedIn, but that one certainly got some link attention on LinkedIn.

[00:09:19] I feel like nobody understands me. And so that's been. The big piece of me, of, of it for me is first of all, recognizing there neither, neither. Neither, you know, mindset, an extrovert introvert is better or worse than the other. They just have strengths and weaknesses. And you, to start with, you have to start in yourself and lean into the strengths that your own skillset possesses.

[00:09:59] [00:10:00] Perspective I was hearing from a different group of members than I dealt with mainly in the advocacy part of the world, and, and hear what they were saying needed to be done and then start to take action after that. And we have, and we've got some things going on, some revamp social media that's coming in particular for a, a o that was a result of that listening.

[00:10:36] Mm-hmm.

[00:11:02] It was fun, it was informative. Um, it was, it had a whole entirely different vibe.

[00:11:18] Trey Lawrence, CEO of AAO: Yep. That's, no, that's what we wanna hear.

[00:11:44] And I'm very excited. We've got several board members coming as the next few presidents that are equal listeners, and we're going to continue to listen and do those things that our members want. And I think you saw that this year.

[00:12:06] And, um, no surprise that a lot of these are in the, um, legal landscape, risk management arena. Um. You know, first we wanted to ask you from your vantage point, um, the most common legal blind spot for orthodontists today, and that may have changed. This question may have been, have been answered differently last year or the year before.

[00:12:35] Trey Lawrence, CEO of AAO: I still continue to think that it's a combination of primarily HIPAA violations, but some other things all wrapped up into social media. Because social media is, I, I mean, it's still relatively new. I mean, the law lags way behind, you know, when something develops.

[00:13:18] We've gotta get active there. So it's really this huge movement of people who have never really even. They, they've not been in that arena to begin with, period. Much less thought about the legal risks in that arena. And that's where I continue to see. I, I always joke every time I get on Instagram, I see somebody that's breaking a law somewhere among all the practices that I follow, I.

[00:13:47] Trey Lawrence, CEO of AAO: oh, I'm doing this,

[00:13:51] Trey Lawrence, CEO of AAO: a big, big category is, is practices not really realizing the. Stint to which HIPAA protects patient information so [00:14:00] everybody knows you can't turn loose treatment details, those kind of things.

[00:14:24] So things like, I see like when practices have drawings and they pull out a winner's name and they read the name and I see them reading the full name. Uh, so I'm hoping every time they do that, they've got a signed HIPAA release from that patient or mom or dad, because otherwise they've just. Disclose the fact that that patient treated there and that's a HIPAA violation.

[00:15:03] So just any of those things that just show that somebody's in your practice receiving treatment. You've gotta have either authorization from them or you've gotta make sure that they're screened from making it into those posts. Yep.

[00:15:17] Dr. Leon Klempner: Yeah. So Trey, you know, if I'm a listener and I'm listening in on here, I'm saying, okay, there's risks here.

[00:15:35] Trey Lawrence, CEO of AAO: Yeah. Uh, well, so the short answer is don't say that. I mean, you have to be on social media. Our a a o data is showing the, the trend that patients who are first come into contact with their practice, you know, it's increasing dramatically.

[00:16:11] So certainly I think working with a reputable, uh, you know, marketing company or practice management team that can help you, you know, working with experts in that area can help you guide, guide you through some of those risks. And then I, I. Obviously the AO legal resources, my own social media, and so much of it is not necessarily, you have to have the law memorized, it's just be conscious of what the risks are and that's, that's easier than knowing exactly what the law is.

[00:16:54] Dr. Leon Klempner: All right, great. Uh, so, you know, we have a lot of topics to cover, so I'm gonna be flipping back and forth, kind of [00:17:00] rapid fire type of thing.

[00:17:24] Non-competes come up, you know, as one topic. But you know, what should new grads or or young associates be on high alert for when they're, uh, interviewing and reviewing job offers?

[00:17:44] I've seen several. What are titled independent Contractor Agreements over the years that you start reading them, and it's very clear that that's an employment relationship, but the hiring entity, it's in their best, best interest, obviously, to classify somebody's an [00:18:00] independent contractor. And so they've titled it that way and, and as a resident who's graduating and not familiar.

[00:18:30] I suspect that. Hiring entities are going to be looking at ways, even if that ban goes in place, to still basically do the same thing. And I think the other challenge where I've seen the most trouble lately is in multi-location. So the employer has multiple locations and your interpretation of a non-compete may only be the one specific location that you're working in, and then you go to leave and find out that they're measuring 10 miles out from.

[00:19:20] Point in their life where they can spend a lot of money on anything. But there are people who will review a contract and do a good job, are credible, you know, very skilled attorneys, and will charge a fee. They know where a resident is at that stage in their career. You know, their, their goal obviously is to get that resident's business later in their career.

[00:19:59] [00:20:00] And that should be, it's, it's an investment that's well worth it for a resident as opposed to end up in a mess that you spend a lot more than that later trying to get out of.

[00:20:18] Uh, so as we talk to our clients, and I'll share it with our growth consultants, um, as they talk to their clients too, that the AO can be a resource here. So that's good.

[00:20:29] Amy Epstein: Um, let's talk about, let's go back to hipaa, uh, for a second and talk about online reviews. And it's something that's probably makes it into every podcast we have together, uh, because it just keeps coming up and, um, we, we handle this.

[00:21:08] Don't respond to that or you know, just lay low. And, but the, the instinct is to defend oneself when you're being accused of something that you feel is, or mis it's misrepresenting what happened. And that's always what happens. It is never really like the honest situation about, or, you know, 'cause everybody's perspective is their own perspective, right?

[00:21:47] What do you advise them? Yeah,

[00:22:11] And it's especially the case because anytime that you're writing one of these, you're emotionally charged and that clouds judgment and. You know, clouds the senses to be alert for these things anyway, so I, I absolutely don't go with that instinct. But then instinct number two is to not respond at all.

[00:22:51] So that's why I think a highly curated, very careful response. The, our a l recommended response is [00:23:00] always. It appears there's been a misunderstanding. Please contact our office to set up a time to discuss. You're not admitting anything factual about the patient, even that they were a patient. Mm-hmm. You, but you are responding.

[00:23:27] Amy Epstein: Mm-hmm.

[00:23:42] Dr. Leon Klempner: times we, we counsel our clients, our orthodontic practices to consult with us. Don't immediately answer.

[00:23:51] Amy Epstein: Keep it simple here. Such way, day. Yeah. Day,

[00:24:07] Amy Epstein: mean, you're, you're in an.

[00:24:29] Dr. Leon Klempner: you know, let's say I'll, I'll treat a thousand cases and I get a beautiful result, and then I have one that.

[00:24:40] Amy Epstein: Yeah, I know. You know, and

[00:24:56] Amy Epstein: Mm-hmm.

[00:25:27] It's gotta be, uh, solid. Um. Most of the, uh, informed consent is, at least in my practice, was, um, filling out the form, maybe asking questions, sometimes not, sometimes it would be done by, you know, the TC and not me. So give us a, some guidelines in terms of what you feel would be the best way to manage, uh, informed consent in orthodontic practice.

[00:26:24] And so if you have a evidence that the patient understood the risk or understood the treatment outcomes and agreed to treatment, knowing that, then that negates. Huge number of those malpractice claims, but the challenge is always that this is not, again, not unique to patients. This is just consumers generally.

[00:27:08] So the key then. You have to design your informed consent process with a patient in a way that removes as much possibility for them to make that argument as possible. So this, this informed consent topic continues to make me nervous because as we develop. You know, all these really cool new tools for patient intake and filling out documents online before they even come in, and all these things that are so helpful in so many ways.

[00:27:59] I. [00:28:00] About what's in the informed consent before they sign. I understand practices have different workflows and many don't regularly have the doctor do that. At the very, very least, give the patient the opportunity. Say, you know, do you, okay, I've explained everything to you. Do you have any questions or would you like to talk to Dr.

[00:28:37] And if they don't have, if they say, well, no, I, yeah, some staff person gave me all this, but I never even had the chance to talk to the doctor about this before I signed that. That's the single biggest place where I see the challenges to an informed consent coming up.

[00:28:58] Smith? And they, they say, you. [00:29:00] We, they didn't say that. Right, because the, I mean, how do you sort of, do you say that's just part of our protocol? You can see our protocols here. It includes the, you know, how do you prove that you offered that opportunity?

[00:29:25] This is our informed consent workflow. That's going to be immensely helpful. Even short of that, just the testimony of staff, you know, if you have your. Treatment coordinator is regularly the one that walks through the informed consent and then she or he is able to testify no, every single time, it's just our policy that I would at least offer to the patient to have the doctor come in.

[00:29:58] Dr. Leon Klempner: uhhuh. And what about just simply [00:30:00] putting a, a, a, a comment in. Uh, form consentment reviewed, patient, given an opportunity to talk to the doctor, had no questions.

[00:30:09] Trey Lawrence, CEO of AAO: Yeah. Uh, that, that individual entry in an individual's chart is going to be another piece of evidence. I mean, any of these things with evidence, you know, it's always, the more the merrier, the more evidence you have, the better. So certainly that's could be an important piece too.

[00:30:27] Um, okay, so, um, moving on from this like negative review situation and then, you know, malpractice or whatever, um, when you see something coming down the pike with a patient or a potential patient where, um, they're either being, um, disruptive, they're not paying, um. Especially in tricky cases and, you know, um, contentious co-parents, things like that.

[00:31:10] Trey Lawrence, CEO of AAO: Yeah, the, I mean, the rule of thumb is that as long as you're not leaving the, by dismissing the patient, you're not leaving them in a worse situation when than when they first came in.

[00:31:35] But these disruptive patient situations, I, I think to Dr. Klenner's point earlier, the perfectionist orthodontist doesn't want to, you know, kind of admit failure by dismissing a patient. You know, this situation was so problematic that we had to move on. But in many cases. That is the, that's the safest course is to move on and, [00:32:00] and two, the other thing I think sometimes the Dr.

[00:32:22] So as long as, I mean, certainly giving the patient or the parent notice, you know, having a conversation with them and documenting that you talked through the concerns, um, sending them a letter saying, you know, these are the concerns that have arisen and we would love to continue to treat you, but may have to consider.

[00:33:03] Um. We will see you in the next 30 days. If you have an emergency, we're happy to provide copy of records to you and we can refer you to another provider if you wanna continue your treatment somewhere else. Those are the legal elements. If you do all of that, then you're covered legally. So why wouldn't you avoid the additional risk that could come up from trying to power through it and continue to treat that really problematic patient or parent?

[00:33:56] Tell, you know, something's happening at the practice and you wanna tell patients [00:34:00] as soon as possible, as clearly as possible. They don't wanna hear it from somewhere else face-to-face, especially as you're talking to your team about a change is, is the best way to do it, you know, and I would imagine that, that it would go really far to be able to have a face to face and be like, look, we're we're facing these, uh, challenges.

[00:34:32] Trey Lawrence, CEO of AAO: Yeah, absolutely. I mean, certainly just on a basic human.

[00:34:57] Yeah. But I know that there are others like you [00:35:00] all that are much better situated to you, you know, provide a, a framework for how to have that conversation.

[00:35:13] Dr. Leon Klempner: So Trey time's flying by, but I can't let you go without talking about my favorite subject, which is AI gave a talk at the a a o about how, how quickly this technology is permeating into the orthodontic profession.

[00:35:53] Trey Lawrence, CEO of AAO: Yeah, it, the AI is like so many other technologies that have come along that offer so much promise from the [00:36:00] proper use, but so many risks or challenges from the misuse of it. And the AI in particular, I think really goes to Dr. Callahan as our president that just wrapped up. He ca, he's called this the existential question for dentistry and it's protecting the sanctity of the doctor patient relationship by not allowing technology.

[00:36:45] And that's the question for ai. So the. Challenges the ai, I think those lines can get a little blurrier. And so this is going to continue to be a conversation that will go on, [00:37:00] I'm sure in the foreseeable future. I will a little a a o commercial here. The a a o has assembled a task force on the use of AI and orthodontics.

[00:37:39] The doctor, but should not be replacing the doctor in the, the areas that only the doctor, uh, you know, that, that are solely the doctor's role. And so, but I, I'm certain that this position paper, once it's finished, uh, like, like they say about so many things in it, it will never truly be finished. I think it will be going an ongoing process, processes, new [00:38:00] particular technologies come out to help define when is this being used properly or when is this replacing the doctor.

[00:38:30] Sure.

[00:38:35] Amy Epstein: Right after the a a o next year. So, Trey, thank you for being here. Thanks for sharing all of this, uh, really valuable information with us. Um, and the, and illuminating where the a a o can be a resource. For orthodontists, um, to get really thoughtful, well-researched, um, information about these questions that we had.

[00:39:05] Trey Lawrence, CEO of AAO: Yeah. The easiest way is if you get on the AO member website, there's a legal resource center. One of the tabs there is they contact the AO legal team tabs so that you, you or a team member, as long as they, you know, if you wanna have one of your team members submit a question, I.

[00:39:43] Members or anybody in dentistry, honestly, through Instagram. Mm-hmm.

[00:40:00] So thank you for that.

[00:40:25] Amy Epstein: Mm-hmm. Yep. And for all those that think that introverts don't like to make connections and be connected to people, like you're looking at a couple of 'em right here and uh, you know, we just take a different route to getting there. So Trey, thank you again for being here. I look forward to seeing you again soon, and if not before, then one year.

[00:40:45] Trey Lawrence, CEO of AAO: deal. Thanks. Thank you all.

[00:41:06] Dr. Leon Klempner: Thanks for watching and listening. I'm happy to say that we've, uh, reached our 1000000th download last month for people that's practice. Mm-hmm. So, um, appreciate everybody there. By the way, it's the ortho attorney I made this mistake. Mm-hmm. It's not the ortho attorney. It's the ortho attorney.

[00:41:24] Dr. Leon Klempner: Ortho attorney, like orthodontist,

[00:41:27] Dr. Leon Klempner: Ortho attorney. Okay. Uh, if you wanna reach me, talk about marketing, talk about. AI talk about risk management, anything that we've talked about here on the podcast, uh, it's leon@pplpractice.com. If you're looking for a deal, our sponsors are offering, uh, uh, a deal to our listeners on our partner page, you go to ppl practice.com and remember, most important thing for forward thinking orthodontist, it has never, ever.

[00:42:05] Narrator: Thank you for tuning in to the Golden Age of Orthodontics. Subscribe now on Apple Podcasts, Spotify, or visit our website at the golden age of orthodontics.com for direct links to both the audio and video versions of this episode.