The bottom line: Problems with surgeons

By Stephen W. Earnhart, MS
President and CEO
Earnhart and Associates, Dallas

One beauty of penning this column every month is the great e-mail, phone calls, and faxes I receive. I am averaging about 75 per month. Most are supportive. I get a lot of comments like this from readers: "You validated to my bosses what I have been telling them for years."

I get great jokes! I appreciate them all — please keep them coming. But even better than the jokes and thanks are the questions and the give-and-take discussions on the issues. I thought I’d share some of the more recent ones with you. The questions and responses have been altered slightly to protect the writers’ identities.

Question: "We suspect one of our ophthalmologists is involved with an IOL [intraocular lens] rep. I don’t know if there is any connection between their relationship and the price of the lens the surgery center is paying. We are up to almost $200 for this lens! He does just enough cases at the center for us to want to keep his business.

"We have tried repeatedly to get a better price on the lens from the rep. She keeps saying that this is what the doctor wants, and this is the price. We have met with the surgeon and explained that we just cannot afford this lens price — especially when the lens the other ophthalmologists use is less than half the price of this "special lens" he uses. We have asked him to let us negotiate a better price with the rep and to support us. Nothing works. Any ideas?"

Response: It sounds as if you have done everything possible. I suggest the following, if you can get support from your ASC board: Explain to the physician that he can use any lens he wishes; however, the ASC will only pay up to $75 per IOL. Any additional price must be paid by the surgeon.

Bottom line: I had to follow up on this issue with the administrator. It seems the board did support the decision and granted her the authority. She told the surgeon, and apparently there was a big stink for a couple of days. The surgeon switched to a less-expensive lens (the same one the other physicians in the center were using) and, after several weeks, he stopped complaining.

Question: "Our facility is owned by several surgeons. They are constantly complaining that our costs are too high, that we pay too much for supplies, and that the nurses are way overpaid. We don’t think that is the case, but we have no way of comparing our prices to others. What can we do to shut these guys up?"

Response: Not much, unless you can prove your indicators are appropriate and in line with the rest of your peers. Benchmarking your top 10 procedures will go a long way to show where you are.

Bottom line: The center did gather cost information about its procedures, and we compared them to a database of like cases at other physician-owned, for-profit centers. The result was that the center was well below the average supply cost per case and right in line with personnel costs. They shared this information with their surgeons, who stopped complaining about the costs.

(Editor’s note: Earnhart can be reached at Earnhart and Associates, 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: World Wide Web: