Q: What do you see as the major challenges and opportunities currently facing orthopedics in surgery centers?
Dr. Douglas Carlan: There continues to be financial challenges in the current economic and managed care environment. One challenge is with the insurance companies and the payors when it comes to using orthopedic implants at a surgery center. There are certain carriers that will pay for implants at a hospital but won’t pay for them at a surgery center for the same procedure, same implant. That creates sort of a logistical problem for me in the fact that I do almost all of my cases in the surgery center. If I get someone whose insurance is not paying for the implant, I have to either ask the surgery center to unfairly take a hit and not get paid for the implant or take the case to the hospital, which changes what I do during the day.
The other challenge right now is with patients and seeing increasing deductibles and decreasing income and increasing cost of insurance. It’s sort of creating a perfect storm that’s making it difficult for consumers to even use the insurance that they buy. Every day I have a patient that says, “Well, let’s put this off either because I can’t afford this deductible or I can’t afford to be out of work. I’m afraid to be out of work because I may get laid off in the interim.”
Q: Is there an initiative your organization has undertaken in the past year that you are particularly proud of?
DC: We are proud of our efforts in opening a new surgery center [Carillon Surgery Center] in the summer of 2009. Upon opening we were immediately able to provide efficient, high-quality care because of the staff that was selected. The nurse manager who was chosen to run the surgery center has done this recently and also hired experienced, quality staff that allowed us to, from day one, operate as if we had been open for years.
Q: What opportunities are you pursuing for your organization to grow and improve efficiency/profitability this year?
DC: We are currently trying to grow our center by adding service lines and physicians. We are going to add a non-operative, sports-medicine trained primary care physician to our practice to try to increase the throughput in our office. That will allow us to see some more people — people with back and neck pain — that we don’t see now, hopefully with the effect that it will increase the volume of surgical patients that we are seeing. Down the road we’re looking to add a foot and ankle surgeon, and have considered adding a total joint surgeon.
For the primary care position, we put some feelers out and found someone who is training locally, interviewed and liked him. As far as adding orthopedic surgeons, we’re going to be pretty selective. We don’t need to add anybody. We have a pretty smooth running machine and would like to keep it that way. If we find the right person who fits the ideals of our practice, we will consider adding somebody.
Q: What is the best professional advice you have received and who was it from?
DC: The best advice I received was from Dr. Martin “Marty” Boyer in St. Louis who advised me to practice medicine in such a way that allows me to sleep well at night.
Learn more about Eaton Orthopedics and Dr. Douglas Carlan.
