Cataract outsourcing companies charge a per-case fee that covers all you'll need to host procedures: a surgical microscope and phaco machine, lenses, disposables, handpieces and an experienced surgical tech. It's a great way to see if you can make the specialty float before committing capital dollars to bring it in-house. How many surgeons will you recruit? Will they bring in all the patients they promise? What will your actual case volume be? Whether you're looking to host a few cataract cases in a rural outpost or start a high-volume program, outsourcing companies can help you answer these critical questions while realizing profits with very little financial risk. Let's explore how.

Start-up savings
An industry expert says a new ophthalmic microscope costs between $60,000 and $80,000 (demo or refurbished models can be had for $30,000 to $50,000), and a phaco machine runs between $40,000 and $50,000. That's $130,000 in potential savings if you work with an outsourcing vendor. Specialty lenses or equipment that is deemed above and beyond the standard of care might cost you extra, depending on the terms of the contract you negotiate.

Bob Smith, RN, BSN, the operations manager of an ASC in the Marshfield Clinic, a health system with locations throughout Wisconsin, says his facility hosts up to 20 cataract cases 3 days a week — more than enough to justify starting a cataract program of its own. During Mr. Smith's discussions with the center's physician-owners, however, they looked at the costs of purchasing surgical microscopes, phaco machines and an inventory of lenses, handpieces and disposables. That's when Mr. Smith came across the outsourcing option, which turned out to be the most viable choice at the time.

It still is. Mr. Smith recently crunched the numbers to see if it was time for the facility to take over its cataract cases. A review of the supply pricing he could secure through the center's GPO and the staffing costs he'd incur by adding trained techs to the payroll couldn't compete with the outsourcing vendor's ability to leverage high-volume supply purchasing into huge discounts and the experienced surgical tech that's included in the per-case fee.

Allana Coleman, RN, BSN, the surgical services nurse manager at Coryell Memorial Healthcare System, a 25-bed hospital in rural Gatesville, Texas, points out that after doling out cash for the surgical microscope and phaco machine, you're still on the hook for maintaining the expensive technology — the maintenance contracts on large pieces of equipment can be astronomical, she says — that eventually becomes outdated and suffers from the wear and tear of regular use.

When an ophthalmologist approached Barbara Blau, RN, BSN, CNOR, with the idea of adding a few cataract procedures each month, she jumped at the chance to bring more cases into her brand new surgery center — with the help of an outsourcing company. "We were just starting out," explains the clinical director at Methodist North Surgery Center in Memphis, Tenn. "The days of 'if you build it, they will come' are over."

Ms. Blau now has the case volume to rationalize managing the cases herself — more than 740 each year — but adding high-definition equipment to the facility's ORs and other needed renovations has precluded another big hit to the capital budget. Once again, outsourcing cataracts is keeping moneymaking cases cycling through her ORs and cash in the coffers.

While cataract surgical technology evolves slowly, you'll know that your surgeons will work with the latest tools in their hands. Outsourcing services supply "state-of-the-art equipment," and can supply brands preferred by your docs, says Ms. Coleman, who admits she's out of the loop when it comes to knowing about the latest and greatest equipment and lenses. Working with an outsourcing company makes that irrelevant. "We know our surgeons won't be dealing with archaic machines," she explains.

Value-added benefits
Some of the financial benefits of outsourcing your cataract cases aren't as obvious as comparing per-case fees to facility reimbursements. For Ms. Coleman, hosting cataracts is about providing a service to the community instead of adding to her facility's eye surgery profits. "We basically do it for good PR," she admits. "Patients feel at home" and come to the facility for other services, which helps boost volumes in other more profitable service lines. Here are some other indirect ways outsourcing might help your bottom line.

• Staffing savings. Have you considered the staffing hours you'd dedicate to ordering and stocking the supplies — particularly lenses — and caring for the equipment needed for cataract cases? Outsourcing services provide an experienced tech to assist your eye docs, manage supplies and help keep the equipment in tip-top shape. According to Stephanie Rubio, RN, executive director of the Surgery Center at Health Park in Grand Blanc, Mich., partnering with an outsourcing firm frees your staff from the labor-intensive tasks of ordering and tracking lenses, getting patients' info from physicians' offices, handling purchase orders, returning unused lenses to manufacturers and ensuring the correct lenses are in stock and available the day of surgery.

"All that goes away, several headaches disappear," says Mr. Smith. If you sign up as a mobile site, the needed supplies are brought in for the day's cases, meaning you won't fill valuable shelf space or worry about par levels and overstocking issues. Even if you have enough volume for the outsourcing firm to keep equipment and supplies in your facility, the on-site surgical tech manages the par levels and reorders items as needed.

Ms. Blau has several nurses who had circulated during cataract cases, but not a single experienced tech. She says not having to train a member of her own staff and relying on the expertise of the company-supplied clinician is a huge plus. The tech at her center maintains the microscope and phaco machine. "She's considered part of my staff," says Ms. Blau, who enjoys not having to worry about properly cleaning and storing equipment at the end of each day. If equipment breaks down, the tech works with her outsourcing employer to promptly fix the problem or get replacements on site, free of charge. Ms. Rubio notes that on-site techs troubleshoot issues that would ordinarily grind cases to a halt and can train staff on new equipment that surgeons want to add.

• Physician satisfaction. The expert techs supplied by outsourcing vendors provide eye docs with a level of comfort and can help them develop trust in your facility. "We were weak from an experience standpoint," says Ms. Rubio. "But our tech has been in the field for a long time. He's the go-to guy for whatever our physicians need. It's really been a saving grace." That comfort factor increases surgeon satisfaction and helps Ms. Rubio's recruiting efforts. In fact, the tech and a rep from her outsourcing partner visit the offices of eye docs who aren't yet operating in her center, a value-added service that she says is invaluable to pumping up case volumes and profits.
• Clinical and supply efficiencies. For a staff with little cataract experience, working with a knowledgeable tech can mean the difference between sluggish patient flow and profitable efficiency. The tech at Ms. Coleman's hospital worked closely with her surgeon and staff to improve their clinical skills (staff had difficulty properly and quickly adjusting the phaco machine's power settings between cases), which helped cut cataract case times in half. "The turnaround was drastic," she says, noting that the day's cases now wrap up by 3 p.m. instead of extending into the evening.

Clear reasons
Mr. Smith says working with an outsourcing vendor leaves him with a "comfortable" margin after he collects the local $923.17 Medicare cataract facility fee. If the Surgery Center at Health Park were to purchase its own equipment, the facility would stand to make more money, acknowledges Ms. Rubio, whose center is scheduled to be reimbursed $1,022.42 per case in 2011. But for now, outsourcing cataracts and leaving the paperwork and equipment upkeep to others makes sense for her maturing center, which is just starting to enter the black in its sixth year of existence. While the earning potential might be greater if you manage cases and supply inventories in-house, working with an outsourcing firm is a great way to add cases and revenue with minimal financial risk. Ms. Blau initially began working with an outsourcing firm to woo docs to her center, but she says that's not what drives the partnership forward: "I wouldn't outsource if it wasn't profitable."