From cataracts and anesthesia to laundry and coding and billing, outpatient surgical facilities occasionally require external assistance to support their day-to-day operations. We surveyed our readers on whether their facilities outsource services, the advantages and pitfalls they've experienced and how to get the most out of such arrangements.

Reasons for the resource
Subcontracting support services is not in the cards for every surgical facility. Those joint-ventured with hospitals, healthcare systems, corporate partners or management firms often have access to such services in-house. But for many other facilities, outside assistance is a positive advantage. About 61% of respondents to our survey say they outsource some type of service at their facilities. Linen and laundry, housekeeping, and anesthesia lead the survey's list of the most frequently outsourced services. Other common choices include biomedical engineering, information technology and coding and billing.

Why outsource? The answer usually comes down to efficiency, economy and expertise, say readers. "There are limitations to what we can do in a given day, and a lot of times it is cheaper to outsource than to buy equipment and hire the employees needed to do the task," says Penny Nichols, MBA, CASC, administrator of the Greater New Orleans Surgery Center in Metairie, La.

As a staffing solution, it can free your employees to concentrate on their core duties — "Outsourcing lets us make better use of our smaller staff," says Kari Stewart, administrator of the Pasadena Plastic Surgery Center in California — or keep your payroll manageable. "It reduces staffing and benefit costs, which are greater than what is paid for the services," says Mary Becker, MSA, BSN, RN, executive director of the Waterford (Mich.) Surgical Center.

Outsourcing can also provide access to the services you need to stay compliant with government regulations and accreditors' standards, to provide high-quality care, to remain fiscally solvent or to keep your technology running, but don't have the ability, budget or inclination to build into your staff. Don't have the budget to stay current with every cataract surgery equipment upgrade? Can't keep up with every coding and billing rule change? Don't have an interest in managing an anesthesia practice? No problem, you can hand it off to the experts.

"The expertise and experience of contracted organizations are often superior to that which an ASC could provide," says Donna Durden, MBA, administrator of Murdock Ambulatory Surgery Center in Port Charlotte, Fla. "In many cases it makes no economical sense to maintain the services in-house."

Snags and solutions
Outsourcing is not always a perfect solution. When you cede control of part of your operations, the results might not meet your expectations.

"Linen services and housekeeping services are the 2 most difficult services to manage and ensure the contract and actual services match," says Karen Gabbert, RN, BSN, clinical director at the Surgery Center of Kansas in Wichita. The delivered scrubs and bedsheets or terminal OR cleaning just might not be up to snuff, and quality control "requires many hours of interaction and troubleshooting." Likewise, coding and billing might not be done as thoroughly or as timely as you'd do it yourself. And outsourcing anesthesia may place you in a precarious position, says a Pennsylvania ASC administrator. "They have the power to pull the plug on operations. They're just a surgeon's temper tantrum away from leaving."

"The challenges come in making sure that they meet our standards, CMS's standards and OSHA's standards," says Ms. Nichols. "We still have to train and audit them." The fact that they're not in-house and on-site means they might not be immediately available or easy to schedule on short notice, say others, which could be particularly problematic with regards to maintenance engineers and IT techs.

Some administrators also doubt that service means dedication. "Some contracted services are not as engaged as an employee would be," says Colleen Heeter, senior vice president of operations for Nueterra Healthcare. Jo Slocum, RN, BSN, director of Cincinnati's Tri-State Centers for Sight Surgery Center, agrees. "No one takes ownership of your facility quite the same way as you do."

The administrator who contracts out ancillary services is not without recourse. Survey respondents tapped into their experience for advice on making the best deal possible with outsourced employees.

Service is often better, or better service can be obtained, when there's more than 1 option in your area. "Put them out for bid if you are able to. Make them compete for your business," says Candy Carpenter, BSN, RN, COE, the CEO of Amarillo Cataract & Eye Surgery Center in Texas. Keep in mind that the best service might not be the least expensive option. "The low-cost bidder is not always the quality choice," warns a Georgia endo center administrator.

Research the company's quality and reputation, especially among your peers. "During the initial interview process, get references. And check them!" says Ms. Gabbert. The job you're hiring them for "is something you do not want to micromanage, so getting a service that is compatible with your current operations is important. This will let you turn it over and be confident."

A detailed contract is the key to compliance with standards. "Develop a thorough service agreement with performance and HIPAA privacy responsibilities spelled out," says Keith Young, MBA, MT(ASCP), the CEO of the Medical Center at Ocean Reef in Key Largo, Fla. "Ensure that the service provider presents and maintains an appropriate level of liability insurance. Make this the contractor's responsibility." Consider including a trial period to avoid being locked into an undesirably long contract if services are sub-par.

The contract may have set forth your expectations and policies, but there still may be a learning curve for the service provider, so be sure to follow up. "You must constantly evaluate the services, have open communication with them and have realistic expectations of what they can provide," says Julia Hensley, RN, administrator of the Eye Surgery Center of Middle Tennessee in Nashville.

This means not only verifying invoices, but also measuring quantifiable outcomes for such services as anesthesia or coding and billing. "Develop measurements to grade performance and make notes, monthly, quarterly or yearly as designed," says Mr. Young.

Otherwise, make a point of interacting. Housekeeping's after-hours work can hinder regular communication, says Shirley Torwirt, MHS, CASC, manager of The Doctors Clinic ASC in Silverdale, Wash., so "drop in periodically to observe the housekeeping staff in action, to see the processes, validate cleaning practices and meet with the manager to discuss any questions or issues that may arise."

Keep in mind that outsourced services are more than just a budget line item — they're a component of your efficient operations — and plan your arrangements accordingly.