READY TO GO Outsourcing companies bring needed equipment, supplies and trained techs and assist your staff in getting the service line up and running.

You supply the surgeon and the patient. The cataract outsourcing company takes care of the rest, sending whatever's needed for surgery, including a trained tech, surgical microscope, phacoemulsification machine and related handpieces, instrumentation and 2 new lenses (1 primary, 1 backup) for each patient. "They told us all we needed was a patient," says Rich Foster, RN, the nurse manager of the Northwoods Surgery Center in Woodruff, Wis. The outsourcing company even communicates with his surgeons' offices to find out which patients are coming to his facility for surgery.

Building block
Northwoods Surgery Center began outsourcing cataract cases as soon as it opened in 2008. "I'm not sure we had a choice at the time," says Mr. Foster. "But it was smart to do it that way. We didn't strap ourselves financially at the very beginning of our operation." Outsourcing cataracts let his fledgling facility gain its financial footing and add cases without capital outlay or investing in staff training.

Northwoods paid $620 per case ($570 base charge plus $50 travel fee) and pocketed the remainder of the more than $900 in reimbursement it collected in facility fees. "It wasn't a great deal, but it was good enough to justify using the service that first year," says Mr. Foster. "We were making money."

No one would mistake Northwoods for a high-volume mega-center — a single cataract surgeon performs about 10 cases a week, reserving a morning block in one of the center's ORs — but the demand is enough to justify offering the service to patients in the community. Besides, aging cataract patients might return for other procedures, such as orthopedic surgeries and GI exams.

About 2 years after opening, when the center's revenues began to climb, its leadership decided to invest in new cataract equipment and strike out on its own. Physician-owners put more than $30,000 into a phaco machine, $53,000 into an operating microscope and a couple thousand more into instrumentation. "With the money we were generating from all the specialties, we had the $90,000 it took to add ophthalmic equipment," says Mr. Foster. It was a move that wasn't possible years earlier. That's part of outsourcing's plus: It lets you add a specialty with little risk or investment.

Peace of mind
JCMG Surgery Center in Jefferson City, Mo., hosts about 8 cataract procedures every Tuesday, so it makes financial sense to outsource the service, says Natasha Gladbach, RN, lead holding and PACU nurse at the facility. Reps from the outsourcing company set up their equipment Monday evening, spend the night in a local hotel and return first thing in the morning. "We like the system and the equipment is state of the art," says. Ms. Gladbach. "We've really been impressed."

She recently attended a seminar where she learned that post-op infections in cataract patients have been linked to the improper flushing and cleaning of instruments and equipment. Working with an outsourcing company can lessen those risks. "They run the equipment every day and know it so well," says Ms. Gladbach. "That familiarity offers us peace of mind."

TEAM PLAYERS Techs employed by outsourcing firms expertly assist your cataract surgeons and often fit seamlessly into your staff.

ASSESSING THE OPTIONS

Partner With the Right Outsourcing Firm

Doing your homework is key to making outsourcing work, says Mark Vandersnick, RN, operating room manager at Sanford Worthington Medical Center in Worthington, Minn. Ask around to other facilities in your area that use the service to ensure you're dealing with a reputable firm. Evaluate the exact equipment the outsourcing company will bring to your center. Is it state of the art? Where do they get the lenses that will be implanted in your patients? Most secure them from major players in the marketplace, but it doesn't hurt to confirm that they do.

Inquire about the education, experience and expertise of the technician the company will send to assist your surgeons, suggests Mr. Vandersnick. The bedside compatibility between the two is vital. "It'll be obvious to see how well they work together," he says. More importantly, make sure outsourcing techs practice sterile technique and follow your facility's protocols. If they continually mess up, it's up to you to demand more and straighten them out. "Outsourcing companies are providing a service to your facility, not your surgeons," points out Mr. Vandersnick. "You're the one who's paying for it."

— Daniel Cook

Saving for the future
Mark Vandersnick, RN, is the operating room manager at Sanford Worthington Medical Center in Worthington, Minn., a facility that hosts 25 to 35 cataract cases each month. Would he like to move his facility's cataract services in-house? "I think about it repeatedly," he says. "But right now, I've got too many things on my plate," including trying to get a robotics program up and running. That points to another benefit of outsourcing: You can keep cases flowing through your ORs and let experts deal with the headaches so you can focus on more pressing needs.

Although content with his outsourcing firm, Mr. Vandersnick admits he's frustrated by one aspect of the relationship: the money he's leaving on the table. "I don't necessarily like the amount we spend on the service each year," he says. "Right now, it's minimally profitable." He says he'll run the numbers next year to determine how many cases his facility would need to host to turn a profit while paying for capital equipment and staffing expenses. Until then, he'll let the outsourcing company do its thing. "It really is a slick process," he says, "which makes it easy for my staff to assist the surgeon rather than caring for equipment and instruments."