The Cataract Van has been pulling up to our facility for 13 years, unloading its precious cargo in our driveway and magically transforming our ORs into sparkling eye suites a few days a month. Be it 5 or 15, when the day’s cases are done, a tech wheels the phaco machine back onto the van and drives off until the next visit.

Welcome to roll-on, roll-off cataracts. The on-demand outsourcing model suits our 2-OR multispecialty surgery center especially well. We do 450-600 cataract cases per year, certainly not an insignificant number, but probably not enough to justify buying our own equipment.

We used to own our own cataract equipment, but in 2005, with cataract case costs rising and reimbursements shrinking, we decided to give outsourcing a try. We’ve been doing so ever since, contracting with a mobile service that provides everything we need to perform cataract surgery around 5 days a month. And I do mean everything — equipment, supplies, intraocular lenses, even a highly trained technician, who always arrives on-time, ready to help make the day run smoothly without any anxiety or frustration for our surgeons and staff.

$31,000 in annual savings

The Cataract Van arrives on the 1st, 2nd, 4th and 5th Tuesday of the month, as well as the 1st Monday of the month. On average, we do 7-10 cases on each of those days. Our outsourcing company charges us $475 to $525 per case, sending one invoice per each date of service. Sound expensive? Well, when you consider that our per-case costs would be around $650 if we went it alone, it’s actually a good deal (see “Each Cataract Case Would Cost Us $649.44”).

Each of our 3 eye surgeons incurs a different per-case charge, the variance due in large part to the disposables in each one’s custom packs. We get a price break of around $20 less per case if we do 11 or more cases in the same day, but we rarely qualify for the discount because it’s difficult to get 2 eye docs to operate on the same day.

Our outsourcing company charges us $475 to $525 per case. If we went it alone, our per-case costs would be around $650.

Our per-case outsourcing cost increases if a patient chooses a premium IOL — we pass the extra cost on to the patient — or if a surgeon wants to use an item outside of his usual pack, such as an iris retractor or BSS Plus. Not to worry. The Cataract Van is stocked with any items our docs might require or request in a case.

While outsourcing may not be cost-effective for facilities with a higher case volume, it’s a perfect fit for us. It saves us around $31,000 per year. We estimated that our annual costs of owning our equipment would be $292,248. Our yearly cost with our outsourcing firm for the same number of cases is $261,636. That’s a savings of $30,612.

Then there’s purchasing power to consider. On our own, we wouldn’t have nearly as much volume as a single-specialty eye center to qualify for volume savings on supplies. But through our outsourcing firm, we technically pay the same discounted price as they do for surgery packs and disposables.

Our per-case outsourcing cost covers:

• phaco machine;
• surgical microscope;
• multiple phaco and I/A handpieces (we need several because we no longer flash-sterilize);
• surgical supplies pack (per each surgeon’s preference), including tubing;
• IOL;
• a technician to set up and operate the phaco machine and microscope; and
• maintenance of the equipment so that it functions properly.

Making ends meet

Outsourcing is a sensible option in many scenarios. It’s a no-risk way to test the vitality of your cataract surgery market without a large capital outlay. If we didn’t outsource, it would be cost-prohibitive to perform our volume of procedures. We’d have to factor all of the equipment, supplies and staff that we outsource into our per-case cost. But that’s not all. We’d also have to account for:

• initial capital outlay of hundreds of thousands of dollars;
• capital outlay each time we upgrade to new equipment;
• technician time in the OR for setting up and operating the equipment;
• inventory acquisition and management for IOLs and other supplies;
• space required to house equipment even when it’s not in use;
• unexpected equipment repair fees;
• annual preventative maintenance costs; and
• time to re-train a technician with each equipment upgrade. Speaking of upgrades: Cataract surgery is constantly advancing, necessitating investment in new machines, handpieces and instrumentation. No way could we afford the constant upgrades, but our outsourcing firm certainly can, so we can offer our surgeons the latest technology for safety and efficiency.

Peace of mind

Although we outsource because it’s best for our bottom line, the quality of service we receive and the technical expertise we benefit from are invaluable. It’s nice to know that if our volume should dip, we wouldn’t be saddled with paying for equipment that we’re not fully utilizing. Outsourcing is the most cost-effective way for us to deliver excellent cataract care that’s affordable for patients, appreciated by surgeons and profitable for investors. Our fundamental mission is to provide first-class surgical services to every patient, every family, every time. There may be no better testament to how outsourcing helps us fulfill that mission than the fact that my own mother had both of her cataract surgeries at our facility.

Well, gotta run now. The Cataract Van just pulled up. OSM