While there was no shortage of patients needing cataract surgery when the Physicians Surgery Center in Rolla, Mo., started an ophthalmology service, the facility kept coming up short: short on storage space for the equipment and short on profits. That's when nurse manager Rhonda Chambers, RN, stepped in and suggested outsourcing.

She'd had a positive experience when she worked in a facility that used a mobile cataract service - a company that brought equipment, supplies and even its own techs to her ORs. Such a service could lower the initial investment and the risks of starting a cataract program, she reasoned with her bosses, who gave her idea the go-ahead. Today, four years later, the Physicians Surgery Center is a testament to the benefits of outsourcing.

"Before, we could only do about 19 or 20 cases a day, and that was during a long day," says Ms. Chambers. "But now we can do 40 to 50 a day."

Can you reap these kinds of benefits by outsourcing procedures that require a large capital equipment outlay? Here's what you need to consider.

Size up the savings
Kathleen A. Hasz, RN, BSN, the manager at the Marshfield Clinic in Wisconsin, was also once in a position similar to Ms. Chambers': Her facility wanted to add cataract and laser procedures. After crunching the numbers, she found that outsourcing the procedures would be more profitable for the facility than purchasing and hiring outright.

"Do an in-depth analysis to see how outsourcing will impact revenue for these cases," she says. "Look at your costs, including the necessary capital equipment, OR staff, materials and management, and be sure to include the cost of maintaining inventory."

But upfront prices are only a fraction of the cost, says David Kaminski, marketing manager for Streetsboro, Ohio-based ForTec Medical, which offers 35 laser platforms for a wide array of specialties. It may be tempting to look at the price of a large-outlay piece of capital equipment such as a laser - which can easily cost $100,000 - and calculate how many patients it would have to treat before it's paid off, he says, but this is misleading.

"One of the hidden expenses that [you might not expect] is a maintenance fee, which is usually about 10 percent of the price per year," says Mr. Kaminski. "Then you have to account for how much it will cost to hire the staff, and bear in mind that even if you have a laser safety officer you're going to have to have a backup for him, or else you won't be able to do procedures when this person is on vacation."

Once you figure out the cost of doing it yourself, you can start talking to companies about their pricing structures. Typically, these capitation fees run as low as $350 to upward of $700 for high-end equipment and a technician per procedure, says Daniel McCartney, vice president of operations and surgical services for MSS, a customized ophthalmic services and equipment company in Bloomington, Minn. The company delivers equipment, instruments, surgical supplies, intraocular lenses and a surgical tech to facilities.

"A good service provider will work with the facility to help them determine true profitability, because a good relationship is based upon a win-win for both parties," says says Dennis N. Deters, the director of business development for Vantage Tech-nology in Effingham, Ill. The company is in its 17th year of providing facilities with the equipment to perform cataract surgeries. "If the facility can provide true data ? the service provider should be able to work with you and the surgeons to make adjustments to maximize profit," he says.

Imagine the freedom
Because outsourcing services tend to be turnkey operations, you might see benefits beyond the cost savings. For starters, there's convenience. Why, even pathology services will come to your door. The Doctors Pathology Service Mobile Intraoperative Consultation Service van lets a pathologist work on site at ASCs or hospitals as needed. The van comes equipped with a grossing area for tissue cutting, a cryostat machine, microscope and a computer. Some companies, such as Greenbelt, Md.-based Mid-Atlantic Mobile Lithotripsy, provide a technician and an experienced RN, so "all the urologist has to do is break up the stones," says Jack Francis, MD, a urologist and the company's director.

Even administrators can be more hands-off: Ms. Hasz says the fact that her provider handles its own logistics and paperwork goes a long way toward improving the service for both physicians and patients.

"The staff, especially the circulating nurse, can attend to the patient without having to worry about paperwork, supplies and room set-up during the case," says Ms. Hasz. "That enhances the patient's experience."

You also free yourself from buying equipment that may soon become obsolete and gain the freedom of choice that comes from letting your surgeons use any supplies they desire when they pick a provider rather than the supplies that are tied to the capital equipment purchase, says Mr. McCartney.

"Some facilities try to keep surgeons happy with multiple machines and products, but I have met very few surgeons who love a vendor's product 100 percent of the time," says Mr. Deters. "I have met fewer than 10 percent of competing surgeons who work in the same facility and who use the same product."

The potential for better profits shouldn't be the only factors in your decision.

"Many surgeons or administrators who get involved with the price negotiations stop at the bid price, which is not the true savings," says Mr. Deters. "A true evaluation of a bid should follow the same scenario a surgeon or administrator would use to evaluate a patient; they should research the ailment but treat the whole person."

Just as you wouldn't hire a nurse based on what she's willing to work for, find out more about the service provider's quality. The best way to do this is to check references, something Ms. Hasz says isn't done often enough.

"In our case, two of our network's ASCs already using [the company we ended up going with] were extremely satisfied with it," she says. "We also asked for the recurrence-free intervals from several other companies."

It was considerably less work for the Clearfield (Pa.) Hospital to pick a mobile lithotripsy service because there was only one local provider 15 years ago, says OR Manager Kathy Simmons, RN, MS. Other services have since tried to win her hospital's business. She admits having been tempted to try another, "but our satisfaction is so great that even a lower price per case did not woo us away," she says. "[Our current company] offers competitive pricing, but it keeps our business with consistent service - they are not late and have minimal technical difficulties with the unit itself."

Other things Ms. Simmons counts on the plus side:

• The company provides "quality technicians with appropriate certifications and credentials."
• It "gives us evidence of an ongoing relevant quality management/quality assurance program."
• Schedule changes due to surgeon vacations, holidays and patient volumes are accommodated, "even if it means putting in an extra day."
• Finally, "the urology department also has great confidence in the technicians and the modality."

She recommends you consider such factors when looking for a company or if you're thinking about switching providers. Ask yourself what you want in a mobile service (or what you'd change, if anything, about your current one) before you explore the options, advises Ms. Simmons.