Staff costs affected by mix of staff, tenure

Supply costs also examined in benchmark study

Reaction to the results of the "staff costs" category of the Ambulatory Surgery Non-Clinical Study for Cataract Extraction with Lens Insertion was mixed, with the organization that reported the lowest cost expressing surprise and the organization posting the highest cost not planning any changes. The study was conducted by the Accreditation Association for Ambulatory Health Care's Institute for Quality Improvement.

Staff costs for the procedure ranged from $26 to $220, with a median of $110. "I was surprised that we posted the lowest staff cost in the study because we use an all RN staff," says Kathleen Donigan, administrator of the Michigan Center for Outpatient Ocular Surgery in Fraser. "My physicians are constantly asking me about mixing LPNs or surgical techs in with the RNs to hold costs down, so this study confirms my belief that a highly experienced, well-trained staff can be cost efficient, even with RN salaries," she says.

"I use a combination of full-time and part-time staff members in the operating room, but everyone is cross-trained to work in the clinic so I can move them to another part of the center if the surgery department is slow," says Donigan.

Cross-training also is one way that the Northeastern Eye Institute Ambulatory Surgery Center in Scranton, PA, keeps staff costs down as the third lowest reported staff cost in the study, says Mary Ann Labas, RN, supervisor. All of the RNs and technicians know how to sterilize instruments, she says.

"My pre-op staff is trained to work in recovery, and scrub nurses are trained to operate lasers," she says. The surgical technicians also type, so they can help secretaries with administrative tasks as well, Labas adds. "This flexibility lets us move people around to make the best use of their time."

Labas does have a mix of surgical techs, LPNs, RNs, per diem, full-time, and part-time staff. "It's important to have a mix of staff so you can schedule based on caseload," she adds.

At St. John's Surgery Center in Fort Myers, FL, Linda Pavletich, RN, BSN, CASC, LHRM, administrator, was not at all surprised that they posted the highest staff costs. "We have 25 people on staff and our turnover is very low, so I have people who have been here a long time," she says. "I have six RNs who have been here 10 years or longer, and with that tenure, you will be paying more for an experienced nurse as opposed to a younger, less experienced nurse."

Her staff is a mixture of part-time and full-time staff, so she does have the flexibility to send people home when the schedule slows, says Pavletich. "We work as late as necessary to complete the procedures schedule for the day, so some days we start at 6:30 a.m. and finish at 2 p.m.; other days we start at 6:30 a.m. and finish at 7 p.m.," she says. "In our case, the experienced staff is necessary to handle the 4,500 cataract extractions we perform each year, so I don't plan any changes."

Although her staff costs per procedure were the highest, Pavletich's supply cost per procedure were the second lowest in the study at just more than $100 per case.

They have standardized all of their supplies so they can buy in volume to cut costs, she says. "We are not part of a buying group because we've found that it is easier for us to get the best price by negotiating our own price based on our volume and our needs," she adds. "For everyday supplies such as intravenous catheters, we use a local supplier to save on shipping costs."

Median supply costs: $310

Supply costs per case reported in the study ranged from $95 to $1,347, with a median of $310. In addition to standardization, Pavletich is able to keep her cost below the median by having two staff members who handle inventory. "I have one person responsible for the bulk supplies and one person responsible for specialty supplies such as lenses," she explains.

With only 25 people on staff, communication with the staff members responsible for ordering is easy, so they can stay on top of unusual needs or expected changes in scheduling, she says. Her staff members order one month's supplies at a time.

"We did belong to a buying group for a while, but we've found that we get a better price negotiating for ourselves," says Donigan. "We order every week so that we keep as little inventory as necessary in the center."

Not only does this system save on space needed for storage, but it also keeps them from accumulating supplies they don't use, she adds. In fact, 26 of the 33 organizations that participated in the cataract study order on a weekly basis. Available storage space for study participants ranged from 30 to 3,000 square feet within the facility, with a median of 441 square feet.

Most organizations in the cataract study use an inventory tracking system to monitor inventory and make usage projections for the future.


For more tips from participants in the Ambulatory Surgery Non-Clinical Study for Cataract Extraction with Lens Insertion, contact:

  • Kathleen Donigan, Administrator, Michigan Center for Outpatient Ocular Surgery, 33080 Utica Road, Fraser, MI 48026. Telephone: (586) 296-7250. Fax: (586) 296-0276. E-mail:
  • Mary Ann Labas, RN, Supervisor, NEI Ambulatory Surgery Center, 204 Mifflin Ave., Scranton, PA 18503. Telephone: (570) 340-8093. Fax: (570) 342-3136. E-mail: