Save $5,000-plus with these cost-saving ideas

[Editor’s note: In this second part of a two-part series on cost savings in ambulatory surgery, we discuss how to save money on occupancy costs and telecommunications. Last month, we discussed cost-efficiency in administrative support, employee benefits, salaries, and services.]

When you have a repair to make at your facility, do you do the easy thing and call the landlord?

That choice isn’t a good one, because the landlord charges a 10% markup, says John J. Goehle, MBA, CPA, chief operating officer of Brighton Surgery Center in Rochester, NY. Goehle gave a presentation on cost savings at the recent annual meeting of the Alexandria, VA-based Federated Ambulatory Surgery Association (FASA).

Instead, hire a handyman, Goehle advises. He hired the father of one of his employees and has paid him $15 an hour for minor repairs. That handyman can’t repair biomedical equipment but can handle smaller jobs such as fixing doors and hanging sharps containers. This one change saved Goehle’s facility $5,000 over several years, he says.

Another option is to hire a local handyman service and put them on a retainer, for example, $100 a month, to come immediately when needed, suggests Stephen W. Earnhart, MS, president and CEO at Earnhart & Associates in Austin, TX.

The most cost-efficient way to handle repairs at your center is to prevent them, he says.

Make sure you have a good maintenance plan in place, Earnhart says. Change air filters regularly, he advises. "Have a good biomed tech come in at least quarterly and check your electronic equipment," Earnhart adds.

Consider these other ideas for saving on occupancy costs:

• If your building is more than 5 to 10 years old, conduct an energy audit, Goehle advises. "Rebates are available to upgrade your electrical fixtures," he says. For more information, check you utility’s web site, he suggests.

Energy audits usually are offered free by your local utility company, Earnhart says. You may have to pay now to upgrade, but you can realize long-term results, he says.

However, it doesn’t always pay to upgrade, explains Mark Mayo, administrator at Valley Ambulatory Surgery Center and executive director of the Illinois Freestanding Surgery Center Association, both in St. Charles. The center performed an energy audit, and the managers found they couldn’t save money as front-end costs for retrofitting had a longer payback period.

"We could not save by cutting back on energy costs when the rooms were not in use," he says. "There was the problem of keeping proper positive air pressures in the OR areas at all times — even when closed nights and weekends — because of the potential for contamination and for growth of mold or mildew spores in ductwork."

• Hire a freelance employee to handle biomedical equipment repairs, Goehle advises. He hired a hospital biomedical technician employee who provides excellent service and response time, he adds. "A biomedical firm charges twice as much and doesn’t know half as much," Goehle says.

Ask a competitor to split the cost with you, he suggests. "That’s how I found my freelancer."

• For repairs, in weighing a contract vs. paying for time and materials, track — at least on paper — how much it cost to repair items.

For computer systems, don’t bother with contracts, because time and materials are worth it in the end, Goehle says. However, for heating, ventilation, and air conditioning systems, it’s almost always more cost-effective to go with a maintenance contract that already includes time and materials.

Equipment contracts are expensive, Earnhart notes, "but in my 17 years experience, they are cheaper than replacing entire OR lights, sterilizers, etc." Whatever you budget for this expense, double it to be closer to reality, he warns.

• Keep extra computer terminals available for times when a system crashes. Goehle formerly paid $3,000 annually for computer repairs. With computer cost dropping to $500 to $600, it’s more cost-efficient to have two extra terminals available for the handyman to set up when a current one fails.

• Use non-Microsoft network servers. "These can save big bucks, and more on consultants," Goehle says.

He uses six file servers including three Windows 2000 Servers (Microsoft Corp., Redmond, WA) and 3 Linux servers. Linux software is free and available in several distributions, including Fedora ( You will have to find a local consultant to set up the system and support it.

"Our Linux servers have not been down in a year, but the Microsoft servers sometimes crash weekly," he says. Thus, the support costs for Windows 2000 is considerably higher.

Most servers can be made by local companies for a fraction of the cost, Earnhart says. Make sure you adhere to the software licensure issues, he emphasizes. "They do go after pirated software users now," he warns.