Q: Outsourcing has become prominent in today's business world. What services can I outsource to grow my practice?

A: With corporate downsizing becoming more predominant in the business world today, providing outsourcing services can prove to be financially beneficial to many audiological practices. These outsourcing services can be provided in several different areas, including industrial, educational, medical and manufacturing.

The first area to look at is the industrial sector. Under regulations of the Occupational Safety and Health Administration (OSHA), many of these businesses need to provide annual hearing evaluations for employees. Outsourcing of this type can occur on site or at your office. On-site testing can be as simple as bringing in a portable audiometer and testing in a relatively quiet environment to renting or providing a portable sound booth.

For a flat fee per hearing test and no waiting on insurance claims and payments, this can be an excellent source of income. The amount of time invested in this venture can range from relatively small to quite a lot depending on the size of the company and number of companies you choose to work with. A good way to make contact with many of these companies is to call the human resources department to find out who coordinates these exams and arranges time to negotiate a contract.

Another area of outsourcing to investigate is education. Many school districts have had to make massive cuts in their overall budgets, resulting in a number of special programs and personnel being reduced or eliminated. Unfortunately, staff audiological personnel have been among the first to go in the majority of districts. Many school districts have taken to outsourcing these services in order to save money on full-time salaries and employee benefits.

Depending on whether your practice is located in an urban or rural setting, outsourcing in this sector has distinct possibilities. Services can be as simple as coordinating annual hearing screenings in the district, training volunteers and retesting children who failed the initial screening, and providing or setting up aural rehabilitation programs in the district. This commitment can be a few hours a week to almost a full-time job depending on the district and time of year.

An area that often is overlooked in this sector is educating the adult population. Many adult community education programs strive to provide classes that will help people understand hearing, hearing loss and available hearing help. You may receive a minimal instructor's fee by offering to provide an informational class. In doing so you will not only supply valuable information to the public, but you also may provide some new business to your practice.

The next area to look at for outsourcing is within our own realm: medical and audiological practices in need of personnel for leave of absences, staff shortages and high-volume time slots. Outsourcing in this area can be beneficial for both parties. The other practice doesn't have to pay employee benefits for those times when full-time or long-term personnel are not necessary, and your outsourcing practice may benefit by making a higher hourly wage, networking with other professionals, and providing additional income during slower times.

A final consideration for outsourcing is the hearing aid manufacturer. With the many advances in hearing aid and computer technology, the need to train audiologists how to work with products has become crucial to our success. People who know and understand this technology and have good training skills are in high demand.

Most manufacturers have superior full-time staff to fill this need. However, when a new product line or software interface is being released, there may be a demand for contract audiologists within a region to help implement the training. A good starting point is to contact your sales representative. It should be noted that this form of outsourcing might require some travel and time away from your practice.

You may find that some of these ideas fit into your practice and some may not, and there may be more areas to explore. Whatever idea or area you pursue, outsourcing can bring stability and versatility to your practice.

-Lois A. Benson, MS, FAAA

A: After spending 15 years as a CFO at several hospitals, I understand the many pressures facing the industry. Managing scarce resources as reimbursement declines is a tremendous challenge. It is always a challenge to reduce non-value-added costs and focus on providing quality health care services.

Hospitals and medical practices produce and mail millions of items, including statements to patients and third-party payers, payments to vendors, refunds, W2s, appointment reminders and so on. In addition, the payroll process results in the printing of thousands of items each month. These processes are time-consuming and expensive and can be a challenge to good internal control. Payroll and payment outsourcing is a viable and economical alternative.

Most medical facilities use preprinted check stock, signature plates and printers to prepare accounts payable, refunds and other payments. After checks are prepared, they must be stuffed and mailed. The mounting costs of this process include staff time, forms and envelopes, secure storage, equipment and postage. From a cash flow standpoint, all of this must be paid in advance of its use.

Payroll checks and direct deposits have the same cost requirements of payables checks, as well as the added concern of confidentiality. This process requires inefficient use of resources to provide adequate internal control during the many steps necessary to complete each check run. Invoices and statements also are intensive in the areas of labor, material, equipment and postage. Paper production is not the core focus of business for a hospital or medical practice. Valuable staff resources could be better served in more critical functions.

Outsourcing also affords financial officers increased administrative productivity through a better utilization of resources. They don't have to worry about risks such as stolen or missing checks, reprints, paper jams and other costly annoyances. They can save on the costs of paper, printing, equipment and postage. Employees and vendors appreciate the accurate and timely disbursement of checks.

Consider this outsourcing case example. Access Partners is a medical information services and practice management company that provides billing and related account management services for health care providers nationwide. Access Partners concentrates on maximizing physicians' productivity and cash flow while minimizing overhead costs. This focus permits medical practices, including major teaching hospitals and specialty centers, to outsource resource-consuming administrative tasks while retaining full control of critical management functions.

Secure transmission of patient information, as required by Congress in the Health Insurance Portability and Accountability Act (HIPAA), is of utmost importance to practice managers and their health care customers. HIPAA represents a new set of government standards guaranteeing the privacy of personal medical information.

By outsourcing the paper factory, Access Partners optimizes the potential of its human and technology resources. Employees formerly assigned full-time to patient statements now support more critical and demanding initiatives to enhance electronic handling of data over a secure wide-area network. Printers once dedicated to patient statements run other important functions that aid the practice managers in their core information processing and practice analysis functions.

Outsourcing payroll and payables is technologically simple. After the normal payment selection process, a payment file is transmitted via a secure connection, processed through edits, and made available for a designee's review and approval. Once the job is released, the checks are printed using laser technology and mailed.

It is important to emphasize that with outsourcing you can retain total control over who gets paid, how much they get paid, and when they get paid. You can even create a print site at your location for printing an emergency check if needed. Checks are returned to you through the normal banking process. This is an easy step toward electronic payment, and the paper check allows you to continue to earn float income.

Before outsourcing any financial process, companies should make sure an outside service bureau offers flexibility for various disbursements, an intuitive program that requires little training for staffers, low-cost service, and proof of high performance and reliability. Outsourcing transactions should be encrypted, compressed and password-protected to provide the benefit of advanced security. Companies should justify the move to out-of-house processing by requesting a return-on-investment analysis for payments outsourcing.

Most importantly, financial executives have the opportunity to focus on their core objectives and goals by outsourcing payment print production to a company whose core competency is just that. The savings on financial and people resources only betters the bottom line.

-David Mayer

Our Panelists For This Issue

Lois A. Benson is technical service manager at Interton/AHS Inc. in Plymouth, MN. She can be contacted via e-mail at l.benson@interton.usa.com.

David Mayer is CFO of Payformance Corp. in Jacksonville, FL. He can be contacted via e-mail at david_mayer@payformance.com.