In-House vs. Contracted Perfusion: A CFO's Cost Framework

Few decisions in a cardiac program carry more long-run cost consequence than whether perfusion is staffed in-house or delivered through a vendor. It is frequently decided on habit or a single relationship rather than a model. It should be decided on the numbers.

The true cost of contracted perfusion

A vendor invoice looks simple, but the effective per-case cost bundles clinical labor, management margin, and often the disposables themselves — where a second, less visible margin lives. When supplies flow through the vendor, the hospital rarely sees line-item pricing, which is precisely where overpayment hides.

The true cost of in-house perfusion

The variable that decides it: case volume

The comparison hinges on volume. Below a certain annual case count, contracted coverage usually wins because you cannot efficiently staff a full call-covered team. Above it, in-house typically wins because fixed labor is spread across enough cases and you capture supply pricing directly. The crossover point is institution-specific — and calculating it, rather than assuming it, is the entire exercise.

How to run the model

Done honestly, the model usually shows one option is clearly cheaper at your volume — and, just as often, that the current arrangement was never actually priced against the alternative.