When the Company Staffing Your Perfusion Offers to Analyze It

An email arrives from the company that staffs your perfusion service. They are offering, at no cost, to analyze your program — cost per case, staffing and coverage model, supply utilization, perhaps a benchmark against the other hospitals they cover. The offer is genuinely useful-sounding. It comes from people who know perfusion. And it is free.

I want to ask one narrow question about that document, and it is not whether the people writing it are honest. Assume they are. Assume they are good at their jobs, which in my experience they usually are. The question is this: what conclusions is that analysis structurally permitted to reach?

The findings that will never appear

Sit with the offer for a moment and list the sentences that will not be in the finished report.

Nobody has to lie for those sentences to go missing. Every analyst carries a private list of conclusions that would be expensive to write down, and a vendor's analyst carries an unusually long one. The report does not come back dishonest. It comes back narrow.

The aperture problem

What a vendor analysis measures tends to be what the vendor is confident it does well. Coverage reliability. Case turnover. Supply utilization against their own catalog. These are real metrics and the numbers in them are usually correct.

What tends to go unmeasured is anything on which the vendor would itself be judged. Whether the hourly rate is competitive against the regional market. Whether the FTE model is padded for the volume. Whether the contract's escalator clause has quietly outpaced inflation for six years. Whether the documentation would survive a survey. These are precisely the questions a hospital most needs answered, and they are the questions least likely to be asked by the party being paid under the contract.

This is not a small omission. Cost per case is the number most programs cannot produce on request, and it is exactly where a vendor's analysis is least reliable — because the vendor's own fee is the largest line in it.

Who holds the data

There is a second, quieter problem. In most outsourced arrangements the vendor holds the operational data. Case logs, staffing records, supply consumption, competency files. When the hospital asks for an analysis, the vendor is not merely writing a report about itself; it is writing that report from records only it can see, using a methodology only it can inspect, with no practical way for the hospital to check the work.

In any other part of the enterprise this would be obvious. A hospital would not accept its malpractice carrier's internal assessment of its own claims handling as a substitute for an outside audit. Somehow, in perfusion, we do.

A test you can apply to any report

Here is a simple way to read one of these documents. Go to the recommendations, and for each one, ask what it costs the company that wrote it.

If every recommendation is revenue-neutral or revenue-positive for the vendor — more coverage, longer term, broader supply agreement, an added service line — you are not reading an analysis. You are reading a proposal with charts. That may still be worth having. Just do not confuse it with an audit, and do not put it in front of your board as one.

The rare vendor report that recommends something genuinely costly to the vendor is worth taking seriously. I have seen perhaps two.

In fairness to the vendors

These analyses are not worthless, and it would be dishonest of me to pretend otherwise. A vendor knows your case mix, your surgeons' preferences, and your turnover patterns in ways an outsider takes months to learn. Their operational observations are often sharp. If you want to understand how your rooms actually run, the people running them are a good source.

The failure is one of role, not competence. Asking your vendor to assess your program is a reasonable way to gather operational insight. It is not a reasonable way to answer whether the vendor arrangement itself is serving you — and those two things are routinely presented as though they were the same exercise.

What independence actually requires

An assessment worth showing a board has a specific property: the party performing it has no financial stake in any of the conclusions it might reach. Not a smaller stake. None.

That last one is the real test, and it is the one most often failed. An assessor who cannot afford to find nothing wrong will always find something. The finding is the product.

Questions worth asking before you accept a free analysis

The answers are informative. So is the discomfort.

Why we do not offer both

Gate Medicals does not supply the perfusionists we govern. That structural separation is the entire reason the firm exists, and it means our assessment of a vendor's performance carries no consequence for our own revenue.

We hold ourselves to it in the one place it could get expensive. Where we provide NRP coverage under contract, we do not also sell independent oversight of that same program. You get one from us or the other, never both. If you want our coverage audited, we will help you find someone else to do it and hand over every record they ask for.

After twenty-five years in this specialty I have read a lot of documents titled "perfusion program assessment." The useful ones share a single trait, and it is not analytical sophistication. It is that the person who wrote them had nothing riding on the answer.