Surgical robots increase efficiency during total joint replacements, but the cost of such robotic systems can be prohibitive.
Here, three administrators shared their thoughts on whether robot systems are worth it for ASCs.
Note: Responses were edited for style and content. Responses are presented alphabetically.
Question: Are surgical robotic systems viable for ASCs?
Claudette Fox, administrator at Short Hills Surgery Center in Millburn, N.J.: There are different robots that are being incorporated in the ASC setting. Currently, the most common is the robot for total joint replacements. Although we perform total joints at our center, we do not use a robot because our orthopedic surgeon does not use a robot for his TJRs at the hospital and therefore is not requesting it at the surgery center. Recently, we have received inquiries from our general surgery and OB-GYN medical staff physicians about the possibility of acquiring a robot for laparoscopic cases. We are currently researching it.
My first concern is the cost and potential reimbursement. Unless we can negotiate a carve-out with the payers that includes a reasonable profit margin, we will not move forward. There is also the consideration for the cost of and reimbursement for extended/overnight stay if that is what the surgeon is requesting.
My second concern is the amount of time it takes to set up the robot prior to the start of surgery and the total time in the operating room from room setup to wheels in and to wheels out. It may not be advantageous to the ASC to tie up an entire OR for one to two cases unless it is profitable to do so. ASC profits are primarily driven by case volume. Robotic surgery falls out of the ASC business model unless payers are willing to reimburse appropriately. It is a conundrum, since the hospitals are pushing joints to outpatient settings.
Larry Parrish, administrator at Illinois Sports Medicine & Orthopedic Surgery Center in Morton Grove: Prior to the pandemic, Illinois Sports Medicine & Orthopedic Surgery Center completed a clinical evaluation of robotic technology for use in total joint replacement surgery. We do intend to acquire a surgical robot for these cases in the first or second quarter of 2021, but not all of our total joint replacement surgeons intend to use it. However, we do believe that having robotic technology will be an asset in recruiting new joint replacement surgeons who trained with this capability, which will enhance the growth of our already well-established program.
Christine Washick, RN, administrator at Triangle Orthopaedics Surgery Center in Raleigh, N.C.: Yes, I think that robotics is an important consideration when planning capital expenditures. Patients are looking not only for safety and value, but advanced technology and the precision of robotics when choosing a surgical facility. With that being said, the most successful outpatient total joint or spine programs are heavily reliant on physician buy-in and involvement, in addition to well thought-out protocols and an engaged anesthesia partner. It is definitely not as simple as "buy a robot and they will come."