Two of the biggest drawbacks of spine surgical robots are their size and cost, but the next generation of robots are addressing these challenges to encourage their adoption at ASCs.
Most surgery centers don't have the budget to install a spine robot, which increases the cost per procedure without bringing in higher reimbursement from insurers. Many ASCs also operate on fine margins, and as spine robots offer minimal value to experienced surgeons, they are considered cost prohibitive in surgery centers.
Some hospitals and health systems are willing to invest in spine robots — which cost about $1 million — to attract surgeons and patients to their spine centers, but the pace of outpatient migration has smaller hospitals thinking twice about such an expensive capital cost.
"I approached a hospital in Las Vegas about purchasing a robot to perform minimally invasive spine surgery and increase volume at that hospital," Vladimir Sinkov, MD, of Las Vegas-based Sinkov Spine Center told Becker's. "But they expect to lose so many elective spine surgery cases over the next five years to ASCs and expect very little cases to be done in the hospital, so they didn't want to invest in the technology."
ASCs don't have the resources or capital to fork out a million dollars on a robot when the surgeries can be performed without them, so device companies are now developing robots with this in mind.
Accelus, formed through the merger of Integrity Implants and Fusion Robotics last year, has developed the Remi robotic navigation system to assist surgeons during spine cases and address the cost barriers ubiquitous with current robotic technology.
Remi was designed to address the "significant limitations associated with those legacy systems, such as extended setup and teardown time, procedural workflow disruptions, large footprints and high cost," said Kevin Foley, MD, neurosurgeon and chief robotics officer at Accelus. "Remi addresses all of these concerns, providing equivalent accuracy with an optimized procedural workflow and duration at a fraction of the cost of previous systems."
While newer device companies focus on bringing their spine robots to market, other companies are developing new business models to help sell or lease their robots to ASCs, which, if they are physician-owned, are more deliberate when it comes to upfront capital costs.
"It's all about efficiency, outcomes and where patients want to go as well as what they're having done," Martin Roche, MD, director of hip and knee arthroplasty at HSS Florida in West Palm Beach, told Becker's. "[Device companies] may link it to how many cases you do, which can help pay it down, and develop various 'at risk' models."