Issue link: https://beckershealthcare.uberflip.com/i/1538336
11 THOUGHT LEADERSHIP The future of robotics in ASCs By Cameron Cortigiano The continued expansion of robotics is the next step for ASCs to provide hospital-level care in surgical and outpatient centers. Robotics previously were not common in ASCs due to financial hurdles, but new partnerships and collaborations are helping bring the technology to more ASCs, according to one surgeon. While still not in the clear for every surgery center to acquire a robot system, there are more alternative paths to the upgraded technology. Shirin Towfigh, MD, a hernia and laparoscopic surgery specialist at Beverly Hills (Calif.) Hernia Center, recently joined the Becker's Ambulatory Surgery Centers Podcast to talk about how the role of robotics in ASCs has evolved at what the next steps are. Question: What key healthcare trends are you paying attention to today? Dr. Shirin Towfigh: There's definitely a push to move as much surgical care outside of the main hospital as possible and put it into surgical centers. That has put the onus on surgical centers to be able to provide hospital-level care in terms of technology. I think the next step is having a broader availability of robotic surgery at surgical centers. It's been something that we really haven't been able to do from a financial standpoint, but that seems to be moving in a direction where collaborating with industry is making it so that we're more likely to be able to offer robotic surgery in the surgical center. The more you offer minimally invasive or robotic surgery, the more likely you are to be able to provide care to patients as an outpatient and not require hospitalization because the pain is pretty well tolerated with those operations. Q: How do you see the future of robotics at ASC? ST: When I first got involved with this surgery center, back in 2013 robotics for general surgery was just becoming something of interest. My hope was to bring the robotic technology into the surgical center, but at that time, you had to spend $2 million to buy a robot, and the insurance would not provide you payment any differently if you use the robot or didn't use a robot, so there was no way financially to make sense of that. At that time, industry was also not eager to bring down their pricing to accommodate for a larger volume of surges in the surgical centers. Now, the price of robotic surgery has reduced, and they've come up with a bit more interesting ways to afford the robots. For example, you can lease it. You can do these, what we call pay, pay per click. It's basically a page time you use the robot. So it's like leasing a luxury car as opposed to buying your luxury car. It's a little bit more manageable. So kudos to the industry for doing that, because when we first spoke to their leadership 12 years ago, there was zero interest, and now there's a lot of interest to work with surgical centers. The problem is the other arm of the finances here, which is insurance has not kicked in. There are three tiers of payment by insurance for the same exact operation. If it's done in the main hospital, you get a large amount of money for it. If the same operation is performed at a hospital-based outpatient surgery center, you get a lesser amount and the least amount is paid to a freestanding surgical center. So it makes no sense financially to do a robotic operation which is expensive in an environment such as a freestanding outpatient surgery center that gives you the lowest reimbursement for that operation. So even though industry has kicked in to help on their side, insurance really has not done their job of allowing that to be a feasible financial situation. So that's a major roadblock right now. n new model? EQ: I think that's where the strategy on the winners and the losers of this model are going to be determined on how they decide to take a step back and strategically look at the landscape. ere is a look back period that is mandated by CMS. It's not just about the reconciliation payments that are going to be calculated in that look back period. It's also your quality. And you're also looking at how you perform under these other models to say, where can we improve and how can we reduce cost where possible? at's going to mean ASCs have to come into the picture, otherwise you are dealing with those higher costs of care, which are now your responsibility as a facility, which is everybody should be more terrified, I think, in my opinion, than they are. ASCs are not listed specifically, but they're going to need to play a role, especially wherever possible where you can see that there's going to be a less complex procedure. e way that facilities, who are going to be winners are going to look at this and say, Where are the ways that we can reduce costs for less complex pieces of the procedures and not treat every single patient kind of in the same fashion? Where are places for improvement for us as a facility and that strategy? Where can we reduce costs and where do our costs land us? at's kind of what we do as Rainfall Health is to synthesize that information, use AI to extract the workflows, financials and provide that post acute support as well. It's an all-inclusive piece, and then facilities see the real hard dollars and cents that are either going to come to our bank account or going to be paid from our bank account. at puts that money on the table for a system to decide how they want to invest in making the infrastructure better for this model. Q: What do ASCs need to do to be prepared for these changes? EQ: ey need to take some of their destiny into their own hands. ese other facilities that are not mandated, but are going to be part of the strategy, can opt in and say, we're already doing best practices. We are going to start adhering to the data sharing and coordination components that are required of this model. Instead of us putting everything on the hospital, then have that dictated to us and then follow whatever the one facility says on this side of the equation and another facility says on the other side of the equation, we're actually going to create a standard that can sit above all that to respond to all the requirements, so that we become part of the strategy more easily. n