Issue link: https://beckershealthcare.uberflip.com/i/170079
26 Executive Brief: Operating Room Imaging & Efficiency If the surgeon didn't catch the initial issue, the patient would have had to do a second surgery. The surgeon said he would never do another spinal surgery case without a CT scanner in the OR. Q: There is a lot of concern with the cost of care in today's healthcare system. Will purchasing this technology be economically viable? EB: These developments create an advantage that is cost-effective, and I don't think they will be difficult for hospitals to purchase. One of our first deliveries last year was to the country of Haiti to help communities ravaged by the earthquake. Their conventional CT scanners were no longer capable of running and at any one time, these small battery operated CT scanners were the only operational imaging equipment in Haiti. We shipped them to provide medicine in one of the poorest nations in the world and found a way to make it economically viable there. Some of our earliest luminaries were also community hospitals in the United States. In hospitals where surgeons perform spinal operations, they tie up the main CT scanner for long periods of time with their patients and others in the waiting room with a non-emergent issue, such as a kidney stone, are left waiting. Hospitals make a lot of revenue on imaging and it's a very profitable service. With new models available they can perform the CT scans in the OR and bill for them along with the surgeries. It's a real CT scan so they can get paid for those images. There is a revenue stream that can offset the cost of the equipment. To some degree, this is the first step in making these images more affordable. Finally, spine surgery is also competitive from a marketing standpoint. Four of five people will have back pain that will cause them to have work loss at some point in their lives. A lot of people get to the point where they need medical care and traditionally people would go to their community hospital. Now, they are looking on the internet, TV and other advertisements to find the place that will give them the best care. People move around more and go where they think they'll have superior care. It's lucrative for hospitals to advertise they have better technology and how their patient outcomes have improved. Q: Hospitals are facing Medicare rate cuts, and surgeons aren't far behind. Commercial payors often follow government payor trends as well. Will payors support this new technology? EB: The government and private payors are more supportive of any technology today that can improve the outcomes and shorten length of stay in hospitals. Medicare has been changed under healthcare reform, and they are releasing requirements for hospitals that tie payments to the quality of treatment. Everything is quality-based. They don't want to see negative outcomes, infections or complications because if your numbers are too high they won't receive payment. Surgeons know medicine is moving to more qualitative indexes that are tied to payment and want to improve their outcomes and patient experience. Q: Where do you see imaging technology headed in the future? EB: One of the major innovations in spine surgery was navigation systems. The navigation systems can operate off of preoperative CT images. We have added to that cycle new CT images to make sure the navigation is on track. I perceive a new technology that will add to those two: robotic assisted equipment that will drastically improve the accuracy of the procedure. In urological and gynecological surgery, the da Vinci robot has done that. There are companies, universities and major researchers investigating robotic equipment to aid in the delivery of screws and needles in spine. That doesn't eliminate the surgeon; it makes them more important and allows them the tools to perform a more accurate procedure. Robots don't have eyes; humans have to see for them and make surgical decisions. We are adding it all together and I think that's the way things will go in the years to come. n 6 Steps to Optimize OR Efficiency & Cut Costs With Minimally Invasive Spine Surgery By Laura Miller B rian R. Gantwerker, MD, of The Craniospinal Center of Los Angeles, currently uses minimally invasive spine techniques with patients and has seen the clinical and economic value of these less invasive procedures. 1. Overcome the learning curve. For spine surgeons who were trained with the traditional open surgical techniques, there is still a learning curve to incorporating less invasive procedures into their practice. "Minimally invasive techniques are becoming the standard way to approach surgery because there is less postoperative pain, earlier mobilization, shorter hospital stays and better quality for the patient," says Dr. Gantwerker. "It's time for us to move forward into that realm. Surgeons who are facile with the minimally invasive approach stand to become leaders in the community and guide where things go." "Doing minimally invasive surgery involves a certain amount of time for the learning curve," says Dr. Gantwerker. "Initially, sometimes it might take longer, but as the surgeon becomes more comfortable with the OR setting and the individual staff there, they all will become more efficient." Here, Dr. Gantwerker discusses six steps for optimizing the cost-effective qualities of minimally invasive technique. Even after mastering the technique in the cadaver lab, incorporating minimally invasive procedures into the OR will take time and the first few cases may last longer than open surgery. Whether operating through a tubular retractor or simply using a smaller incision than a traditional microdiscectomy, it takes time to get used to the restricted space. Dr. Brian R. Gantwerker