Becker's ASC Review

Robotic Technology Roundtable 44 Sponsored by: Partial Knee Replacements With Robotic Technology: A New Trend for ASCs J efferson Surgical Center at the Navy Yard Administrator Joseph DeMarco and surgeon Jess Lonner, MD, and Orthopaedic Associates of Wisconsin Chief Administrative Officer Mark Smith discuss why they created a robotic technology program at their ASCs and where they see the biggest opportunities for success in the future. Q: Why did you decide to consider a robotics program at your ASC? Mark Smith: We've been familiar with robotics in orthopedics since around 2009. Our surgeons have used them for a few different procedures since then and it became a natural evolution for our ASC. We are now looking to do more traditional inpatient procedures in the outpatient setting and since we were familiar with the technology we wanted to look for an opportunity to incorporate it into our ASC. Joseph DeMarco: The robotics program was requested by one of our surgeons. The surgeon believes that partial knee replacement is the right format for the ASC and the robotic technology allows for the precision he needs in this type of procedure. Therefore, it was an initiative for Rothman Institute to be successful in the outpatient arena and robotics played a key role in that function. Q: Dr. Lonner, why did you decide to incorporate robotics into your practice? Dr. Jess Lonner: Robotic technology is now used in 15 percent of partial knee replacements in the United States. We have shown, in addition to other investigators that compared to conventional techniques the use of robotics can substantially improve the precision of bone preparation, prosthesis alignment and soft tissue balance in partial knee replacements, all of which improve outcomes and durability. The enhanced precision and optimized outcomes have raised substantially the interest in robotics in partial knee replacement surgery, but until Navio became available, it just wasn't economically feasible for it to be used in ASCs since prior robotic systems cost upward of $1 million. Q: Mr. Smith, why did you decide to purchase the Navio system? MS: From a business standpoint, being able to perform those surgeries traditionally inpatient in the outpatient ASC will deliver volume to the ASC. It's much less expensive for the patient and payer because charges are less than in the hospital. Additionally, we think the Navio robotic technology gives patients a superior outcome. There is greater precision, minimal incision and shorter rehabilitation times. Q: What benefits do you see over comparative technologies? MS: First of all, there is no CT scan required. That already makes it a less expensive procedure because you don't have to include those images. There is also an ease of use our surgeons experience with this technology. Our surgeons are excited about that. "The enhanced precision and optimized outcomes have raised substantially the interest in robotics in partial knee replacement, but until Navio became available, it just wasn't economically feasible for it to be used in the ASCs." — Dr. Jess Lonner, Jefferson Surgical Center at the Navy Yard We were really fortunate because our guys have used the robotic technology for years, so there was a high degree of familiarization with it. JD: The cost of the new technology is important. There aren't a lot of choices when it comes to robotics, especially systems that had what we were looking for in partial knee replacements. I think the real benefits are in the fact that as healthcare continues to change and the ASCs become more of a leader in the answers to healthcare costs, insurance companies will look for more opportunities to approve cases for the outpatient setting. Patients will also look to control costs, especially for higher acuity cases. Q: How many partial knee replacements are performed in the United States today? Do you think that number will grow in the future? JL: Estimates vary regarding the penetration of partial knee replacements in the United States, but a current conservative estimate is that approximately 10 percent of the knee replacements performed are partials. This is a relative underutilization of a procedure that may be appropriate for 30 percent to 40 percent of surgical candidates who have single compartment knee arthritis. It is projected that the numbers of knee replacements will explode by more than 650 percent over the next 25 years. If we consider that between 1998 and 2005 the utilization of partial knee replacements increased at an average yearly rate of 32.5 percent compared to the total knees which increased by an average of 9.4 percent during the same interval, one can only imagine the future growth rate of partial knee replacements, particularly as we train more current and future generations of residents in the use of partial knee replacements. This will create tremendous opportunity for ASCs, where growing numbers of partial knee replacements will continue to be performed. Q: Will Medicare and other payers embrace partial knee replacements and robotic technology in the outpatient ASC? JL: Relative costs to Medicare and other payers are less in the ASC than a general hospital, so they are welcoming in a big way this initiative. Medicare pays ASCs a percentage of what they pay general hospitals, but in our ASC analysis, the profits even with Medicare patients have made our program

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