Issue link: https://beckershealthcare.uberflip.com/i/239362
Robotic Technology Roundtable worthwhile. The profits with commercial payers are as good as the contracts you negotiate. For our ASC, some contracts are better than others, but we are collecting our outcomes data and negotiating with commercial payers. Q: How many procedures will you need to do in order to break even on the Navio investment? MS: That will be contingent on the payer mix, but we estimate if we can do somewhere in the neighborhood of 35 to 40 total procedures we'll break even. We don't think that's a lot. We're going to be very selective in the patients we bring to the ASC, but we hope to see a return on investment within six months to a year. Q: Dr. Lonner, you have performed a few of the partial knee replacements in the ASC with Navio. How did the transition go? Are you happy with the results? JL: We performed an initial cadaveric study of 25 knees and determined that the precision of bone preparation using Navio was far better than what is achieved with conventional instruments. In a clinical study of the initial 70 cases performed with the Navio we found that the achieved alignment was within one degree of the preoperative plan in 92 percent of the cases. Additionally, we have had no instances of inadvertent soft tissue complications. The technology has proven safe. Finally in our feasibility study assessing our initial experience with 30 outpatient partial knee replacements in our ASC — some days having done five partials and an arthroscopic surgery or two — we found that all patients were successfully discharged home after spending a mean of three hours in the PACU. We have had no readmissions to nearby hospitals in this initial cohort. Q: Based on your experience, what are your strategies for success with the Navio system in an ASC? JL: "Buy in" from ASC administrators, nurses, anesthesiologists, technicians and other staff members is critical for successful implementation of an outpatient robotics program in your ASC. In ours, this was never in doubt. All critical personnel have more than embraced the program, risen to the occasion and enjoyed the challenge of training with Navio and doing cases in an ASC that until now focused on conventional outpatient procedures. Staff and space have been allocated specifically for these robotic cases and requisite inventory. Each member of the team has taken pride in the care of these patients and relishes in knowing that they are doing something that has never been done in the greater Philadelphia area. 45 JD: The biggest challenge has been that partial knee replacements include more equipment and trays than some of the other procedures at our ASC. That adds some extra work for our staff. Before bringing in the procedure, the staff have to attend an in-service day so they understand how the technology is used successfully. There is a mindset for the surgery center that needs to be challenged with these more complex procedures. The operating room times are longer — about an hour — so staff must become aware of that. Q: What needs to happen before ASCs can fully implement robotic programs? JL: Specialized clinical pathways must be formalized and implemented to make the program work. Preoperative education and planning are keys to our success. Thorough counseling by a nurse and explicit handouts should review the details of the procedure and perioperative experience — from preop physical therapy to setting up postop PT in advance; preop and periop medications and prescriptions with detailed instructions regarding timing and dosages; ensuring support at home; providing prescription for cooling unit; details regarding dressing and wound care; timeliness regarding anticipated functional milestones. All of these will help with the entire perioperative process and enhance patient understanding and comfort. Regional anesthesia, periarticular injections, fluid and nausea management and compassionate and competent perioperative nursing care and the other critical and achievable elements to a successful outpatient robotic partial knee replacement program. Q: Do you think we will see an increase in ASCs adopting robotics? JD: I do. I think we are all concerned about healthcare in general and surgery centers are an answer for a lot of the higher acuity cases as long as the patient fits the criteria for outpatient surgery. We are talking about high acuity cases, but treatment for healthy patients. A lot of our surgeons focus on sports medicine, and these athletes are injured, but otherwise in great shape. Then patients can go home and we bring services to them. Depending on what part of the country you live in and the choices people have, ASCs can be a great option for the more complex cases. MS: I certainly hope [we'll see an increase]. We see some real advantages in seeing those procedures in the outpatient setting. We are allowed to do Medicare partial knee replacements in ASC, which is what the robotic technology allows us to do. We see this as a natural evolution of the ASC and this technology allows us to provide patients with the latest equipment and best outcomes possible. n Q: Mr. DeMarco, from your perspective, how has the system fit into the surgery center? Blue Belt Technologies is the manufacturer of the Navio™ and STRIDE™ implant. Navio is a robotics-assisted smart surgical system indicated for unicondylar knee replacement. The Navio combines the strengths of a surgeon (flexibility, complex thinking, soft tissue management) with robotics and navigation (accurate planning and localization, accurate and repeatable cutting). Through a CT-free approach, Navio enables kinematic and anatomic registration, sophisticated implant planning with soft-tissue balancing techniques and robotics-assisted bone preparation for precise and repeatable results. The STRIDE unicondylar knee system is indicated for treatment of medial and lateral compartment osteoarthritis. The STRIDE system is a bone-sparing solution that has been designed to pair perfectly with the precision of Navio.