Becker's ASC Review

16 ASC Management 11 Things to Know About Robotic Surgery By Anuja Vaidya center, but pain procedures including implantable stimulators and trial stimulators have been suc- cessful as well. Finally, urology procedures like cystoscopies and prostatectomies have efficient turnover times and a financial upside. "Most of the ENT procedures are very quick and reimburse well," says Dr. Movva. "We have found some centers avoid procedures that can be done at low margins or even a loss, but we find offering those procedures keeps our physicians in the ASC and keeps them efficient." e implant-driven or disposables-driven proce- dures are more costly and require favorable pay- er contracts to turn a profit. But they can keep physicians at the center and potentially bring in more cases. High-deductible health plans Patients are coming in with higher deductible health plans today, and they're more cost-aware than in the past. "ere still seems to be a lack of knowl- edge about the economic benefits to the consumer and employer for using an ASC over the hospital or HOPD setting," says Dr. Movva. "We are seeing some consumers become more aware and that poses challenges to people who have more skin in the game when it comes to the actual procedure." Providers are becoming savvier about the pa- tients' expectations and communicating to set reasonable goals post-operation. is way ASCs can be ready for increased volume in the future. "We are expecting the cost and quality pres- sures to drive more cases to the ASC," says Dr. Movva. "Insurance companies are looking at hospital systems consolidating and seeing them direct patients strongly within their own facili- ties. That poses a threat to ASCs and it's not clear how it will shake out. We'll have to stay tuned and position ourselves to be ready for what comes next." n R obotic surgery is being performed more, both in the inpatient and outpatient spheres. While some surgeons do not see the value in this technology, others swear by it. Here are 11 things to know about robotic surgery. 1. In 2000, the da Vinci Surgery System became the first robotic surgery system approved by the FDA for general laparoscopic surgery and made commercially available in the United States, according to a Health Re- search Funding report. More than 1.5 million da Vinci procedures have been performed worldwide since 2000. It is used to perform minimally invasive surgeries in a number of specialties, including cardiac, gynecol- ogy, urology, general surgery and colorectal procedures. 2. Intuitive Surgical, the company that manufactures and markets the system, shipped 118 systems in the second quarter of fiscal year 2015. According to its most recent financial report, the company earned a non- GAAP net income of $173 million. 3. Approximately 400,000 robotic surgeries were performed across all types of surgery in the United States in 2012. e rate of robotic surgeries is increasing by 25 percent annually. 4. Analysts from Grand View Research predict the global medical robotic system market will reach $17.9. billion by 2020. e compound annual growth rate is anticipated 12.7 percent from 2014 to 2020. 5. e market is expected to grow due to technological innovations such as the capsule robot system, soware/applications and imaging system, increasing geriatric population base and increasing per capita healthcare expenditures. Major players in the market include Intuitive Surgical, MAKO Surgical (now owned by Stryker), Accuray, Mazor Robotics, Blue Belt and Titan Medical. 6. As of 2013, 15 percent of unicompartmental knee arthroplasties in the United States were performed with robotic systems. e expectation is that those numbers will grow over the next five to 10 years. According to projections, the number of robotic partial knee arthroplasties is expected to rise to 37 percent in 10 years. In the next 10 years, 23 percent of total knee arthroplasties are expected to include robotic technology. 7. e high costs of robots have made many healthcare providers and pa- tients hesitant to utilize the new technologies. A 2013 study found robotic prostatectomy cost an average of $2,118 to $2,274 more per case than a laparoscopic prostatectomy. 8. A 2010 perspective published in e New England Journal of Medi- cine notes on average the additional variable cost of using a robot-assisted procedure was about $1,600 — that's about 6 percent of the cost of the procedure. e analysis was conducted across 20 types of robotic surgery that existed in the literature. 9. Jess Lonner, MD, of Rothman Institute in Philadelphia, and his col- leagues examined 200 cases using Blue Belt's Navio technology with 50 percent done in the surgery center; the rest were done at the hospital, and all patients were discharged home. e average cost of care at the hospital inpatient was $16,495; the hospital outpatient was $13,295 and the ASC was $9,969. 10. e list price on a first generation robotic system in Dr. Lonner's study was $1.2 million and the break-even on return-on-investment was 240 cases; however the list price on the second generation robotic system is $450,000 and the break-even on return-on-investment is 60 cases. First generation devices have an approximate set-up time of 40 minutes, as compared to second generation devices with a 15 minute set-up time and no complex calibration. 11. Increasingly, outpatient surgery centers are adopting robotic tech- nology. In April, Eric Green, MD, of St. Cloud (Minn.) Surgical Center performed the first CT-free robotics-assisted partial knee replacement in the state by a surgical center using Blue Belt Technologies' Navio Surgi- cal System. As recently as July, Piccard Surgery Center in Rochville, Md., added a Navio robotic orthopedic surgical system and Minnesota Valley Surgery Center in Burnsville incorporated the MAKOplasty procedure. In addition, Blue Belt Technologies partnered with SurgCenter Devel- opment. e partnership will enable SurgCenter Development locations to develop orthopedic robotics programs with Blue Belt Technologies' Navio Surgical System. n subscribe today free educational up-to-date Visit beckersorthopedicandspine.com or call (800) 417-2035 BECKER'S SPINE REVIEW E-WEEKLY

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