by Audra Coleman
Consulting Director, Advisory Solutions
Robotic surgeries have increased dramatically in popularity around the world, as this technology offers surgeons more dexterity and 3D high resolution visuals. It can also provide direct benefits for the patient, as it is a minimally invasive option that can greatly reduce a hospital stay and recovery time. Until recently, many conditions required traditional, large incisional surgery. Robotic technology has been shown to offer improved patient outcomes and satisfaction, specifically with shortened length of stay, smaller scarring, less blood loss, less pain and easier/faster recovery and is most commonly used in hernia repair, bariatrics and prostatectomies. With these factors in mind, it’s easy to assume robotics are the better choice when it comes to patient care, but hospitals must examine closely these assumptions to determine if the robotic procedures are profitable as well as beneficial to the patient.
As an Advisory Solutions consulting director with almost 15 years’ experience in health care, I am responsible for clinical supply integration to reduce unnecessary variation in procedures, lowering cost per case and optimizing utilization to improve patient care. Most recently, I worked with a hospital system to identify practice pattern variation and provide savings opportunities. After the hospital provided information on cost, quality and outcomes, I noted a large disparity in cost between robotic and incisional laparoscopic procedures. To investigate this potential opportunity further, I gathered these key data points:
- Reimbursement
- Cost per case
- Profitability
- Length of stay
- Patient acuity scores by physician
- Readmissions
- Hospital acquired conditions
This hospital’s highest-volume robotic procedure was outpatient laparoscopic cholecystectomy, and I wanted to compare this data to the same procedure, but without the robot, i.e., using a traditional inpatient laparoscopic approach. After evaluating these cases, I noticed laparoscopic cholecystectomy are reimbursed at the same rate or amount regardless of modality. Also, these patients are discharged on an outpatient basis or the same day.
Next was comparing the robotic instrumentation to the laparoscopic instrumentation cost. I noted robotic cost was over 200% more expensive. The outcome data, including complications, blood loss and readmissions were equivalent. Plus, robotic cholecystectomy has longer total operating times (115.3 minutes vs. 128.0 minutes) and longer preoperative times (32.4 minutes vs. 53.4 minutes).
In order to evaluate this information more closely, the organization formed a robotics steering committee that included a representative appointed by each of the 11 hospitals’ executive leadership. The committee, which included surgeons, administrators, robotic program managers and surgical nurses/techs, collectively reviewed the data for strategic decision making and determined robotic laparoscopic cholecystectomies were not appropriate based upon the large variation in cost, as well as lack of improved patient outcomes.
Physician participation was key in our success. Not only did they support the decision regarding this procedure, they were also instrumental in developing criteria for determining which procedures should be performed robotically and which should not. The robot was then freed up for surgeons to use for other procedures such as hernia repair, bariatrics and prostatectomies.
Going forward, the robotics steering committee team would meet every other month to continue the performance improvement work by reviewing:
- Best practices such as, instrumentation charging, staff training, continuing education, etc.
- Product recalls
- Evaluating alternative clinically equivalent less expensive products to be utilized without impacting patient outcomes
- Physician presentations on techniques
Open transparent dialogue among key stakeholders with supporting data not only saved the health care organization money, it helped build a trusting relationship to further gain savings opportunities. Questioning the perceived wisdom on the benefits of the latest technology was the conversation starter that got it all going.
About the author
Audra Coleman is a consulting director responsible for providing savings opportunities to members by making clinical recommendations to reduce variation and cost without impacting quality or outcomes. She engages directly with physicians in analyzing practice patterns and recommends less expensive clinically equivalent alternative products that will provide cost savings to physicians and hospitals.