Evaluating the hardware & software can prevent disastrous financial results
Surgical technology, including preplanning software and robotics, can improve patient outcomes and help health systems market their orthopedic surgery services.
Technology suites allow orthopedic surgeons to preplan cases, using data from MRI or CT scans. The surgeon can evaluate the patient’s anatomy, choose the best implant size, determine the optimal cut positions in a hip or knee resection, or pedicle screw position in a spine procedure.
Patients are also more educated about surgical procedures compared to a decade ago. With orthopedic implants increasingly featured in local news, doctors and health systems are evolving to meet patient expectations. “The prospective patient might opt for a hospital due to regularly passing a billboard declaring it a Robotics Center of Excellence,” says Brent Ford, Senior Director, Medical Device Management at HealthTrust. “Their decision could be made by the expectation of the potential benefits a robot might offer during their procedure.”
Choosing the best advanced technological solution to meet patient and physician needs is vital. The technology can be costly, with many variables, so it’s important to seek expertise and conduct appropriate research before signing on the dotted line.
Why robotics matter
“Through the use of robotic technology, surgeons can enhance precision by utilizing a smaller incision, leading to reduced blood loss and a shorter hospital stay,” says Ford. The procedure becomes less invasive.
The robots can help surgeons make more accurate resections than doing so by hand. For example, when a surgeon resects a section of sclerotic bone, it’s like hitting a patch of ice on the road. The saw blade can deviate to the path of least resistance. Robots can alert the surgeon to these deviations in bony resections.
Robots can also track to .5 mm in some cases, says Scott Driskell, Clinical Director, Medical Device Management, HealthTrust. This precision leads to more accurate cuts, allowing surgeons to use implants that can be more stable over time. He explains that more expensive porous implants let bone grow into the pores of the prosthesis, providing better adhesion and outcomes than cement. But they only work if the cut is perfect, with the right bone to implant contact, and robotics can help.
Robotics especially help surgeons with lower-volume practices. Using robotics and software, these surgeons can improve outcomes to align with the higher-volume operators. Given the increase in the population hitting Medicare eligibility, there will be a greater need for surgeons to provide these types of procedures.
Software and robot-assisted surgery are frequently applied in spinal surgery. These robots aid surgeons in aligning and positioning pedicle screws. According to Chris J. Stewart, VP of Medical Device Management at HealthTrust, this technology offers assurance that screws are accurately placed, giving surgeons peace of mind.
New technologies changing the landscape
Smart implants are one of the latest technologies in orthopedics. Implants contain sensors that gather and share post-operative data with the surgeon. Sensors can help the surgeon understand the patient’s range of motion, effective placement, the level of wear and tear, and the number of steps the patient takes with the implant. “It provides the surgeon with more intelligence than ever before,” says Stewart. Like a smartwatch, it measures those outcomes. These implants also provide the manufacturer with information on how implants work in different patient populations, offering previously unavailable information for future implant development.
Technologies to watch include augmented reality (AR) headsets or “holographic glasses.” Surgeons wear these device headsets, with images projected into the air. With a patient scan uploaded into the software, the surgeon can preplan the case and determine where to place a hip cup, for example.
How to evaluate technology suites
The Medical Device Management (MDM) team at HealthTrust can complete a comprehensive analysis of surgeries performed at a facility or health system, compare them to benchmarking at peer organizations, educate on the pros and cons of the various technologies available and make recommendations based on the many factors important to that organization.
“We’re looking at total acquisition cost,” Stewart explains. Buyers should know that manufacturers likely have other costs beyond capital expense, whether it be mandatory service fees or per-case disposable costs. The manufacturer may share a pricing model showing that the robot can be paid off faster by increasing the volume of their devices or implants used. If the health system representative is not a subject matter expert, they may not know the historical volumes or be able to predict which physicians will increase utilization. This can result in the facility not being able to pay off the machine, taking a financial hit.
“It’s also helpful to understand if a technology is implant-specific or implant-agnostic. Augmented reality technologies are becoming increasingly more common in the orthopedic space. One of the main benefits of AR technology is its implant-agnostic status, as opposed to an implant-specific robot,” says Sam Wudel, Financial Supervisor on the MDM team. That includes some augmented reality technologies, so the physicians can continue using their preferred implants. Wudel explains that his team analyzes the case volume for the specific procedure, then factors in whether the robot will stay in a specific operating room or be moved between rooms. If it’s only in one room, some physicians may not have access when they need it, which can decrease usage. The chosen implant may increase case costs without additional compensation, and these costs add up over time. This is especially important if the more expensive implant does not improve clinical outcomes.
It is also essential to consider the physician profile for the technology. If the requesting physicians will not be in the system for a long time, it could affect usage and return on investment. If the new technology requires changing implant suppliers, and most physicians are resistant, that could also lead to problems like a lack of physician support, and not meeting utilization rates, which can degrade the supplier’s cost-savings provision.
Lastly, a facility will have to consider which payment model makes the most sense for them—essentially, whether the equipment is leased or purchased outright. Some suppliers have more flexibility with cost modeling, as selling a large robot into a health system is a win for a supplier. “It can cement market share for the system to stick with them long term. It’s a way to make sure their implants are used day to day,” and they may be more open to negotiation, Wudel adds.
Technology is helpful for patients, surgeons and hospitals. But it’s vital to understand how the cost will affect the health system. Younger doctors are learning and becoming dependent on the technology, and patients are expecting it. “We’re at a tipping point for technologies,” says Driskell. “I think it will be mainstream in 15 years.”
HealthTrust’s orthopedic dashboard tools enable members to track utilization by specific technology, illustrating how a robot could potentially drive costs outside of the capital purchase and the disposables.
Learn more by contacting the MDM team at corp.medicaldevicemgmt@healthtrustpg.com. Or, if attending HTU in Orlando, visit the MDM team in the HealthTrust Village for a demo.
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