OR Manager - January 2018 - 24

Technology
Robotics: Building a winning business case
obotic-assisted surgery offers
many potential advantages, including
shorter operative time,
less morbidity, and faster patient recovery.
But rigorous comparisons with
traditional surgical methods and costeffectiveness
analyses are still limited,
and the price tag of the robot (in the
neighborhood of $1 million) and annual
maintenance contract (roughly
$150,000) may give decision makers
sticker shock.
R
In this context, perioperative services
leaders at large urban institutions and
small community facilities alike must
develop compelling business cases to
support acquisition of robotic technology.
These cases require detailed analysis
of market demand, upfront and
ongoing costs, attraction and retention
of surgeons, facility space, productivity,
efficiency, and staffing.
Compiling all of this information
takes time, but it is time well spent,
judging by those who have successfully
added robotic procedures to their case
mix.
MGH experience
Massachusetts General Hospital (MGH)
in Boston, where more than 42,000
operations are performed annually, took
the robotics plunge almost a decade
ago, according to Ryan Brumit, MBA,
program manager for perioperative services.
Its business case emphasized
clinical advantages, the hospital's
teaching mission, and the types of procedures
being done.
The technology was initially pushed
forward by the urology, gynecology, and
cardiac surgery services, Brumit told OR
Manager. In 2007, the robotic approach
was being increasingly adopted as the
standard of care for radical prostatectomies.
Additionally, the data available
at that time on length-of-stay reductions
for specific cardiac procedures done
robotically (off-pump coronary artery bypass
grafting and mitral valve repair)
helped garner support for adoption.
24
OR Manager | January 2018
Increased volume and utilization may offset
higher costs of robotic surgery.
" We adopted the technology in 2008
to better serve our patients and support
our surgeons and surgical trainees, "
Brumit says. " We made the investment
based on which care could best be delivered
using the robot. Although our robotic
program remains a cost-intensive
endeavor, our surgeons continue to advocate
for availability of the technology
where it is most appropriate. "
Ryan Brumit,
MBA
The hospital began with
earlier iterations of surgical
robots and, in
2013, purchased a da
Vinci Si Surgical System
(Intuitive Surgical,
Sunnyvale, California).
The multipurpose robot
is used by the urology,
gynecology, general surgery, emergencyurgent
care, thoracic, otolaryngology,
and pediatrics services. " We chose a
dual console model to support program
growth and educational aims, " Brumit
notes.
Operationally, the robot is stationary,
so MGH has a dedicated OR for
the equipment; however, the OR block
schedule is separate from the robot
schedule. " Even with an average of
58 ORs running daily, we don't want
a dedicated robot room to go unused
because there were no robotic cases
scheduled, " he says.
In 2016, they added a ROSA Robot
(Medtech Surgical Inc, New York) for
functional neurosurgery procedures.
" As the robotic approach is still in
its infancy relative to open and laparoscopic
procedures, robotic cases, for
the most part, are still longer and costlier
than their nonrobotic alternatives, "
Brumit acknowledges. " However, these
disadvantages have the potential to
diminish over time as surgeons gain experience
and as the market grows more
competitive. "
Stakeholders made a commitment to
collecting data to help guide the growth
of the robotics program, such as volume,
case length, and equipment and
robotic room utilization. " We have observed
vast improvements in these metrics
over time as a result of targeted
initiatives, " Brumit notes.
From the fourth quarter of Fiscal
Year (FY) 2016 through the third quarter
of FY 2017, utilization of the robot
increased 25% and monthly volume
nearly doubled. Additionally, changes to
the schedule and communication about
availability have given robotic surgeons
a sense of increased access to the
technology.
" Supply costs are higher for robotic
cases, but our volume and utilization
have increased considerably since we
adopted the technology, " Brumit says.
" We prefer that the technology be utilized
rather than sit idle. "
Among less tangible benefits, MGH
has applied lessons learned from investing
in robotics to evaluation of other
high-cost technologies. For example,
hospital leaders now strive to get more
out of existing technologies before purchasing
newer ones. " In the fourth quarter
of FY 2016, the consensus from
our robotic surgeons was that there
weren't enough opportunities to use
the robot, yet our utilization was 56% at
that time, " Brumit notes.
Additionally, a more comprehensive
financial assessment has been adopted
that scrutinizes not only costs generated
in the OR, but all those incurred
during the entire patient stay. " This was
simply a shift in the way we viewed financials,
driven by changes in the landscape
of the healthcare industry. It was
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OR Manager - January 2018

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