Many organizations invest in robotic-assisted surgery. Growing and sustaining a successful service line, however, requires a comprehensive strategy and dedicated resources at a time when hospitals and health systems face unprecedented financial challenges and staffing shortages.
During a Becker's Hospital Review webinar sponsored by Intuitive, Stephen Mumford, chief operating officer at Baton Rouge General in Baton Rouge, La., discussed the medical center's investment in robotic-assisted surgery and its service line growth strategy.
Five key takeaways were:
1. Treating robotic surgery as a service line can lead to significant growth in patient volumes. Since starting its robotic surgery journey in 2011, Baton Rouge General has treated almost 7,000 patients with innovative, minimally invasive procedures. Most of those individuals have been seen since 2020. "That is the year we started treating robotic surgery as a service line and that led to exponential growth. We have five da Vinci robots and 31 robotic surgeons credentialed. General surgery is the highest volume specialty in our robotics program," Mr. Mumford said.
2. By converting procedures from open to minimally invasive, organizations see improved contribution margins. At Baton Rouge General, 53 percent of ventral hernias are treated with robotic surgery, while 25 percent are open procedures and 22 percent are laparoscopic. The revenue from open procedures is significantly lower than minimally invasive procedures. "You can turn a robot into a revenue-generating machine, rather than just a cost center tool," Mr. Mumford said. "By converting all of our ventral hernia patients from open to minimally invasive, we could more than double the bottom line coming into the system. Even if we converted just 50 percent of cases to minimally invasive, we could gain around $400,000."
3. Robotic surgery reduces length of stay, freeing beds for other patients. After robotic colorectal surgery, the median length of stay for patients at Baton Rouge General is four days, compared to seven days after an open surgery. Although the median surgery times for colorectal robotic surgery are a bit longer than open surgeries, from an operational perspective the shorter length of stay is much more important. "I'd gladly trade some time in the OR to get three bed days back per case," Mr. Mumford said. "We constantly have patients waiting in our emergency department for beds. If we could convert half our cases from open to minimally invasive over a three-year period, we'd get 384 bed days back, which is huge for hospital throughput and bottom-line revenue."
4. Expanded access to robotic surgery has generated significant value for Baton Rouge General. When considering whether to perform robotic surgery on nights and weekends for colon and small bowel resection procedures, Baton Rouge General found that patients would benefit and the shift would reduce costs tremendously. "Minimally invasive is a huge cost savings opportunity for us and we are providing patients with better care. They leave the hospital faster and they recover faster. We felt we should offer all patients the same level of technique, no matter when they need surgery. That's why we began offering robotics around the clock," Mr. Mumford said. Performing more robotic surgery also means that surgeons get more proficient. "Volume actually generates value," he added. "Over the last 12 months, we've reduced surgery times for colon resections by 81 minutes. We are also below average in terms of the number of instruments used. The fewer instruments used, the less expensive the procedure." Baton Rouge General's surgeons have also reduced operative time per case for robotic ventral and inguinal hernia surgeries.
5. Organizational alignment and program champions are essential for successful robotic surgery service lines. According to Mr. Mumford, C-suite engagement and alignment from the top all the way down to the bedside are keys to success. A surgeon champion is also critically important. "Ideally, this should be a paid medical directorship. If done correctly, however, this role will pay for itself many times over," Mr. Mumford said. In addition, Intuitive representatives can be very helpful. "Intuitive isn't just a robot vendor. The company understands that its role is to help you turn a robot into a program that provides high-quality, low-cost care for patients," he added.
Robotic surgery service lines lower the total cost of care, which works well under fee-for-service, value-based and full-capitated risk models. Developing a service line requires both the right equipment and the right infrastructure.
"You must provide an environment where physicians and staff want to work and where patients want to receive care," Mr. Mumford said. "If you do that, you will see exponential program growth and incremental savings. The robot will pay for itself in no time."
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