In a session at Becker's 12th Annual CEO + CFO Roundtable, Nick Barcellona, chief financial officer, and Dr. Kristy Ward, director of the division of gynecologic oncology at West Virginia University Health System (WVU) in Morgantown, W. Va. discussed advancements in equitable surgical care, with a particular focus on the implementation and benefits of robotic surgery.
Dr. Ward and Mr. Barcellona emphasized WVU's unique socioeconomic and geographical challenges and stressed the importance of delivering high-level care through state-of-the-art robotic surgery tools.
Their discussion highlighted a commitment to equitable care, the positive impact of robotic surgery on patient outcomes and financial performance, and the ongoing efforts to optimize and expand the program.
Here are the three key takeaways from their conversation:
1. Expanding access to robotic surgery is critical for delivering equitable care.
WVU has seen significant expansion, adding numerous hospitals and increasing its capacity to over 2,800 beds. Through this growth, their core mission remains focused on improving health outcomes through excellent patient care delivered by their skilled staff and advanced technology.
Dr. Ward emphasized the critical need to increase access to robotic surgery, particularly in rural and underserved areas, to improve patient outcomes and provide care closer to home. A key aspect of this initiative is enabling patients to return home and resume work as swiftly as possible.
"A lot of patients are worried because they don't have any paid time off," explained Dr. Ward. "If I do a traditional hysterectomy with an open surgical approach, it can be four to six weeks before the patient can return to work. They would rather deal with cancer because that means that their family gets to eat. If I can do robotic surgery, I can tell them I can get you back to work in a week. It's really important that we are able to offer these things to our patients."
Robotic surgery also enhances the patient experience beyond the procedure itself. With da Vinci® surgery, Dr. Ward noted that they've decreased the length of stay and now perform same-day discharges for all hysterectomies. Surgical site infections have decreased, with less than 1% readmissions for infections or complications. Both factors positively impact the system's patient throughput by freeing up beds and increasing capacity.
2. “Robotic surgery is financially sustainable, even for low-acuity procedures.”
WVU's data demonstrates that robotic surgery can be a financially viable option, delivering improved outcomes and positive contribution margins, even for less complex procedures.
The AMP model — a customizable approach for da Vinci surgical systems that consolidates system cost, service, and interest into a per-procedure operational fee with a lifetime or annual cap — has been instrumental in expanding WVU Medicine's robotic surgery capabilities. This approach allows for better resource allocation and improved patient care across the state.
"Da Vinci surgery is financially sustainable even in low-acuity procedures," Dr. Ward and Mr. Barcellona stated. "This is an investment in population health because you are getting folks home faster with fewer readmissions. These are all factors that the payers care about as well."
For Dr. Ward, these smaller procedures are the true game-changer for robotics in healthcare. She emphasizes that low-acuity procedures are crucial for training surgeons for the future while enhancing patient care. Surgeons become more efficient and learn which instruments to use, and care teams learn how to manage their back tables effectively.
"You have to do the less complex cases on the robot," Dr. Ward advised. "Nobody should just be doing robotic surgery occasionally. No, we're robotic surgeons because robotic surgery provides better outcomes for our patients."
3. Aligning on common goals, needs, and priorities is essential for successful implementation.
WVU attributes the growth of its da Vinci surgery program, in part to open communication and shared goals between clinical and administrative teams. They put an emphasis on leveraging data and analytics to build compelling business cases that demonstrate potential improvements in patient care and increased return on investment.
"Better clinical outcomes always translate into better financial outcomes," said Mr. Barcellona. "You have to monitor it, you have to manage it, but if you build it the right way and have open communication with set targets and metrics and then hold each other accountable, it's going to translate into financial success."
WVU has established a robotic committee to ensure that stakeholders across the organization can participate in decisions impacting patient care and health system performance. The organization is transitioning from integration to optimization, adding more robotic systems across their facilities. Dr. Ward and Mr. Barcellona continue to work on aligning priorities and goals at the system level.
"The key is to make sure you find the right leader for your robotics service line," Mr. Barcellona emphasized. "If you pick the right leader who's going to engage, is a great teacher and a great mentor, and is passionate about this, that's the secret sauce to really shifting it from a culture perspective."