Robotics vs. laparoscopy: How smarter surgical practices help expand your hospital's referral base

Although robotic and traditional laparoscopic surgical techniques achieve comparable patient outcomes, hospitals often overuse expensive robotic techniques, potentially hurting their bottom line.

During a webinar sponsored by Olympus Corporation of the Americas and hosted by Becker's Hospital Review, Kevin M. Audlin, MD, a gynecologic surgeon and co-director of the Endometriosis Center at Mercy Medical Center in Baltimore, shared how he expanded his referral base and solidified his role as a low-cost, high-value provider in his network. He explained how he achieved this through the use of cost-efficient, advanced laparoscopic technologies in lieu of robotics.

A changing reimbursement landscape

In the fee-for-service reimbursement system, few surgeons felt tethered by costs, according to Dr. Audlin.

"If it cost more, we charged more and in the end, we got reimbursed more," he said. "But in today's system, which entails more bundling and grouping of costs, profit margins shrink as a surgeon spends more."

In the next few years, as the value-based model is tweaked and refined, it is very likely higher costs will hurt a surgeon's bottom line, said Dr. Audlin. Surgeons need to exercise greater awareness of financial implications associated with the surgeries and procedures they perform. They must make more informed treatment decisions to lower costs while maintaining quality patient care, especially under value-based payment systems.

In 2015, national healthcare expenditures grew 5.8 percent to $3.2 trillion, or $9,990 per person, which accounted for nearly 18 percent of gross domestic product, according to national health expenditure data from CMS.

"If current healthcare spending trends continue, we will reach the point where we are unable to manage our healthcare spending and the pressure placed on hospitals and healthcare providers to lower costs will continue to grow," said Dr. Audlin.

Facing downward pressure from the government, surgeons will likely turn to common, yet high-cost procedures like hysterectomies or knee replacements when identifying saving opportunities.

Weighing the options

Surgeons can help bolster their hospital's bottom line by using robotics more wisely, according to Dr. Audlin. Surgeons should weigh the various advantages and disadvantages of each surgical system before choosing whether a robotic or laparoscopic procedure is better for a patient.

A surgical robot offers several large advantages, according to Dr. Audlin. Robotic systems provide three-dimensional high-definition vision, limit physician fatigue since surgeons operate from a console in a sitting position, and allow for seven degrees of freedom, which means surgeons can achieve 90-degree articulation in seven different motions. However, the Olympus ENDOEYE FLEX 3D system offers depth perception and 100 degrees of articulation in a laparoscopic platform.

"At first, the AAGL (formerly the American Association of Gynecologic Laparoscopists) fully embraced robotic surgery as a major improvement to laparoscopic surgery," said Dr. Audlin. "Over time, AAGL conducted several studies and found that, at best, it was essentially the same as laparoscopy."

According to a report from the AAGL, robotic surgery systems are associated with similar— or longer — operating times compared to laparoscopic surgery, along with higher costs. At the same time, there is no difference in outcomes, complications and length of stay between the two surgical methods, according to the report.

Expanding your referral base

In 2013, Mercy Medical Center became the first hospital in the U.S. and third in the world to implement the Olympus ENDOEYE FLEX 3D laparoscopic surgical system, which offers a dual optics 3D sign and infinite viewing angles.

Prior to using the ENDOEYE FLEX 3D technology, Mercy Medical Center conducted a high volume of robotic hysterectomies as a regional referral center for advanced laparoscopy and endometriosis. Since implementing the Olympus 3D system, Mercy Medical Center has expanded its referral network and now treats patients from almost half the states in the U.S., according to Dr. Audlin.

"The technology has really turned Mercy Medical Center into a national referral center," he said. "I get patients who come from all over the country for [total laparoscopic hysterectomies with] the Olympus 3D system."

The technology has not only boosted the hospital's referral network, it has also helped Dr. Audlin lower costs. In the three years since he started using the 3D surgical system, Dr. Audlin has reduced his robotic hysterectomy cases by 23 percent and increased total laparoscopic hysterectomy cases by 1,200 percent.

Now, Dr. Audlin performs about 90 robotic hysterectomies annually and, this year, he's on pace to complete 125 total laparoscopic hysterectomies. By cutting back on robotic cases and performing more laparoscopic procedures with the Olympus 3D system, he was able to save the hospital between $744 to $1,244 per case.

Dr. Audlin said the technology is just one way surgeons can push more of these high-cost procedures off the robotic platform to help hospitals maximize their bottom line and reduce national healthcare spending.

To listen to the webinar recording, click here.

To view the webinar slides, click here.

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