How Methodist Healthcare System is using robotic surgery technology to deliver the quadruple aim

The popularity of robotic surgery is growing and it's easy to understand why. These procedures support minimally invasive procedures, which can deliver better patient outcomes, better patient and surgeon experiences, and lower the total cost of surgical care. In addition, many patients seeking robotic surgery have commercial insurance, which is beneficial to a health system's bottom line.

At Becker's 8th Annual CEO & CFO Roundtable in Chicago, Intuitive hosted a workshop to explore how and why healthcare organizations are embracing innovative robotic surgery technology. Allen Harrison, president and CEO of Methodist Healthcare System, described how his organization,  San Antonio's largest health system, uses robotic surgery to help achieve its Quadruple Aim ambitions.

Leveraging robotic surgery to improve the patient and surgeon experience

Methodist Healthcare System comprises 10 hospitals and 2,400 beds. This year, the system will earn between $2.3 and $2.4 billion in net revenue. San Antonio is served by four health systems and Methodist is the largest, with 38 percent market share.

Methodist Healthcare System has enthusiastically embraced Intuitive's da Vinci robotic surgery platform and continues to invest in new robots. Mr. Harrison explained, "Switching to the da Vinci surgical robot platform alone doesn't guarantee that your costs will go down. However, robotic surgery drives surgeons away from open procedures to minimally invasive ones. Those case outcomes are dramatically better."

Methodist Healthcare System has seen a significant increase in robotic colorectal surgery and those patients have close to zero surgical site infections. General surgery has been another major growth area for robotic surgery. The patient outcomes have been much more consistent than with other approaches.

Mr. Harrison noted, "We'll finish the year with around 6,000 robotic surgeries. Our payer mix has improved due to robotic surgery. Patients who do research choose robotic surgery and they also have insurance."

Implementing a successful robotic surgery program

Methodist Healthcare System has identified four components that are critical to implementing a robotic surgery program:

1.      Executive leadership and involvement. The executive in charge doesn't necessarily have to be the CEO. Mr. Harrison said, "In general, 90 cases per robot per quarter is what you're looking for. If you're the CFO, you should probably target 45 cases a month. CEOs should focus on getting new surgeons in the door. If they come for robotic surgery, they end up bringing all their cases."

2.      A service line mindset. Methodist Healthcare System has dedicated physician leaders and a robotic surgery coordinator in hospitals with more than two surgical robots. Intuitive provides granular data that the coordinators use to run reports on surgeon utilization. According to Mr. Harrison, there is no better driver of standardization than robotic surgery. 

3.      Standardization. The robotic surgery coordinators standardize the instrument trays at Methodist Healthcare System. Regardless of surgical specialty, one tray is used for robotic surgery and everything else is placed in the OR in peel packs. Mr. Harrison said, "If you execute on standardization, you will win. Standard room setups, instrument trays and team roles provide a better surgeon experience."

4.      Staying current with technology. Healthcare systems need sufficient da Vinci Xi capacity to attract surgeons. Many general surgeons and colorectal surgeons insist on operating with newer Xi robots, rather than the older da Vinci Si platform.

Financial considerations when investing in a surgical robot

Methodist Healthcare System has seen higher contribution margins on its robotic surgery cases than nonrobotic cases. One reason is the favorable payer mix and the other is the reduced supply costs. The payer mix is the more powerful driver.

Mr. Harrison commented, "Initially we feared that as surgeons did more robotic cases, their minimally invasive and open cases would go down. We worried that when we netted it out, we wouldn't have any incremental growth. That hasn't been our experience."

As robotic surgery volumes have increased at Methodist Healthcare System, the minimally invasive and open cases have also increased since surgeons have grown their practices overall.


Robotic surgery is a medical innovation that is gaining traction among patients and surgeons alike. Mr. Harrison said, "Methodist Healthcare System is in a very competitive market with a lot of private practice surgeons and a relatively laissez-faire payer environment. We've succeeded by providing a better provider experience for surgeons through our robotic surgery platform."

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