Virtua Health

Jennifer Smith

Robotic-assisted surgery is increasingly popular with both patients and surgeons. It can offer greater precision and a faster, less painful recovery, among other benefits. However, the equipment is expensive, and surgeons must be trained to perform these advanced procedures.

Based on my experiences, I strongly believe that robotic surgery is worth the investment. 

Patient preference is driving consumers to robotic-assisted orthopedic surgery. At my New Jersey-based health system, for example, many patients come from neighboring states and beyond for full and partial knee replacements and full hip replacements. 

Moreover, extensive marketing is not needed for robotic joint replacement. For instance, online searches point to a manufacturer’s directory of providers that use the technology. That helps to guide patients to surgeons who perform these procedures. Also, a healthcare provider’s website can easily offer searchable information about these services.

 Purchasing Decisions

My organization’s journey started in 2016 with the purchasing of a leading robotic-assisted joint replacement system.

A products committee thoroughly evaluated the purchase. (Such committees include surgeons/providers, the purchasing team, service-line leadership, and other relevant leaders.) A profit-and-loss analysis considered the costs of the equipment and supplies and the expected revenue and volume from the procedures.

Robotic surgery is more expensive per case than other minimally invasive procedures, in part due to the use of disposable intra-operative supplies and no additional reimbursement.

But our assessment projected a break-even point in three years – well within our standard five-year goal. To our delight, it took less than two years to recoup our investment. 

Since that successful launch eight years ago, we’ve added more robots across our health system. We now have six robotic joint-replacement systems across two hospitals and two jointly owned ambulatory surgery centers. 

These systems can be financed through various methods, including purchasing and leasing.

Onboarding Surgeons

While some surgeons did not initially embrace robotics, patient demand has convinced many to adopt the technology. Today, most new surgeons at my organization have already received robotics training during their fellowships. 

Now, all 11 of my organization’s joint-replacement surgeons are certified in robotics and perform about 75% of these procedures robotically.

As with any new procedure, it’s important to establish a credentialing process for robotic joint replacements. This process helps ensure that teams are proficient in the procedures.

Surgeons have several ways to receive robotic joint-replacement training, including through the manufacturer, on-site through their health system, and via fellowship training.  

Extra Differentiators

Providers of robotic surgery can stand out from competitors in several ways.

For example, a rapid-recovery model can enable many joint-replacement patients to be discharged home – instead of to a rehab facility – in under 24 hours. I have also found that outpatient physical therapy is more effective than in-home PT.

To achieve these outcomes, it’s important to support early post-operative mobility. The use of spinal anesthesia, instead of general anesthesia, can enable most patients to leave the OR in about an hour. It’s also vital for patients to receive PT and walk on the same day as their surgery.

In addition, the use of oral pain medications – rather than IV drugs – keeps patients more alert while still controlling their pain. 

Lessons Learned

Initially, we didn’t anticipate how quickly our robotic joint-replacement program would grow. Early demand outpaced our processes for acquiring more robotic systems. We were slowed by time-consuming price, contract negotiations with the manufacturer, and a lengthy internal approval process for capital expenditures.

Now, we have effective systems for predicting long-term growth and addressing these needs. We’ve incorporated robotic surgery expansion into our five-year strategic plan.

This has allowed us to maintain the appropriate number of robots throughout our health system.

We’re using these same decision-making processes for our impending launch of new robotic technology for spine surgery and are evaluating its use for carpal tunnel syndrome.

These efforts demonstrate a commitment to staying on the forefront of new technologies that enhance people’s lives.