Part 1: Unrecognized Costs in Computer Assisted Surgery – The Learning Curve.
This is the first in a series highlighting how gaps in data collection, data analysis or cost accounting leads to unrecognized financial losses in laparoscopy and computer assisted surgery. This series draws upon CAVA Robotics extensive experience in assisting hospitals with their operating room clinical and financial data analysis and the lessons learned. Today’s discussion focuses upon unrecognized costs in computer assisted surgery that are either difficult to assess, impossible to ascertain or frequently neglected. For these reasons, they often are not considered in the “cost” of running a robotic program.
The first and most costly is the cost of a robotic learning curve. Almost all surgeons are extremely efficient in their laparoscopic or open surgery already. In making the transition to robotics, a unique “learning curve” is associated with every specialty and with every operation and is well defined. During this learning curve, excessive time in the operating room, consumption of supplies, medical malpractice exposure and risk to the patient usually exist. It is imperative that a robotic program establish expectations regarding the progression of a “novice” robotic surgeon through this learning curve as well and empower the surgeon with the resources necessary to conquer this learning curve in the expected time/case frame.
To give a more concrete example that we frequently see in the healthcare environment, let’s take an example of inguinal hernia repair. Hospital X does laparoscopic bilateral inguinal hernia repair with a net margin of +$700/case and completes the operation in about 45 minutes. When it started doing the case robotically, that same margin was expectantly negative. After 100 cases however, that margin is still -$1200/case! Factors which contribute to the negative margin include excessive robotic reposable use ($200/case), excessive operative time (60 min/case longer) and excessive supply usage ($600/case). This example shows how the “urban legend” of robotics that it “costs too much” is perpetuated but is an all to common phenomenon in many robotic programs.
CAVA’s advice: avoid this happening in your computer assisted surgical operating room by making sure that you define your learning curve, empower your surgeons with the knowledge and resources needed to progress through the learning curve then monitor your computer assisted surgical performance to make sure that excellent clinical and financial outcomes are maintained.
Next: Part 2: Unrecognized costs in computer assisted surgery – equipment malfunction and repair.