robotic surgery

Data Deficiencies Are Costing You Millions (Part 2):

Part 2: Unrecognized Costs in Computer Assisted Surgery – Equipment Malfunction and Repair.

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 lessions 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.

Several years ago, CAVA encountered a request from a hospital to evaluate costs that were not being fully represented in the financial analysis of each robotic surgical case.  As a beginning robotic surgical program, scope repairs were frequent and reposable instrument dysfunction was high.  The full breadth of the costs associated with the issue and the underlying factors influencing these events were unrecognized.

Together, we discovered that scope repair costs were underappreciated.  Due to a multitude of factors including staff training, sterile processing and scope handling, the incidence of scope repair was much higher than anticipated.  The total cost though of such repairs were very high.  Scope repair provided by the vendor despite a maintenance contract approached $9k/incident and over $60,000/year!

Unfortunately, reposable malfunction was much more difficult to quantify.  When an instrument malfunctioned, it was sent back to the vendor for evaluation.  The vendor determined the reason for the malfunction and whether the unused “lives” of the reposable instrument remaining were able to be credited back to the hospital.  In the cost accounting software and methodology of the hospital, keeping track of these incidents was challenging.  Our own analysis of the reasons for instrument failure however revealed several things.  Surgeon error and potential internal collisions were frequently a cause of instrument malfunction as indicated by things such as fracture of the “shaft” of the instrument.  Perhaps more worrisome was that most of these events often went unrecognized during the operation.  Another cause can be attributed to excessive or improper handling and processing of the reposable instruments.  This brought to light important changes in turnover and sterile processing protocol that are important to maximizing the life of these reposables.  The last cause is unknown in which a specific cause for instrument malfunction could not be found.  This includes things like a cable being displaced, the instrument not responding well and the scissors not cutting well.

CAVA’s advice:  avoid untracked costs of computer assisted surgery by keeping track of such “under the radar” costs and repairs.  More importantly, have the processes in place such as handling of reposables and scopes in all departments such as the operating room and sterile processing because the consequences can be significant.

Data Deficiencies Are Costing You Millions

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.

Beware: The Dabblers!

Experience Counts!  Be sure to ask the right questions before undergoing a procedure.

https://youtu.be/8yEI9nHZJfg

Robotics Programs in Europe and Asia

Watch this week’s video to open the discussion about Robotic Programs around the world!

https://www.youtube.com/watch?v=slKuUUx534A

Reducing Medical Malpractice in Your Robotics Program

Watch this week’s video to learn about reducing medical malpractice risk to your program.

https://youtu.be/AFA3WfXpya8

Data Deficiencies are Costing You Millions: Part 2

Unrecognized Costs in Computer-Assisted Surgery: 

Equipment Malfunction and Repair

Several years ago, CAVA encountered a request from a hospital to evaluate costs that were not being fully represented in the financial analysis of each robotic surgical case.  As a beginning robotic surgical program, scope repairs were frequent and reposable instrument dysfunction was high.  The full breadth of the costs associated with the issue and the underlying factors influencing these events were unrecognized.

Together, we discovered that scope repair costs were underappreciated.  Due to a multitude of factors including staff training, sterile processing and scope handling, the incidence of scope repair was much higher than anticipated. Scope repair provided by the vendor despite a maintenance contract approached $9k/incident and over $60,000/year!

Reposable malfunction was much more difficult to quantify, however. When an instrument malfunctioned, it was sent back to the vendor for evaluation.  The vendor determined the reason for the malfunction and whether the unused “lives” of the reposable instrument remaining could be credited back to the hospital.  In the cost accounting software and methodology of the hospital, keeping track of these incidents was challenging.  However, CAVA’s analysis of the reasons for instrument failure revealed several things: surgeon error and potential internal collisions were frequently a cause of instrument malfunction as indicated by things such as fracture of the “shaft” of the instrument.  Moreover, many of these events went unrecognized during the operation.  Another cause was attributed to excessive or improper handling and processing of the reposable instruments.  This brought to light important changes in turnover and sterile processing protocol that are important to maximizing the life of these reposables.  Lastly, there were “unknown” factors in which a specific cause for instrument malfunction could not be found, including things like a cable being displaced, the instrument not responding well, and the scissors not cutting well.

CAVA’s advice:  Avoid wracking-up unmonitored costs of computer-assisted surgery.  Be sure to track your “under the radar” costs and repairs.  More importantly, have processes in place such as handling of reposables and scopes in all departments (i.e., the operating room and sterile processing) because the financial consequences of unmonitored repair costs are significant.

Data Deficiencies are Costing You Millions

Part 1  

Unrecognized Costs in Computer-Assisted Surgery:

The Learning Curve

This is Part 1 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 helping our client hospitals with their OR’s clinical and financial data analytics and the associated lessons learned in the process.

As a starting point, let’s focuses on the unrecognized costs in computer-assisted surgery that are either difficult to assess, impossible to ascertain, or frequently neglected.  For these reasons, these areas are often not considered in the “cost” of running a robotic program.

The first–and most costly–is the cost of the robotic learning curve.  Almost all surgeons are already extremely efficient in their laparoscopic or open surgery.  However, in making the transition to robotics, a unique, well defined “learning curve” is associated with every specialty and with every operation. During this learning curve, excessive time in the operating room, excess consumption of supplies, medical malpractice exposure, and risk to the patient usually exist.  It is therefore imperative that a robotic program establish expectations regarding the progression of a “novice” robotic surgeon through this learning curve as well as empower the surgeon with the resources necessary to conquer this learning curve in the expected time/case frame.

To give a concrete example that CAVA frequently sees 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 starts doing the case robotically, that same margin was expectantly negative.  After 100 cases however, that margin is still -$1200/case!  Factors that  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 actually an all-too-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 surgeons’ learning curve
  • Empower your surgeons with the knowledge and resources needed to progress through the learning curve and get out the other side!
  • 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.

Save Your Program Millions, Just Follow the Data!

Be sure to watch this week’s video from CAVA Robotics to learn how to save your program by tracking your data.

[youtube]https://www.youtube.com/watch?v=Nkq-maimNOo[/youtube]

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