Rise of the Machines

Rise of the Machines

Advancements in robotic surgery are increasing demand for the technology for use in minimally invasive procedures, but the market still requires greater adoption by surgeons and new competitors to drive down the price of equipment.

Dr. Jay Redan, Medical Director of Minimally Invasive General Surgery at Florida Hospital Celebration Health, is pulling long hours these days.

Redan, a pioneer in the field of minimally invasive surgery and a 20-year practitioner in the field, dedicates a lot of time to helping drive greater adoption of such surgical techniques, from laparoscopic to computer-assisted practices (more commonly known as robotic surgery). He is a proponent of physician education in these areas, and an erstwhile champion of the benefits of such learning.

But these days, Redan is seeing as much action in the hospital emergency room as he might otherwise in the operating theater; a side-effect he chalks up to confusion around the issues of the Affordable Care Act.

“[Patients] have insurance now … and they come into the office because they have something like colon cancer,” Redan said. “The hospital comes in and says, ‘Well we need that $5,000 deductible up front,’ and they can’t have the surgery. So they just show up in the emergency room.”

“In the emergency room, they can’t deny care.”

As insurance laws continue to change, Redan said, the dollars available to address patient needs for different procedures, including minimally invasive surgery, are changing, too; so are the ways they are allocated.

“Congress has voted for all these single-payer instructions, so the hospital gets this lump sum to take care of something,” Redan said.

“Say the hospital will reimburse the surgeon $25,000 for a colorectal procedure,” he said. “The hospital will pay themselves first, [then] nursing staff, [then] supply costs — and that’s going to depend on how much equipment and what equipment you choose to do that procedure.”

Performing a traditional, open surgery puts equipment costs around $1,000, Redan said. Laparoscopic procedures can cost around $2,000, and robot-assisted surgery puts equipment costs up near $3,500 or so. After those institutional costs are met, physicians are left with the question of choosing which of these technologies they will use to handle the patient’s case, not only cutting into their personal bottom lines, but directly affecting the patient’s duration of hospitalization — a decision that is its own gamble.

As Redan points out, “There’s a chance that the reimbursement from the insurance company will go to zero if you have one of these sentinel-type events.”

The calculus for physicians then becomes a question of balancing a lot of competing impulses: security, income and technique.

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