Focusing on data and process improvements, payer reform and pushing the technology further are three ways that orthopedic and spine surgeons are looking at the next iteration of robotics.
The robots used for spine and orthopedic procedures are expensive and facilities are currently facing the brunt of the cost, which surgeons believe is not a sustainable practice.
These four surgeons recently connected with Becker’s to talk about some of the overlooked aspects of spine and orthopedic robotic integration and use.
Note: Responses were lightly edited for clarity and length.
Question: What is something that is missing from the current conversation about spine and/or orthopedic robotics?
Jason Brustein, MD. Orthopedic Surgeon of Resurgens Orthopaedics (Atlanta): I think one thing missing from the current conversation in robot surgery as it pertains to orthopedics is the focus on implementation of the data that we have gained. We have a much better understanding of our patients’ anatomy and the subtle manipulations that we are making to achieve our intraoperative goals. I think the power of the information in conjunction with close postoperative follow up and patient reported outcomes, will give us the tools to understand better how to perform hip and knee arthroplasty in the future. I think this is the primary focus of how we improve, not necessarily the redesign or reinvention of new implants.
Brandon Hirsch, MD. Orthopedic Spine Surgeon of DISC Sports and Spine Center (Newport Beach, Calif.): I think that the conversation around robotics and musculoskeletal surgery should focus more on payer reform. These innovations in surgical technique are costly. Currently these innovations are received free of charge by patients and payers as CMS does not recognize this innovation in technique as worthy of reimbursement. Facilities are left to pick up the cost. This is not sustainable, particularly given the migration of musculoskeletal surgery to the non-hospital setting where margins are under significant pressure.
Erik Schnaser, MD. Chief of Orthopedic Surgery of Eisenhower Health (Rancho Mirage, Calif.): At this point, there are several items that need to be further pursued in orthopedic robotic platforms. The first would be trackerless guidance. Currently, arrays are used to give the robots a reference point to identify the patient’s anatomy. These can have several pitfalls and often require separate incisions. Scanning technology that will be able to see the anatomy and adjust to patient movement in real time will be a huge innovation when available. These technologies are on the horizon for several companies.
Autonomous robots will be an enhancement to workflows in the operating room. These will be guided by surgeons, but AI has the ability to, in real time, analyze intraoperative variables and make decisions based on those variables and how they tie to post operative outcomes. That will be the future of robotics. Outcomes driven research coupled with intraoperative variables will be paramount to proving the effectiveness of this technology.
Joshua Siegel, MD. Director of Sports Medicine and Arthroscopy of Access Sports Medicine & Orthopaedics (Exeter, N.H.): I think the missing piece for robotics is how to implement these relatively expensive, non-reimbursable tools into smaller independent ASCs. Margins continue to shrink and are even worse for ASCs vs HOPDs. Adding this expense would erase most profit margins from total joints, which is where most orthopaedic robots are being used. The companies have tried to introduce creative financing options and prices have come down, but why the industry is not lobbying for reimbursement for robotic use, or even a CPT code that includes it (and adds reimbursement at least enough to offset the acquisition and operating costs) is beyond me.
Many high-cost implants can be negotiated even as pass through reimbursements to disincentivize forcing facilities to offer lesser or older products, basically making physician choice of implants a non-financial decision. With robotics, we are not there.
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