To buy or not to buy? How ASCs should approach spine robots

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Spine surgery robots have the advantage of assisting physicians with procedure planning and increased precision and can bolster patient recovery.

But for ASCs, which are becoming promising landscapes for spine surgery, the cost of the technology might be a barrier.

Five spine surgeons discuss considerations ASCs should weigh and how medtech companies could meet them in the middle.

Note: Responses were edited for clarity. 

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): Ambulatory surgery centers should consider factors such as cost-effectiveness, patient outcomes, surgeon experience with robotics, and potential for increased efficiency and precision in surgeries. Conducting a cost-benefit analysis and consulting with surgeons and industry experts can help inform the decision-making process. 

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: The most important thing to know is what the return on investment will be. Some important questions to ask are:

1. What is the amortized cost and how long will it take to make it back? 

2. Will you be doing well-remunerated multilevel fusions (most likely not)? 

3. Do you want it to say you have it, or do you really think it will save that much time or improve patient safety to justify its cost?  

4. Will you be able to draw new surgeons for having the robot?  

So far, there is very little additional revenue gained from using a robot in spine surgery. The main savings is in time and potentially the risk for misplaced hardware. However, current navigation systems do a very nice job of guiding the screws. Perhaps there will be a white paper in the future that can gauge safety increase/risk mitigation that can lead to higher reimbursements, but that might be waiting for Godot. Until then, ASCs should think very clearly and cautiously if it is worth it.

Stephen Hochschuler, MD. Texas Back Institute (Plano): Most places cannot afford [robots] because of the capital goods and the price of a robot. However, the robot companies could change it and charge in a different way, like a per case rather than having to buy the robot. Make it so it's like any other industry. There are ways for the companies to make money and for the individual to be able to afford it.

Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): Robotic-assisted spine surgery allows the minimally invasive instrumented spine procedures to be done with more precision and efficiency while minimizing radiation exposure. Such technology would be a great addition to an ASC to provide high-quality care. The current robotic systems, however, are quite expensive. Such significant purchases can be profitable in a high-volume ASC with several spine surgeons involved in robotic surgery. There are also opportunities to "rent" the robot for lower-volume ASCs.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): All of the usuals apply in regard to advanced technology acquisition like level of training, surgical experience and, most importantly, prospective usage. These are expensive pieces of durable medical equipment and coding/billing/remuneration remain issues of consideration.

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