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1.
The Untold Economic Advantages of
Robotic Surgery
Robert Poston, MD
Chairman, Cardiothoracic Surgery
St Francis Medical Center, Trenton, NJ
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2.
Conventional Wisdom: Robotic
surgery is more expensive than
open or laparoscopic surgery
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3.
LIMITATIONS OF LITERATURE: ACCOUNTING FOR DYNAMIC COSTS
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4.
• Standard accounting practice for
determining ROI
• Spread out fixed costs of capital over the
timeframe in which revenue is generated
• Hospitals allocate fixed costs to the
responsible department
Decision to Purchase a Robot Decision to Use a Robot
• Not standard practice for calculating
costs/profitability of specific procedures
Allocate fixed
robot costs
only to
robotic cases
Costs/case
increased
for robotics
More cases
done open/
laparoscopc
Decreased
volume of
robotic
cases
Sunk cost fallacy
LIMITATIONS OF LITERATURE: AMORTIZATION OF CAPITAL EQUIPMENT
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5.
AVAILABLE SAFEGUARDS
Totally endoscopic (TECAB)
Minithoracotomy
safety frontier
Unsafe
Safe
Robotic Heart Surgery Tradeoffs
LESSINVASIVENESS
Sternotomy
• Standardized, automated
• Prerequisites understood
• Easy access to safety net (CPB)
LESSINVASIVENESS
AVAILABLE SAFEGUARDS
Safe
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6.
Totally endoscopic (TECAB)
Minithoracotomy
safety frontier
Unsafe
Safe
Robotic Heart Surgery Tradeoffs
Sternotomy
• Standardized, automated
• Prerequisites understood
• Easy access to safety net (CPB)
safety frontier Unsafe
Safe
Culture of safety
- “no blame” approach
- psychological safety
- collaboration
LESSINVASIVENESS
AVAILABLE SAFEGUARDS
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7.
Expectations
Time
Performance
Low
High
Low
High
Rapid Improvements
1st case …Nth case
Expectations-
reality gap
Robotic program
introduced
Trial and error
Status quo
Life Cycle of Robotic Surgery
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8.
Conclusions
1. Control for costs that are dynamic or sunk
2. Focus on the opportunity costs
3. Tie value into the “big picture”
Rational economic analysis of robotics:
However, the expert recognizes that limitations of available technologies, the team and organization where he/she operates causes a trade-off btw safety and less invasiveness and this creates a frontier. is Attempting to operate outside the frontier by performing less invasive surgery on patients that require more safeguards than inherently available is a hallmark of inexperience.
However, the expert recognizes that limitations of available technologies, the team and organization where he/she operates causes a trade-off btw safety and less invasiveness and this creates a frontier. is Attempting to operate outside the frontier by performing less invasive surgery on patients that require more safeguards than inherently available is a hallmark of inexperience.