Tension in the healthcare executive suite continues to rise as our clients face difficult decisions at the intersection of increasing transparency and an emphasis on evidence-based medicine. With the transition from fee-for-service payment and care delivery to value-based payment and population health programs, health systems and physicians are confronted with the need to reconcile care that is labeled – through peer-reviewed publication or advanced data analysis – as too costly or possibly medically unnecessary, with the investments and practices that have historically supported margins and sustainability. Robotic surgery, a practice embraced by most hospital systems, offers an instructive example of this tension.
A new study published recently in Obstetrics & Gynecology adds to the growing body of evidence that robotic surgery will face increased scrutiny. This Columbia University study included 90,000 women who had undergone surgery to remove ovaries or ovarian cysts between 2009 and 2012. The results found that using a robot added $2,500 and $3,300 to the cost of removing the ovaries and cysts, respectively, when compared to laparoscopic approaches without a robot. There were also slightly more complications such as bladder injury, bowel obstruction, and excessive bleeding in patients who underwent robot-assisted surgery.
In February 2013, the same group of Columbia investigators reported in the Journal of the American Medical Association (JAMA) on costs associated with surgeries performed on 260,000 hysterectomy patients. The group found that the median hospital cost for robot-assisted hysterectomy was $8,868, and the median hospital cost for laparoscopic hysterectomy without robot was $6,679. In March 2013, the American College of Obstetrics and Gynecology (ACOG) issued the following policy statement: “There is no good data proving that robotic hysterectomy is even as good as—let alone better—than existing and far less costly, minimally invasive alternatives.”
A 2010 New England Journal of Medicine analysis of 20 robot-assisted surgical procedures performed in 2007 found that the robot added 13% or $3,200 to the average cost of the surgery; the investigators were unable to demonstrate with the limited data available that robotic surgery is superior to less expensive, alternative procedures.
With the Affordable Care Act and the private market advocating for transparency, measurable outcomes, and cost effectiveness, healthcare executives will continue to face difficult d ecisions. Thoughtful decision making in response to publications surrounding historically reliable investments and practices, such as these recent analyses of surgery robots, will be critically important for healthcare executives.