ON TARGET Orthopedic robots add value by improving surgical accuracy and reducing potential complications.

Don't think you can justify spending $1 million on an orthopedic surgical robot? Check this out. Our surgery center recently invested in the technology and passed the break-even point in less than a year. In fact, after 6 months, when the facility's bean counters saw the cash flowing in and the trend line rising, they wanted to add a second robot so the orthopedic surgeons doing outpatient total hips weren't limited in the number of cases they could do. Now we're up to 3 robots, including a robotic-assisted navigation device. The first 2 paid for themselves in less than a year, and the third took only slightly longer.

We ended up doing more than 300 robotic total joints last year, and the demand keeps growing — I expect our facility to host 400 cases in 2017. We've also recently introduced total knees as a service line and have 6 surgeons trained to do them robotically. We're just now beginning to schedule cases, and I expect to see the same explosive growth we realized with hips.

Intrigued? Let's drill down to a few more reasons why adding the technology makes good business and clinical sense.

1. Little up-front cost
We've always embraced new technology at our multi-specialty surgery center, and I knew robotics would provide an important step up to the care we provided. The question was what the return on investment would be. When I made the request to our steering committee, they wanted a number. How many cases would a robot bring us? I looked at our payer mix and the number of patients I thought would be medically eligible, and estimated 300 in the first year alone. The committee did a pro forma, came back and said it was a go — that if we could get that many cases that quickly, the robot would be well worth the price. And we didn't have to shell out huge money upfront to add the technology. With a capital lease program — basically a lease-to-own arrangement with monthly payments spread out over several years — our one payment covers everything from hardware to software upgrades to maintenance fees.

UP TO SPEED With a little practice, surgeons who've never used robots may be able to do more cases in a given day.

2. Better outcomes
Outcomes can be the key to driving and shifting market share, and the improvements robots provide is dramatic. In a widely quoted 2011 study of 1,823 total hips done at Massachusetts General Hospital (osmag.net/ds5vfd), surgeons without robots managed to place acetabular cups within both the desired abduction range and the desired version range (the angle of femoral neck in relationship to the shaft of the femur) only about half the time.

Why should that matter? When implants aren't in optimal position, there's a higher risk of dislocation, there are variances in leg lengths, and there's likely to be accelerated wear and loosening of parts. It may take long-term studies to prove that improved accuracy afforded by robotics promotes longer implant wear, but we're already seeing decreased dislocation rates and indications that patients have better functional outcomes when all of the implant parts are placed in optimal positions.

Beyond that, imagine telling patients that you're going to replace their joints the way it's been done for the last 40 years or so, and, by the way, your surgeons have only about a 50% shot of getting it completely right. I think most people would say there has to be a better way. And there is. With robotics, surgeons can hit a much smaller target and improve implant placement at least 95% of the time.

3. User-friendliness
The next big hurdle to acceptance is getting robots introduced into learning and training institutions, and exposing physicians to them during their residencies. I think we'll see that happen in the next couple of years. When it does, the floodgates are going to open and most surgeons will want to adopt this new technology.

It isn't hard to learn, and it also has the potential to improve efficiency. Surgeons who've never used a robot might find their first few cases taking 20 or 30 minutes longer. But within a very small number of procedures, the vast majority will quickly become as fast as they were before, or faster, and may even be able to do more cases in a given day. My colleagues and I improved our efficiency almost immediately once we started using the robots. Robotics reduces the overall operative times of my unicompartmental knee replacements by 15 to 20 minutes. Plus, with robots, there are fewer instruments to process. That could be a significant advantage for high-capacity centers.

FINE TUNING Robotic platforms help surgeons place implants in optimal positions, which can improve functional outcomes.

4. Separation from the competition
It may take just one physician champion who can confidently say he'd be able to bring lots of new business to your facility with a robot to justify adding the technology. In the absence of that champion, a strong case can be made regarding the importance of improved surgical results and reduced complications. Correctly marketing the clinical benefits of robotics can shift market share away from competitors. In fact, that begins to happen organically once patients and physicians see and hear about enhanced surgical accuracy, reduced risk of adverse outcomes, faster recoveries and, ultimately, improved joint function.

Our marketing has evolved in a way that speaks to the efficacy of robotics. Initially, we bought some newspaper and radio ads, did some Internet outreach, and made it a point to have physicians speak at community events about arthritis, surgical options, the benefits of outpatient joint replacement and robotics.

But it didn't take long for word of mouth to become our best advertising. Once we started doing a lot of outpatient joint replacement cases, patients went back to their communities, where they could be seen walking around with their canes, and chatting about how they'd had surgery just a day or two earlier.

And of course their neighbors would say, "I didn't know you were in the hospital."

"Well, I wasn't," they'd explain, adding that, "they use this robot, you see "

We've actually done much less advertising in the last 6 months, because our patients are doing the job for us. Potential patients are now seeking us out, wanting to know if the robots might be able to help them, too.

5. Staying ahead of the curve
Buying into orthopedic robots now will position your facility to tap into new markets by adding the capability to do outpatient total joints — one of surgery's hottest procedures — just as demand for hip and knee replacements is set to explode in the coming years. The technology lets surgeons perform joint surgery faster and more efficiently, and will help attract and keep orthopedic surgeons who want access to cutting-edge tools. It will also raise your overall profile and increase your market share by making patients aware that you offer the newest and best technology.

If you don't invest in robotics, you may eventually find the justification stemming from a negative rather than a positive. Surgeons and administrators who are late to the game will eventually have to scramble to prevent more and more cases from leaking out of their facilities and into the ORs of early adopters. OSM