MAY 20219platforms at ASC's: the pandemic and a majorshift to increased outpatient surgery by Centers for Medicare and Medicaid Services (CMS). During the pandemic, hospitals were forced to decrease surgery volume, limiting access to main hospital operating rooms.Many hospitals and surgeons shifted cases to ASC's, which felt safer to patients, away from COVID-19 units in hospitals, and helped reduce hospital resource utilization and staffing burdens (many ASC's have separate staff and PPE supplies). As most surgical robots are installed at hospital operating rooms, not a free-standing ASC, this limited the number of robotic procedures that could be performed. Up to now, the cost of acquisition and higher per procedure cost has restricted the number of ASC's with robots. The second major driver is the upcoming shift in CMS policy regarding "inpatient only" procedures, with an expansion in the number of cases that can and will need to be done at ASC's. There are several elements of this policy shift that can be beneficial; however, there is a nested cost-containment plan here, as outpatient procedures are typically reimbursed less than procedures performed at an inpatient operating room. This shift in policy has highlighted limited surgeon access to ASC's as well as limitations on what patients are healthy enough to receive surgery at an ASC. However, a large percent of current robotics cases can be safely performed at an ASC if the technology were more available. Due to reduced reimbursement, this shift to ASC's willresult in a drop in revenue for institutions. It will shift volume to the ASC without a clear incremental increase in surgical volume to fill the gap at the hospital operating rooms and could increase costs per procedure if it's not deployed effectively.We are working through this presently at my institution, but challenges include:· Physical size of the current robotic platforms· Per procedure costs · Procedural variability by surgeon, specialty, and complexity of the patient· Reduced reimbursement rates · Sterile processing/cleaning equipment requirements· How to identify appropriate patientsRegardless of how you evaluate these two market forces, this will be a challenging business plan to write but will need to happen.Data, Key Performance Indicators, and the Definition of ValueAs amazing as "big data" in health care can be, a lot of these data and metrics are dependent on the quality of the information collected and the IT systems in place. In regards to "value", even if Christopher W. Macomber
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