Rolling Out a Robotic Surgery Program:
Dr. Dieter Bruno, Intuitive Proctor and Experienced Robotic Surgeon, Teaches How to Manage a Successful Roll-Out
A Complex Endeavour with the Potential for Astronomical Success
By John J. Otrompke, JD
In any newly developing field, greater experience assumes a role of greater importance. But in a field like robotic surgery, where not only a hospital’s fiscal health and reputation, but patients’ lives, can be at stake, having real experience can be something of a rarity.
That’s why Dr. Dieter Bruno, MD, a practicing robotic surgeon and a proctor for Intuitive Surgical, has drawn on his wealth of personal experience to modify the training process for physicians new to using the robot.
“I originally started in robotics before there were fellowships or training courses, because it was only a couple of years after the robots had been FDA-approved in this country,” said Bruno, who was the first urologist in North Carolina to use the Da Vinci when the program was first rolled out at East Carolina University in Greenville in 2002.
Bruno will be speaking at a robotic surgery conference in June in Philadelphia, on rolling out and managing a robotic surgery program.
“We set up model back then was very different,” said Bruno. “I was in private practice, but at an academic institution. After a course by Intutive we started doing cases, and we got specialists such as ob/gyn, general surgery, cardiac surgeons and urologists, and we helped each other because we all understood about the robot.”
Bruno was one of about seven physicians at the university who first began using the robot, but of the five physicians in Bruno’s urology practice, he was the only one who began learning robotic surgery.
Since that beginning, Bruno, who practices surgery at four different California hospitals, has performed well over 100 robotic prostatectomies, and if you add kidney surgeries and pyeloplasties, that number is much higher.
Partly due to Bruno’s influence, today’s training programs are structured much differently. "In the past cases were difficult because you had to struggle through an entire case on your own. Now with the adoption of robotics into training programs learning is easier because residents and fellows can do part of a case and work on specific skill sets. However, there is a difference between doing a full case 10 times and being able to do a part of 10 different cases. In the old paradigm by the time you had been involved in 10 cases you had a reasonable amount of experience because you had to struggle through the entire endeavor," he said.
A Systems Approach
“When rolling out a robotic surgery program, people need to take a step back and say, ‘This is an expensive piece of equipment.’ Unless the whole health care system understands, the program is doomed to failure. There are institutions that bought a robot and never did a case,” Bruno added.
Everybody from the Board of Directors to the operating room nurses, recovery and floor nurses should be facile with using the system.
“This really requires many different points of contact. But when it is done well, the success is really just astronomical,” Bruno said.
Part of that is improvement in the reimbursement picture for robotic surgeries, Bruno said, which has definitely improved the profitability for hospitals. “Economics becomes a very complicated issue depending on what point you start assessing your data. The bill for robotic surgery is higher, but when you look at being a center of excellence, it allows you to get a secondary gain,” he said.
It used to be the case that there were no codes specifically for a robotic procedure. Today, the picture varies from one insurance company to the next. “The actual surgeon fees aren’t significantly higher, but the hospitals really do better, because they get reimbursed a lot more,” said Bruno. “I may get a few hundred dollars more than when I did an open procedure, but the hospital may get many thousands more,” he added noting that reimbursement by certain Blue Cross plans may go as much as 45% more for a robotic than a traditional open surgery case.
In addition, quality and outcomes for patients are better using a Da Vinci, Bruno said. “In the prostate model, you have better chances of negative margins, and a better likelihood that there will be a curative operation. And data for continence from large series shows that people who undergo a robotic operation will get a return to continence sometimes as much as six to nine months earlier,” he added.
Just what does it take?
In addition to sound business planning, relevant training and a well-honed surgical team, a successful roll-out also requires a certain degree of marketing. “You need to start working with marketing early, to do a dual-phase rollout, and know how to market your program to the medical community that services your hospital,” Bruno said. “The area that I’m in is high-income, so everybody knows about the Da Vinci. But in other areas, you can talk to patients all you want about robot, robot, robot, but if they go back to their primary care doctor and haven’t heard of it, then what are you going to do?”
In sum, having a successful roll-out requires not only a good environmental fit, but the willingness to make it work. “A lot of what goes into the success of a program depends on what goes on behind closed doors, before the institution ever buys it. It takes a significant commitment to get a good core group of surgeons. Some hospitals offer a multidisciplinary approach. But other hospitals I go to don’t give a darn about marketing the robot,” Bruno said.
A Complex Endeavour with the Potential for Astronomical Success
By John J. Otrompke, JD
In any newly developing field, greater experience assumes a role of greater importance. But in a field like robotic surgery, where not only a hospital’s fiscal health and reputation, but patients’ lives, can be at stake, having real experience can be something of a rarity.
That’s why Dr. Dieter Bruno, MD, a practicing robotic surgeon and a proctor for Intuitive Surgical, has drawn on his wealth of personal experience to modify the training process for physicians new to using the robot.
“I originally started in robotics before there were fellowships or training courses, because it was only a couple of years after the robots had been FDA-approved in this country,” said Bruno, who was the first urologist in North Carolina to use the Da Vinci when the program was first rolled out at East Carolina University in Greenville in 2002.
Bruno will be speaking at a robotic surgery conference in June in Philadelphia, on rolling out and managing a robotic surgery program.
“We set up model back then was very different,” said Bruno. “I was in private practice, but at an academic institution. After a course by Intutive we started doing cases, and we got specialists such as ob/gyn, general surgery, cardiac surgeons and urologists, and we helped each other because we all understood about the robot.”
Bruno was one of about seven physicians at the university who first began using the robot, but of the five physicians in Bruno’s urology practice, he was the only one who began learning robotic surgery.
Since that beginning, Bruno, who practices surgery at four different California hospitals, has performed well over 100 robotic prostatectomies, and if you add kidney surgeries and pyeloplasties, that number is much higher.
Partly due to Bruno’s influence, today’s training programs are structured much differently. "In the past cases were difficult because you had to struggle through an entire case on your own. Now with the adoption of robotics into training programs learning is easier because residents and fellows can do part of a case and work on specific skill sets. However, there is a difference between doing a full case 10 times and being able to do a part of 10 different cases. In the old paradigm by the time you had been involved in 10 cases you had a reasonable amount of experience because you had to struggle through the entire endeavor," he said.
A Systems Approach
“When rolling out a robotic surgery program, people need to take a step back and say, ‘This is an expensive piece of equipment.’ Unless the whole health care system understands, the program is doomed to failure. There are institutions that bought a robot and never did a case,” Bruno added.
Everybody from the Board of Directors to the operating room nurses, recovery and floor nurses should be facile with using the system.
“This really requires many different points of contact. But when it is done well, the success is really just astronomical,” Bruno said.
Part of that is improvement in the reimbursement picture for robotic surgeries, Bruno said, which has definitely improved the profitability for hospitals. “Economics becomes a very complicated issue depending on what point you start assessing your data. The bill for robotic surgery is higher, but when you look at being a center of excellence, it allows you to get a secondary gain,” he said.
It used to be the case that there were no codes specifically for a robotic procedure. Today, the picture varies from one insurance company to the next. “The actual surgeon fees aren’t significantly higher, but the hospitals really do better, because they get reimbursed a lot more,” said Bruno. “I may get a few hundred dollars more than when I did an open procedure, but the hospital may get many thousands more,” he added noting that reimbursement by certain Blue Cross plans may go as much as 45% more for a robotic than a traditional open surgery case.
In addition, quality and outcomes for patients are better using a Da Vinci, Bruno said. “In the prostate model, you have better chances of negative margins, and a better likelihood that there will be a curative operation. And data for continence from large series shows that people who undergo a robotic operation will get a return to continence sometimes as much as six to nine months earlier,” he added.
Just what does it take?
In addition to sound business planning, relevant training and a well-honed surgical team, a successful roll-out also requires a certain degree of marketing. “You need to start working with marketing early, to do a dual-phase rollout, and know how to market your program to the medical community that services your hospital,” Bruno said. “The area that I’m in is high-income, so everybody knows about the Da Vinci. But in other areas, you can talk to patients all you want about robot, robot, robot, but if they go back to their primary care doctor and haven’t heard of it, then what are you going to do?”
In sum, having a successful roll-out requires not only a good environmental fit, but the willingness to make it work. “A lot of what goes into the success of a program depends on what goes on behind closed doors, before the institution ever buys it. It takes a significant commitment to get a good core group of surgeons. Some hospitals offer a multidisciplinary approach. But other hospitals I go to don’t give a darn about marketing the robot,” Bruno said.
posted by John J. Otrompke | 11:02 AM
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