How adding da Vinci robotic-assisted surgeries at ASCs can increase access, shorten patient wait time and boost overall revenue

As ambulatory surgery centers continue taking on lower-acuity cases to reduce costs for health systems, many may be considering what role robotic-assisted surgery can play in an ASC.

During the Becker's 28th Annual Meeting: The Business & Operation of ASCs in a session sponsored by Intuitive, Natalie Christy, RN, BSN, vice president of surgical services at Community Visionary Enterprises in Indianapolis, shared why her organization expanded robotic-assisted surgery into ASCs, barriers they faced and overcame and the benefits realized.

Three key takeaways were:

1. Expanding robots from the hospital setting to ASCs was a natural transition for Community Visionary Enterprises in helping patients select site of care. This health system began its journey into robotics in 2005 and continued to add robots to only its hospital ORs through 2016. "We didn't even start thinking about robots in our ASCs until 2017," Ms. Christy said, noting that the first ASC robot was added in 2019. "Growth was gradual. We want our patients to have easy access to the simplest care they need, when and where they need it. Robotic-assisted surgery used in the right space for the right procedure at the right time provides that care and increases that access."
2. Community Visionary Enterprises faced initial hesitation and barriers that needed to be addressed. According to Ms. Christy, the main driver for adding robots to ASCs was "to get lower-acuity cases out of the main OR and free up time for higher-acuity cases." Yet several concerns surfaced including:

• • Financial impact. "Although the hospital has ownership in the ASC and would benefit from distributions, it's not the revenue that would be generated from doing the same procedure at the hospital," Ms. Christy said. "The reimbursement model is lower in our ASCs compared with the hospital."
  • Hospital backfill uncertainty. The team expected that hospital volumes would decrease initially as cases moved to ASCs. "However, our year-one reality was wildly better than we could have imagined," she said. "Both our main OR and our surgery center showed growth in overall robotic volume."
  • Surgeon hesitation. Surgeons had concerns about who would get priority on the robot and how credentialing would be managed. These were addressed through surgeon champions.
  • ASC concerns. Finally, the ASC was concerned about adding appropriate cases at the surgery centers with reasonable procedure lengths and timely discharges.

3. Expanding site of care options delivered measurable success to the entire health system. Community Visionary Enterprises has experienced quantifiable benefits due to expanding its Intuitive da Vinci robotics program. Benefits include:

• • Improved access. For every robot added in the ASC, 50 hours of available da Vinci time was added at the main hospital.
  • Shorter wait time. While wait time at the main hospital for da Vinci-assisted surgery was greater than eight weeks, the ASC wait time was less than four weeks.
  • Decreased turnover. The average main hospital turnover time of 32 minutes between cases was reduced to 15 minutes at the ASC.
  • Reduced length of stay. All ASC patients are released in less than 24 hours.
  • High patient satisfaction. More than 90 percent of patients are consistently satisfied with their experience. 
  • Increased revenue. As lower-acuity cases move to the ASC, the hospital can take on more difficult cases. "The complex cases are taking longer, which increases revenue," Ms. Christy said. "As a result, we're seeing revenue increases, even in the product lines where we have flat volume."

By expanding da Vinci-assisted surgery into ASCs, health systems can successfully increase patient access to needed procedures in a more timely fashion while maximizing revenues for both the hospital and ASC with appropriate acuity-level cases at each site.