technology that enables outpatient surgery. That requires excellent sur-
gical technique and excellent perioperative management — picking
patients who are healthy enough for the procedure, treating their pain
effectively and getting them in the mindset of going home on the day
of the surgery.
Dr. Kusuma wants healthcare resources invested in low-volume
surgeons who get poor outcomes, the docs who would benefit the
most from the enhanced accuracy offered by robotics. He says top
surgeons who already achieve excellent outcomes are frustrated
that health systems won't pay them for performing better opera-
tions, deciding instead to invest in robotics. "Let's pay the great sur-
geons more money for doing a better job," says Dr. Kusuma.
He'd be happy to pay out of pocket to have a good surgeon use a
robot to achieve an optimal outcome. "But to ask a third-party payer
or Medicare to pay for me to have a robotic operation is ludicrous
when we have lots of public health problems that need resources ded-
icated to them," he says.
Replacing reps
Gary Botimer, MD, fully admits vendors' reps bring great value to joint
replacement service lines by making sure needed equipment is pres-
ent, the supply inventory is complete and the surgical team knows
how to use proprietary sets of instruments during procedures.
"But once you become an experienced surgeon, you don't need a
rep to tell you how to perform the procedure," says the chair of ortho-
pedic surgery at Loma Linda (Calif.) University Medical Center, which
recently trained some of its ortho techs to replace vendors during
knee replacement procedures. "In fact, you probably shouldn't be
doing it if you need a rep in the OR. Vendors are mostly involved in
making sure staff are capable, and that's all very trainable."
1 6 8
O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | O C T O B E R 2 0 1 5
