The great equalizer — Why a New Jersey ASC surgeon wouldn't perform a total joint without a surgical robot

Robotic-assisted joint replacement procedures have the potential to decrease complications and implant failures by ensuring implants are properly placed within a fraction of a millimeter, and can help ASCs capture a growing patient base.

Integrating robotic-assisted joint replacement surgeries into the outpatient setting was the subject of an August 26th featured session part of Becker's Orthopedics + ASC Virtual Forum and sponsored by Stryker.

The speaker was:

  • Scott Schoifet, MD, of Vantage Surgery Center in Moorestown, N.J., and a paid consultant for Stryker.

Here are four key takeaways from the session:

1. The grey wave is coming. CMS recently proposed to add total hip arthroplasty to the ASC payable list in 2021. The coming patient population will be almost entirely outpatient where procedures can be performed on a more affordable basis. If CMS follows past precedent in its reimbursement calculations, it's expected the rate for total hip replacement will be much lower for the outpatient setting than the inpatient setting. This will require ASCs and surgeons to take several measures to control costs. Centers that begin preparations today will capitalize on a growing market that could include around 51 percent of all total joint replacements procedures by 2026, according to Sg2 data. One way centers can control costs and improve quality is by installing and implementing a Mako Robotic System.

2. Establishing an outpatient robotics program. Dr. Schoifet began performing outpatient orthopedic procedures in 2001. In 2010, he performed his first series of knee replacements in an outpatient setting. While he was performing procedures successfully in 2016 and had about 95 percent of his total knee-volume tied into his hospital's 23-hour stay program, it wasn't until he used the Mako robotic arm system that he saw the potential for a highly successful outpatient program. "I started utilizing the Mako and realized right off that this was going to be something special for the outpatient arena in an ASC," he said. "The Mako was going to allow me the possibility of moving a higher volume of my patients safely to the ASC." While his operation times increased with his first cases, the time dropped significantly as he continued to get accustomed to the robot. He attributed his success to the fact the Mako system combines 3D CT-based planning software, haptic-feedback safeguarding technology and data analytics to improve outcomes for total hip, total knee and partial knee patients.

3. Robotics is growing. Dr. Schoifet couldn't imagine performing a total joint replacement without Mako. "In my practice, 100 percent of all my knees and partial knees are implanted robotically," he said. That's because the Mako robot allows surgeons to place implants with accurate positioning within 0.5 millimeters. During the procedure, the robot assists the surgeon to make sure incisions are made within the proper perimeters and protect crucial patient assets. Dr. Schoifet said the Mako robot leads to less bone and soft tissue damage, reduces the need for opiate analgesics, decreases discharge times and increases procedure outcomes.

4. The great equalizer. Where hospitals have ample spaces to function as high-volume joint replacement centers, size constraints limited procedure volume in ASCs. Mako is the great equalizer in this space, leveling the playing field for ASCs. Dr. Schoifet was able to cut his instrumentation tray size from six to seven trays, down to two. He can do up to six total knee replacements in a day and have the last patient out the door by 4 p.m. Economically speaking, relying on the Mako system has allowed Vantage to make total joint arthroplasty among one of its highest paying procedures. Dr. Schoifet predicts the Mako system will allow the center to eventually perform 70 percent of all its total joint replacements in the outpatient setting.

View a copy of this session here. Learn more about Stryker here.

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