Monday, January 13, 2014

What happens when the profession speaks up

I never wish any one bad luck, like losing a job.  But in this case, I am happy to see it happening because it is an indication that there is hope in the battle against the medical arms race when people in the medical profession stand up for what is right.

The story is from Bloomberg about the maker of the daVinci surgical robot:

Intuitive Surgical, Inc: Layoffs total 7% of sales organization
 

Jan 13 2014 4:01:21

ISRG laid off 7% of its sales force recently; more details are expected this week. Layoffs were focused in GYN, where growth has slowed.


Bravo to James T. Breeden, president of the American Congress of Obstetricians and Gynecologists, who last year said:

At a time when there is a demand for more fiscal responsibility and transparency in health care, the use of expensive medical technology should be questioned when less-costly alternatives provide equal or better patient outcomes. 

A study of over 264,000 hysterectomy patients in 441 hospitals . . . found that robotics added an average of $2,000 per procedure without any demonstrable benefit.  

Aggressive direct-to-consumer marketing of the latest medical technologies may mislead the public into believing that they are the best choice. Our patients deserve and need factual information about all of their treatment options, including costs, so that they can make truly informed health care decisions. Patients should be advised that robotic hysterectomy is best used for unusual and complex clinical conditions in which improved outcomes over standard minimally invasive approaches have been demonstrated. 

6 comments:

Anonymous said...

Does anyone know if the professional (surgeon's) CPT code for a robotic hysterectomy is higher than its comparative non-robotic procedure, which I assume would be a laparoscopic hysterectomy? Just curious on this point.
Kudos to ACOG who came out early and forcefully on this, unlike their urologic and other brethren. Cost is not the only issue; these surgeries typically take longer which is never a good thing for a patient (infection, anesthesia, etc.) I am told there is also a fairly steep learning curve for the surgeon.

nonlocal

Anonymous said...

Does anyone know if the professional (surgeon's) CPT code for a robotic hysterectomy is higher than its comparative non-robotic procedure, which I assume would be a laparoscopic hysterectomy? Just curious on this point.
Kudos to ACOG who came out early and forcefully on this, unlike their urologic and other brethren. Cost is not the only issue; these surgeries typically take longer which is never a good thing for a patient (infection, anesthesia, etc.) I am told there is also a fairly steep learning curve for the surgeon.

nonlocal

Nancy Thomas said...

Thank you for posting this - when you see commercials directed at the consumer to ask for robotics, then one has to wonder about the hype. Keep tabs on this over time...do we not remember keyhole open heart? And its demise?

APhotoWizard said...

While I can not speak to the cost-benefit of hysterectomies, I can speak to the use of the daVinci surgical robot in heart surgery. My friend and I both had mitrial heart valve repair/replacement. She had standard open heart surgery and I had robotic surgery using the daVinci surgical robot. I entered the hospital on Tuesday morning, and Friday noon I went home and spent the next two weeks playing with my grandchildren and doing Home Dialysis on my wife as I recovered from the after effects of the anesthesia. My friend did not fare as well. She made several emergency ambulance trips to the hospital and was in severe pain for the better part of 4 months. She later told me that they would not do that to her again - she would rather die. So it my be true that for some surgeries the robotic method is un-needed, for heart surgery I will wait for the robot if you please. Glee over the problems of the company that makes this difference possible is clearly not justified.

Paul Levy said...

I'm pleased for your results, but anecdotes do not comprise scientific assessment of the value of this type of procedure.

JAMES C. said...

I concur with the mitral valve repair. Same deal - my 81 year old dad had Da Vinci for mitral repair (Good Sam Hospital Cincy, OH. The great Dr. J. Micheal Smith) - home in 2 days and back at work in 10 days. One year later he is stronger than ever and every doc who listens to his heart says it sounds like a swiss watch. Da Vinci is AWESOME!!