Monday, December 22, 2014

Women, please don't fall for it in Great Falls

Almost two years ago, James T. Breeden, president of ACOG (the American College of Obstetricians and Gynecologists) offered a direct and scathing criticism of the use of robotic surgery in hysterectomies.  An excerpt:

Many women today are hearing about the claimed advantages of robotic surgery for hysterectomy, thanks to widespread marketing and advertising. Robotic surgery is not the only or the best minimally invasive approach for hysterectomy. Nor is it the most cost-efficient. It is important to separate the marketing hype from the reality when considering the best surgical approach for hysterectomies.

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. Hysterectomy is one of the most common major surgeries in the US and costs our health care system more than $5 billion a year.

At a price of more than $1.7 million per robot, $125,000 in annual maintenance costs, and up to $2,000 per surgery for the cost of single-use instruments, robotic surgery is the most expensive approach. A recent Journal of the American Medical Association study found that the percentage of hysterectomies performed robotically has jumped from less than 0.5% to nearly 10% over the past three years. A study of over 264,000 hysterectomy patients in 441 hospitals also found that robotics added an average of $2,000 per procedure without any demonstrable benefit.

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.

I guess the word didn't make it to Great Falls, Montana.  Here's the website for Great Falls OBGYN Associates, whose providers are members of ACOG.

In addition to links on the home page to PR reports on the da Vinci surgical robot, the practice offers the following service offering to patients:

da Vinci Single-Site hysterectomy is available for benign (non-cancerous) conditions. Your uterus can be removed minimally invasively through a small incision in your belly button. da Vinci Single-Site technology allows for virtually scarless results.

Strikingly, the Great Falls OBGYN Associates web page on clinical offerings sends patients to two Intuitive Surgical sites for "Important Safety Information, including surgical risks, indications, and considerations and contraindications for use," and ends with the following:

© 2014 Intuitive Surgical. All rights reserved. All product names are trademarks or registered trademarks of their respective holders.

Content provided by Intuitive Surgical.


Rob said...

I would add that statistically, robotic hysterectomy is very likely to be associated with more complications, as is laparoscopic hysterectomy. Vaginal hysterectomy, when appropriate, is the best in all categories. It is rapidly disappearing from gynecologic practice.

Peter said...

We’re talking about competitive advantage here. And how does a righteous Gyn demonstrate opposition? He refuses to use the damn thing. Then he needs an extra hour with each new patient to explain why it’s bad. His production falls, the doc’s in the hospital-owned-whatever-it’s- called are concerned, blah, blah.

Maybe not on the right coast, but in small towns across the USA I’ll bet a million it’s the norm.

Richard said...

All within about 15 miles of each other in central NJ. The math regarding dollars is stunning.

Richard said...

Wow. FYI, here’s another. I just stumble on these practices mostly when trying to get old records for my new patients. Seems women are a goldmine for cash.

Sadly, it never ceases to amaze me how far out of the confines of obstetrics and gynecology so many Ob-Gyn’s are willing to go to fill the coffers. The bio-identical hormones, saliva testing and compounded hormone preparations have been roundly criticized as ineffective and dangerous by nearly every healthcare agency including ACOG, NIH and FDA. But the practice continues to thrive at the hand of board certified fellows of ACOG. Sadder still are the patients/victims of these unethical practitioners.

Paul Levy said...

Not just women, Richard. The same kind of direct-to-consumer advertising first worked on men.