In today’s time of demand and supply of healthcare needs, organizations must discover or improve services that can meet the needs of patients’ whole at the same time generating revenue as well as achieving high standards for quality of care. One way organizations have done this is by investing in robotic systems to carry out a range of surgeries.
In the following presentation I will discuss the topics of: Investing in the MAKO RIO Robotic System, The Utilization of the RIO Robotic System, Stakeholders of an Orthopedic Surgery, Impact to the Stakeholders, Internal and External Factors that Impact the Purchasing of the MAKO RIO Robotic System, Reaction of the Patients About the RIO Robotic System, and the Impact to the Orthopedic Center’s Competitiveness. Investing in the MAKO RIO Robotic Arm System
Investing in a MAKO RIO Robotic System can become a very beneficial and profitable tool that can propel the center towards reaching our ultimate goals of revenue as well as patient quality of care. The MAKO RIO Robotic system is the “first FDA-cleared robotic arm system for orthopedic surgery,” (MedGadget, 2009). The RIO system consists of a robotic arm that is equipped with intelligent surgical instruments that enables a high level of precision to be achieved as well as high accuracy. The RIO Robotic Arm is available to patients that suffer from Osteoarthritis in the knee and/or hip.
Before the RIO Robotic Arm, only medial resurface was possible, but with the RIO medial, patellofemoral, or both components of the bones can be resurfaced (MedGadget, 2009). This innovated robotic system now opens the door for more patients that need total hip and/or knee replacement. The cost of the RIO Robotic system does come with a heavy price tag around 200,000 dollars. However, the purchase of this system will quickly pay itself off within the first year of its purchase. The following information is provided by a hospital that has already purchase the RIO Robotic Arm system and successfully implemented into the organization. MAKO Surgical Corp, 2009). The Utilization of the RIO Robotic Arm System The RIO Robotic Arm system aides the surgeon in two stages, pre-surgery planning and during the surgery. The pre-planning stage enables the surgeon to use Cat Scans of the patient’s knee and puts them into 3-D images. These 3-D images give the surgeon the ability to the more accurately match the implant size, orientation, and as well as the aligning of the implant (Robotic Surgery Center, 2011). The RIO Robotic Arm system works with the surgeon during surgery so that precision and accuracy are increased.
The system also improves the hand eye coordination of the surgeon as well as providing more dexterity and visualization. The Internal and External Stakeholders of the Orthopedic Center The internal and external stakeholders of an organization play and have pivotal roles in the success of that organization. The internal stakeholders have a monetary stake in the success of the center. The internal stakeholders may include, but not limited to: director of programs and services, trustees, board committee members, and the owner(s) of the orthopedic center (Markwell, 2011).
Internal stakeholders are committed, because of the monetary interest that the center continues to strive and meet financial goals as well as quality of care goals. The internal stakeholders provide guidance during new or existing programs of services. They also identify options and recommend solutions that would be essential to the continued success of the orthopedic center. The external stakeholders are those that are impacted by the decisions of the organizations. The external stakeholders include, but not limited to: Providers, the community, consumers/patients, and investors (Markwell, 2011).
Even though the external stakeholders may not aide in the day to day decisions of running the center, their values and views are just as important. They are the voices that speak if the services are not up to par or are poorly constructed. External stakeholders often bring in views that are not considered by the internal stakeholders. External stakeholders, like investors, play a particular crucial role in the success of the center. Without their financial backing, it would be hard for the center to fund for investments, ig the funding for a robotic system, and to continue to strive for success.
Whether it is an internal stakeholder or an external stakeholder, communication is the key between these two groups. Communication leads to discovering new ways, ideas, and/or programs that will ultimately lead to the center generating revenue and delivering high standards of quality of care. Impact to the Stakeholders The impact of purchasing a MAKO RIO Robotic Arm system will be felt by both internal and external stakeholders. The internal stakeholders will need to develop and implement a plan to successfully incorporate and market the robotic system into the centers existing programs and services.
Fortunately, the makers at MAKO have a program already established to assist stakeholders through this progress. MAKO has a COE (Center of Excellence) marketing program that enables the orthopedic center to have resources at their disposal to use in the development of a marketing plan and awareness (MAKO Surgical, 2012). The marketing plan will help the center gain the interests of the patients about the RIO Robotic Arm system and the type of procedures that can be performed using it.
In corporation of the robotic system is not the only hurdle the internal stakeholders must overcome; funding for the robotic system will prove to be a challenge in itself. The internal stakeholders will most likely have to go to the investors of the center in order to cover a portion of the robotic system’s price tag. Research will also need to be conducted to locate grants for facilities looking to expand services, patient base, as well as improve quality of care. Donations are another avenue that can be explored to aid in the funding of the robotic system.
The external stakeholders will also be impacted by the purchase of the RIO Robotic Arm system by MAKO. With the RIO Robotic Arm system being a new program and technology, surgeons (providers) will need to acquire the proper education and training to be able to perform procedures using the robotic system accurately and successfully. MAKO offers an on-site education program so that surgeons will have the proper knowledge and Bio-Skills to successfully perform procedures using the RIO Robotic Arm system (MAKO Surgical Corp, 2013).
The investors of the center will more than likely aide in the funding of the robotic system; however they have the potential to recoup from the investment in two ways. The reimbursement cycle will be the first way the investors can recoup from their investment. By having the system within the center it will give the patients an option of surgeon using the robotic system in the necessary procedure. The second method that the investors can gain profits from the RIO Robotic Arm system is by purchasing stock options from MAKO.
The RIO Robotic Arm system is the latest technology for robotics in surgery and it is quickly becoming very popular amongst facilities that want the technology within their facility. The more of facilities that purchase the technology the more profits the investors will gain. Lastly, the other stakeholders that will most definitely be impacted by the RIO Robotic system are the patients of the orthopedic center. This new robotic system will enhance the chances of the patient having implants that are more accurate with smaller incisions.
The RIO Robotic system gives the surgeon the ability to spare healthy bone and tissue; allowing the patient to have a faster recovery time and if it is necessary, a shorter hospital stay. Internal and External Factors That May Impact the Purchasing of the New Technology With the rising costs of healthcare, changes are being made within this industry in an effort to slow down or reverse the results due to the costs. The orthopedic center will need to be able to handle and accept the changes that have occurred or will occur if the center is going to continue to be successful.
More complexed procedures are being lead to being performed in an outpatient setting, making it harder for non-multi-special facilities to stay operational. The reimbursement cycle is also being affected due to the rising costs of healthcare. An example of this would be, “Medicare and private payers have such low rates that seeing some patients becomes unprofitable,” (Miller, 2012). The recession that the economy is currently facing and trying to dig out of, patients are less likely to have “elective surgery” due to being financially strained.
A study showed that “75 percent of Americans felt financially insecure, and these people are less likely to invest in a new joint while missing work to do so — even if they would benefit from the procedure,” (Miller, 2012). Another factor that could potentially impact the center in the purchase in the robotic system is that the demand and supply may not meet the qualifications of the needs of the surrounding community; therefore purchasing the expensive robotic system would be frivolous. Reaction of Patients The reaction of the patients will vary from patient to patient.
The key is known what the patient’s personality is and what the patient is comfortable with. This is where the patient and provider relationship becomes useful. The more the provider knows about the patient, medical history, personal life, the patients interest and even the patient’s education level or knowledge of the medical field, and of the course the health of the patient. Majority of patients like to be very active and communicate their expectations of the type of care they want or the type of procedure that will best suit them as a person as well as their lifestyle.
However, patients may feel that with a procedure done with a robotic system, they would lose the patient/provider relationship during the most crucial moment of the care or treatment. This is where a benefit of the RIO Robotic Arm comes useful. The RIO robotic system works hand-in-hand, so to speak, with the surgeon. The surgeon is right by the patient and actually performing the surgery or procedure themselves, just using the precision and accuracy of the RIO Robotic Arm system to produce better results. Patients also fear the unknown.
It is crucial for the provider to explain in detail and what the patient can expect during the procedure. In today’s time of modern technology most patients are very familiar with the benefits of technology and how they can actually assist and improve their way of living. “Patients realize what the computer has done in their personal life, and if they are going to have an operation, they want the best thing going for them,” (Miller, 2012). The key and most important aspect is that the patient feels comfortable with the procedure and how or who will carry it out before the procedure can take place.
Impact of the Organization’s Competitiveness The MAKO RIO Robotic Arm system can improve or increase the revenue of the orthopedic center. By investing the RIO robotic system the center can potentially be the first healthcare facility in the area to offer services that involve the RIO robotic system. This could lead to expanding the center’s patient base as well as attract surgeons who want to work with the latest technology. The robotic system can also increase the number of knee arthroplasty and hip replacement procedures in an extremely competitive environment.
Younger patients can be attracted, adding to the mix of payors and ultimately generating more revenue for the center. Since majority of private health insurance, as well as Medicare, cover the procedures the center can improve their reimbursement cycle. Ultimately, investing in the MAKO RIO Robotic Arm system, the center can offer more treatment options and at same time increase their volume of surgical procedures. Centers who invest in the newest technologies it enable them to be established as a Center of Excellence giving them an upper footing in the competitive world of healthcare.
Phase 5 IP Assignment The relationship that is created between the physician and patient is the essential cornerstone in the field of medical practice; therefore as well as it is in medical ethics. Communication and trust enables the foundation of the cornerstone to be built. The patient/physician relationship is key into gathering the data needed to properly diagnose the patient, developing the most effective and efficient plan of treatment, and as well as the care of the patient post-treatment.
Without the proper communication between both the physician and the patient, trust will be difficult to establish, potentially leading to poor quality of care. Trust is a pivotal factor that influences the patient’s decision about the course of their healthcare needs. Patients trust in the fact that the physician will do what is best to meet their healthcare needs. However, trust in the patient/physician relationship is a two way street. Physicians trust that their patients are fully disclosing all pertinent information in order to deliver the highest standard of quality of care to the patient.
Patients need to be informed by the physician of all the choices that are available to them so that the patient can make the proper decision for their plan of treatment of their care. Patients are trusting in the fact that the physician is giving them all the options that are the best solutions for their care and not just the ones that will make the physician the most money. An example of this would be that the patient needs a procedure as part of their treatment plan. The physician gives the patient a list of choices that are available for them to select.
The physician informs the patient of the choices available which one is covered under the patient’s insurance provider. The patient will most likely select the procedure, even if it is the least effective and does not match their preferences that are covered under their insurance in order to avoid coming out of pocket for a procedure that is not. One of the many keys needed to unlock a patient’s satisfaction is that the physician needs to take in regard the patient’s preferences when formulating a treatment plan for that patient.
This will ensure stability in the patient and physician relationship as well as a higher standard quality of care. Another factor that influences the patient’s decision in their healthcare is the setting in the physician’s office as well as the appearance of the physician. If the office appears to be cluttered, unorganized, and chaotic it may ultimately lead the patient to believe that the physician is ill equipped to deliver the standard of quality of care the patient may accustomed to or expecting.
The physician’s physical appearance also weighs in as a factor that influences the patient’s decision about taking the appropriate steps in delivering the care the patient is not only needing but expecting as well. A study showed that patients preferred that the physician have an appearance of semiformal and a smile, than those who were more dressed to suit the profession and not having a smile (Thiedke, 2007). Shared decision making amongst the physician and patient can ultimately lead to reducing costs in healthcare.
A study showed that patients who are more involved in shared decision about their healthcare selected surgeries that are less invasive and more conservative. Group Health located in Washington State conducted a study in 2012 that revealed that patients involved in the shared decision for “for hip and knee replacements substantially reduced both surgery rates and costs — with up to 38% fewer surgeries and savings of 12 to 21% over 6 months,” (Emanuel & Lee, 2013). Physician and patient shared decision making will not only potentially lower healthcare costs, but mprove the level of quality of care given to and received by the patient as well. Money is what makes the world turn; this concept is no less different in the healthcare industry. Even though money should not be the mitigating factor in a physician seeing and treating a patient, it does however, weigh in on how a physician will proceed with the treatment plan for a patient. Depending on the patient’s insurance provider and how the physician gets paid, salaried or fee-for-service, will influence how the decisions are made in the process of treating a patient.
It is important for consumers/patients to have some type of knowledge of how their physician’s payment methods are established. By knowing this you can judge whether the quality of care that is being received is either poor or of a high standard. In a study conducted it revealed that physicians were being paid “more for ordering or conducting fewer than the average number of tests” (Cleary, Davis, Green, Kao, & Koplan, 1998) had a negative effect on the quality of care given to their patients. Insurance plans are ultimately affected by the decisions that are made between a physician and their patient.
In the development of a treatment plan a procedure may be medically necessary in order to properly treat the patient. Insurance healthcare plans are notorious for not explaining in detail what types of services and procedures are covered; leaving the door open for denials in the reimbursement cycle and ultimately making more money for them. Insurance plans usually cover services and procedures that are medically necessary in the process of treating a patient, but how does health insurers define medically necessary becomes the question that is often asked.
The AMA defines medically necessary as: “Health care services or products that a prudent physician would provide to a patient for the purpose of preventing, diagnosing, treating or rehabilitating an illness, injury, disease or its associated symptoms, impairments or functional limitations in a manner that is: (1) in accordance with generally accepted standards of medical practice; (2) clinically appropriate in terms of type, frequency, extent, site and duration; and (3) not primarily for the convenience of the patient, physician, or other health care provider,” (American Medical Association, 2011).
This is where the line becomes blurry and ultimately confusing to healthcare providers due to the fact that health insurers definition is very different from the AMA’s. Health insurers defined medically necessary as an arbitrary cost as the least costly alternative or procedure (American Medical Association, 2012). This blurred line is what causes majority of reimbursement denials to occur. Health insurers need to have a system that has an ease of access in order for a physician to get confirmation about whether a service they deem medically necessary is actually covered by the patient’s health insurance plan.
Obama Care is an example of how insurance plans are going to affecting the decisions made in the patient/physician relationship. “Medicaid pays physicians about 56% of the amount private insurers pay. Because reimbursement rates are so low, many physicians refuse to provide care to Medicaid patients” (Emord, 2013). The reimbursement cycle of insurance plans, like Medicaid, are so low that it would cost more for the physician to see and treat patients then they feel it is worth. Hence, physicians are avoiding or refusing to see patients that have Medicaid as their insurance carrier.
Due to the rising costs of healthcare, the government is being forced to take the reins in an attempt to take control of these rapidly rising costs. However, the actions taken by the government are having an adverse reaction and causing damage to the sacred relationship shared between physicians and their patients. Laws and regulations imposed by the government are negatively affecting how and what physicians can communicate with their patients ultimately affecting the type of care and quality of care delivered to patients.
Laws and regulations that several states have already adopted are beginning to notice how they have already or the potential of affecting the patient and the physician relationship and the decisions that are made within the relationship. One area that is feeling the impact of the new laws and regulations are what the physician can or cannot discuss, or even ask, with their patients in regards to risk factors (American College of Physicians, 2012); this ultimately can affect the health of not only the patient’s, but their families as well.
This could lead up to more malpractice suits costing healthcare more money in the long run. Another area affected is just how much information that a physician can disclose or reveal is being limited by the regulations and laws being enforced by the government. A physician’s duty above all is to their patients and their patient’s care and the new laws and regulations imposed by the government are interfering with this duty.
The government’s newly imposed laws and regulations are actually requiring physicians to deliver care that is not individualized to that patient nor is the care supported by evidence-based guidelines of care. This in itself can damage the patient-physician relationship because patients may feel as though that the physician is not meeting their needs for healthcare and in turn causing that physician to possibly lose part of his patient base, which causes the physician to lose that source of revenue (American College of Physicians, 2012).
Micromanagement by the government regulations and laws as well as the insurance companies are forcing physicians to choose between practicing healthcare with the highest level of ethics or give in to pressures and take shortcuts in order to ratchet down the costs of healthcare. Doctors are starting to feel the brunt of the regulations and laws enacted by the government and the end result is a lot of doctors/physicians that have private practices or either closing the doors to join larger groups or hospitals, or their quitting practicing all together.
This leads to shortage of meeting the demand and supply of healthcare that is only increasing year after year. The Affordable Care Act, or more commonly referred to as ACA, is a prime example of this laws and regulations that are being enforced. The ACA may in the short run solve the healthcare costs on a temporary basis, but what is the long run result? The ACA is causing more and more families to be put onto Medicaid as their health insurance provider, but this does not really resolve the problem.
The more families put on government insurance plans, like Medicaid, the more likely they will not receive the care that is needed. As the Association of American Medical Colleges noted, by 2020 we will already need 91,500 more doctors than we are projected to have (American College of Physicians, 2012). Due to Medicaid reimbursements being so low, majority of physicians are not accepting patients that have Medicaid as their insurance carrier. So the question remains, are the newly imposed laws and regulations by the government truly helping meeting the demand and supply for healthcare, or are they causing more harm than good?