Economic Impact of R-PCI

Economic Impact of R-PCI

Why you should invest in CorPath GRX

One question which is associated with robotic-assisted PCI (R-PCI) is whether the benefits can be quantified. This is a question that anyone considering an investment in major new technology should be asking, and this paper explores that question in some detail. More specifically, the paper will look at the top-line impact of robotics on growth and revenue gains, as well as the bottom-line impact from mitigating expensive risks and other cost savings. To that end, this article explores the short- and long-term economic effects of adopting the CorPath GRX System.

For the purposes of this paper, the benefits of R-PCI – more specifically of the CorPath GRX System – were broken out into four different areas, all of which have significant potential for return on investment (ROI). These areas are:

  • Physician protection
  • Procedural automation
  • Precision stenting
  • Differentiating technology

As this paper will show, based on most current evidence, all four of these features contribute to the significant economic value of adopting R-PCI, making it an investment you cannot afford not to make.

Corindus Virtual Demo

Corindus CorPath GRX is a robotic system that helps to create a safe and healthy workspace for interventionalists. It allows operators to perform interventions by manipulating guidewires, guide catheters and devices from a radiation-shielded, ergonomic workplace with a set of joysticks and touchscreen controls without the need to wear heavy protective lead.

Automated movements of the robotic system aid operators in navigating tortuous anatomies and crossing complex lesions. Exact measurement of anatomy aids in selecting the appropriate stent, while precise movements support accurate device-positioning. All this can contribute to more consistent, high-quality outcomes. These capabilities allow more operators to perform complex PCI with confidence and help interventionalists reduce unwarranted variations.

How important is employee health? Viewed through an empathetic lens, the answer is obviously “extremely.” It turns out, however, that there are also compelling bottom-line reasons for worrying about the health and well-being of employees. Hospitals that ignore this fact may take a costly risk. And hospitals that underestimate the dangers of working in a cath lab do that as well.

Revenue losses caused by orthopedic injuries

The simple fact is: the cath lab is a hazardous workplace. Standing at the bedside table for long hours wearing heavy protective lead, which interventionalists have traditionally had to do, takes a very significant physical toll – specifically in the form of orthopedic injuries. These are all too common among interventionalists, ranging from spine problems, both lumbosacral and cervical, to hip, knee, and ankle issues. 62.8% of interventional cardiologists report at least one orthopedic injury during their career (≥ 25 years).1 That is nearly two thirds. That figure alone makes a very compelling case: hospitals and institutions must protect their interventionalists by relieving them of the burden of wearing heavy lead. It is the right thing to do, and it minimizes the risk of unplanned physician absence and consequent revenue loss.

The figure above contemplates a two-week absence from injury. But some orthopedic injuries can involve significantly longer periods of absence. Lumbar disc herniation can take a person out of commission for as long as three months. And once they return to work, there is always the danger of re-herniation, which is reported to happen between 5 and 18% of the time.2,3,4 The musculoskeletal strain that accompanies work in a cath lab may help explain the high prevalence of burnout among cardiologists. Midcareer cardiologists with 8 to 21 years of experience are more likely to report burnout (39%) than fellows in training (10%), or early-career cardiologists (23%).5 This is certainly an expense that hospitals would like to avoid. At an organizational level, the annual economic cost associated with burnout related to turnover and reduced clinical hours is approximately $7,600 per employed physician.6

Leaving aside orthopedic injuries, there is another hazard in the cath lab with which interventionalists have to contend. Despite the protective lead covering that they wear, the cumulated radiation exposure they face over the course of their career remains high. Exposure to radiation has been linked to the development of carotid artery disease, cataracts and various cancers. Carotid artery disease can occur after just 10 to 15 years in practice.7 Interventionalists just 16 years into their career were observed to have three times the risk of posterior subscapular cataract compared to non-exposed individuals.

Clearly, the cancers and other diseases suffered by employees in the cath lab take a toll, both on them and on their hospitals, when they are forced to leave their work in the cath lab, change their career paths or retire altogether.8

How R-PCI can help

R-PCI may solve all the problems mentioned above. Performing interventions from a radiation-shielded workplace in a seated position in front of a high-resolution, widescreen monitor helps to create a safe and healthy workplace for interventionalists. Radiation exposure to the primary operator drops by more than 95% in R-PCI, compared to manual PCI.10 Radiation exposure at head-level is reduced by 80% compared to suspended lead.11 In addition, since robotic-assisted tasks are being performed from a radiation shielded workplace, there is no need to wear heavy protective lead during these tasks. Clearly, reducing musculoskeletal strain and fatigue can provide tangible benefits to the bottom-line of your service line. But there is also potential top-line benefit. Less strain and fatigue may allow interventionalists to perform more PCIs. This could pay off: One additional PCI every second week results in an additional $409,708 of revenue per year ($15,758 * 26 weeks).

Greater productivity may help address physician burnout

Beyond making the cath lab a safer place to work, R-PCI can also help make it a less exhausting place to work. Physicians spend 27% of their working day on interactions with patients and nearly 50% on desk work.12 These tasks take up so much of their time that they often have to work overtime just to catch up. Consequently, this overbearing workload often leads to physician burnout. However, physicians who are performing interventions from an ergonomic workplace can make better use of their time, establish workflows that allow them to catch up on other activities, and take advantage of seamless access to additional patient data, leading to additional productivity gains.

$3,700 cost savings/case

One extremely impressive example of greater revenue at reduced costs is performing PCI using Left Transradial Approach (LTRA). It is well established that LTRA and consecutive Same Day Dismission (SSD) due to lower complication rates can save an astounding US$ 3,700 per case.13 But it is also known that these benefits for patients come at a cost for the physician. Physicians receive twice the amount of radiation exposure when performing radial procedures vs. femoral. At least that was the case until now. With R-PCI, the ergonomic challenges and increased radiation exposure associated with the left transradial approach could be eliminated.14

Extended years of service and lower replacement costs

cath lab brings with it a number of challenges, and a number of hazards. Interventionalists have been known, as a result, to retire early. This is an expensive proposition for hospitals. Replacing an interventional cardiologist can be costly; revenue loss and costs for recruitment and training can add up to $1,000,000.15 In the safer and healthier work environment created by R-PCI, interventionalists may decide to prolong their careers, resulting in cost savings on recruitment.

Complex PCI procedures are increasingly common, accounting for approximately 40% of all PCI cases today.18 Complex PCI procedures can last as long as two hours,19 with much of that procedure time spent delicately manipulating wires to navigate diverse vascular anatomies and cross complex lesions. Interventionalists may need multiple attempts with various guidewires to finally cross the lesion. What is effectively a “trial and error” method for navigating vessels and crossing lesions is not optimal. It is unpredictable, can require additional fluoroscopy time, as well as more radiation and contrast agent. Contrast-induced acute kidney injury (CI-AKI) represents a common but serious complication of PCI,20 and unwanted radiation is never a good thing.

How R-PCI can help

R-PCI has the potential to overcome the limitations of manual PCI by providing operators with reproducible, automated, robotic movements. These movements replicate the manual techniques of highly skilled interventionalists and provide even low-volume operators with high-volume skills to aid in guidewire navigation and lesion crossing. These automated movements are designed to reduce time associated with lesion crossing. Rotate-on-Retract is one of four automated movements available on CorPath GRX. It has the potential to reduce wiring time by 53%.21 Shorter procedures involving less fluoroscopy time can increase patient safety by reducing the need for contrast media and lowering radiation dose.

Increased patient safety due to 35% reduction in contrast agent and 20% dose reduction

R-PCI is associated with a 20% reduction of radiation exposure to the patient22 and a 35% reduction of contrast media.23,24,25 A reduction of radiographic contrast media may help reduce the incidence of CI-AKI and the costs associated with it.

More operators working at a high level

The availability of advanced wiring skills at the push of a button allows more operators to navigate diverse anatomies and cross complex lesions, which can result in greater confidence. Users of CorPath GRX report that they now treat more complex cases successfully, where they might once have deferred those cases to other, more specialized institutions. Institutions that adopt R-PCI are able to treat additional patients and shift their case mix towards more complex cases. All of which is of real benefit to the bottom line.

Precision is essential to the success of PCI. Lack of precision can result in geographic miss (GM), which can negatively impact patient outcomes. Geographic miss occurs in 66.5 % of all PCI patients, with a high prevalence of longitudinal geographic miss (LGM), which occurs in nearly half (47.6 %) of all PCI patients. GM is as sociated with a twofold increase in target-vessel revascularization (TVR) rates, and a threefold increase in myocardial infarction (MI) rates within one year.27

Inaccurate assessment of lesion length

Inappropriate stent length selection is one of the reasons for geographic miss. Visual assessment of coronary lesion length is highly variable and often results in overstenting or understenting. Due to the 2-dimensional angiographic view, visual assessment of lesion length can be particularly challenging in moderately (45-90°) and extremely (> 90°) angulated lesions. In fact, two out of three stents are selected inaccurately after visual assessment.28

Suboptimal stent placement

In addition to stent length, stent placement can be a challenge. Accurate stent placement is particularly crucial to the treatment of complex, high-risk lesions. Up to 20% of all PCIs are performed to treat coronary bifurcations.29 These PCIs are known for being technically challenging and have historically been associated with lower procedural success rates and worse clinical outcomes than PCIs treating non-bifurcation lesions.

Poor patient outcomes can result in avoidable costs

Stent placement can result in poor patient outcomes. 9.3% of all PCI patients experience an unplanned readmission within 30 days. Mean hospital costs are 62% higher for readmitted patients. ($23,211 vs. $37,524).30 12% of cardiology-related lawsuits are caused by the improper performance of a treatment or procedure29 and are associated with lawsuit defense costs which can easily run into 5-digit numbers. Some institutions may decide to avoid the risks associated with the treatment of high-risk lesions altogether and defer these cases to other, more specialized hospitals. To these hospitals, these cases represent lost potential revenue and wasted opportunities to build their reputations.

How R-PCI can help

Simply put, robotic precision can improve patient outcomes, thereby also reducing costs. R-PCI with CorPath GRX can help address the incidence of poor patient outcomes. The robotic system measures coronary anatomy down to a fraction of a millimeter to help physicians determine the length of the lesion and to select the appropriate stent length. Accurate stent length selection may reduce the incidence of longitudinal geographic miss and the need for extra stents.

Beyond the cost savings on stents, a reduction of stents and accurate stent placement can reduce the incidence of complications and associated costs. R-PCI has a significantly lower incidence of longitudinal geographic miss (12.2%) compared to manual PCI (43.1%).33 Potentially fewer complications stemming from stent selection and geographic miss may help avoid lawsuits and associated costs.

Meeting and ideally exceeding the expectations of staff and patients is a priority for healthcare providers today, because the competition for both is growing more intense every year. Greater competition puts healthcare providers under pressure. Average operating margins of hospitals dropped 39% over the three years from 2015 to 2017.34

Competing for patients puts hospitals in the position of trying to duplicate services relative to their local competitors, which ends up driving down prices, possibly eroding prices and profits, and compromising market share.35

Some providers may choose to aim for greater efficiency to compensate for eroding profits, which may affect patient experience and lower patient satisfaction. Lower patient satisfaction is associated with dissatisfied physicians and nurses. Dissatisfaction, stress, and burnout among the healthcare workforce threaten patient-centeredness.36,37 All this amounts to a downward spiral that benefits neither patients nor providers.

In addition to competing for patients, healthcare providers need to worry about a growing shortage of clinical staff. In 2020, the average hospital turnover rate in the U.S. increased to 19.5%. In rural areas, turnover is on the rise.38 The average time to fill physician vacancies is 180 days, and for specialties it is more than 200 days.39

Retention of key personnel such as interventionalists is just as important today as recruitment of younger talent, as the hospital workforce continues to age. Today, the median age of interventional cardiologists is 54 years.40 By 2025, there will be a projected deficit of 7,080 cardiologists in the U.S.41 Interventional cardiologists’ average net annual revenue impact on the hospital is $3.4 million.42

How R-PCI can help

R-PCI can support organizations in addressing their needs by helping attract both patients and providers. Hospitals that choose to go this route have a good chance of realizing increased market share, higher profits and lower costs.35 In 2021, medical robotics saw an increase in sales of 29%. This trend is projected to continue. Experts project a growth of procedures performed by medical robotics of 72% through 2025.43 74% of future patients would consider being operated by a robot.44 Offering innovative procedures can help to improve caregiver and patient experience alike, leading to increased patient volumes.

The calculation above is very conservative. A realistic addition of one PCI per week would mean the annual growth for the first year would reach > $819,000 ($15,758 x 52 weeks]. Robotics can also help to improve retention and attract new talent. Access to leading technologies allows physicians to participate in clinical innovation, enhancing their reputation and that of their institution. It also elevates the role of the cath lab team and can increase job satisfaction.

R-PCI is worth the investment

R-PCI with CorPath GRX has the potential to pay off in a multitude of ways for hospitals that want to take their place at the forefront of a new technology. CorPath GRX can help you protect key personnel, improve patient outcomes, and potentially reduce the number of complications and unplanned readmissions. It can also help you realize your growth ambitions by expanding your services into treatment of more challenging, complex cases, helping you grow patient volumes and improve provider retention as well as provider recruitment. All in all, that is a return-on-investment worth exploring.

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