Recently my hospital looked at our costs and revenue for robotic v. open prostatectomy at my insistence. They had maintained that robotic surgery was far more expensive and that they lost money on each case. With a more careful, global analysis and with improving operating times by most of the surgeons performing robotic surgery, they have now concluded that it is profitable. However it is not as profitable as open surgery. I pointed out to them that the total number of cases, open and robotic, is up over the last three years (there is still a cadre of surgeons who won't switch to robotics), meaning that the robot is bringing in new patients to the system and not just taking away open cases. That is new revenue that would be lost without the robot. With the new analysis they have decided (at last) to undertake a marketing program to promote the robot in our community. We have the largest series (500+ cases), with the possible exception of the Mayo Clinic Scottsdale, and we have many firsts in the Southwest (first prostatectomy and cystoprostatectomy, first nephroureterectomy, first colposuspension). We now have one gyne-oncologist starting to do cases. I hope things will really take off from here now that the economic picture is clearer.

It was interesting to learn that, when the data was broken down by insurance carrier, that there were three plans on which the hospital lost money on robot cases. They still pay on a perdiem basis, meaning that the hospital is penalized if we get the patient our quicker! Two of them, Aetna and United Healthcare, are big players in most markets.

Dale Russell, MD
Scottsdale Urologic Surgeons

Who cares if the hospital makes money! We urologists in private practice cannot afford to spend that much time in the OR for such a relatively poorly reimbursed procedure: robotic OR open radical prostatectomy. Two vasectomies pay better than one of these procedures if the patient is on Medicare.

I agree that the reimbursement for a radical prostatectomy should be more than it is, but that is true for nearly everything we do these days at the hospital. You are paid a little more for the code for a laparoscopic prostatectomy (the code for a dVP) than for an open radical and with experience you can do a dVP in about the time it takes many urologists to do an open (2-3 hours). Granted some folks can do an open in 90 minutes, but, given the lower positive margin rates with the da Vinci and slightly better potency and continence rates, I don't see how anyone can continue to justify doing opens.