The demand for hybrid operating rooms (ORs) is linked to the first FDA cleared transcather device, which was approved in 2011. Although the integrated ORs were introduced in the 1990s, the high risk transcather procedures pressured surgical teams to have an open surgery alternative available. The ECRI Institute has measured this growth, and predicts by 2018 about 75 percent of cardiac surgeons will be working in these tech-heavy rooms.
At the cost of $5 million to $10 million, contingent on construction costs, facilities have walked the line of investing in technology to support patient outcomes while also making smart business decisions, particularity in measuring their return on investment (ROI). Off the record, OR managers and other facility leaders have called them a ‘necessary evil’ and a ‘scheduling nightmare’, but given that more procedures are becoming minimally invasive, therefore higher risk, this is the way of the future. To figure out how facilities can prepare to discuss ROI, Surgical Products connected with Rohit Inamdar, a senior associate in ECRI Institute’s Applied Solutions Group, and Carla Thorson, MSN, APRN, ACNS-BC, CNOR, CNS-CP, content manager in the Center for Nursing Leadership at Association of periOperative Registered Nurses (AORN).
Competing Views of ROI
From a business perspective, Inamdar says surgical team members are not typically tasked with counting the dollars and cents to measure ROI, but they have to understand how having a hybrid OR impacts the department.
“Surgical teams and administrators have a process to assess surgical service line needs and ensure implementation meets surgical/procedural objectives with performance measures,” Thorson agreed. “The measurable objectives are based, in part, on the needs of the surgeon/proceduralist and the case types that are predicted to be the high volume cases. The team must calculate the costs of the hybrid room by tracking costs, case types, and patient turnover. So it is tangible, and it’s an educated forecast that would vary by facility, and that is based on the specialty type cases and respective reimbursements.”
Although there are tangible elements to ROI, some are not. They include:
- Local competition and market share of procedures
- Patient safety and overall risk
- Meeting patient demand
- Role in industry innovation
Inamdar says every stakeholder in a facility has a different perception of these intangible ROI factors, but consistent communication about expectations will keep all the stakeholders on the same page and conversations productive. He also added it is important to pinpoint how facilities will make their money back from this roughly 10-year investment. To do this, they can ask:
- How many procedures will be done in the hybrid OR, and how will this improve how they are done now?
- If there is not a surgical case scheduled, how can the OR be used to recoup installation cost?
- How can scheduling and billing be managed between departments?
- Will we phase out imaging equipment elsewhere to reduce equipment redundancies?
Inamdar says, as a contracted planner, building a hybrid OR involves many variables and is more difficult than many of his clients realize. “It’s not just about a hybrid OR. It is about the cath lab and IR suite potentially,” he explained.
The Pros and Cons of Investing
A decision with so many stakeholders will include a myriad of perspectives on whether a hybrid OR should be constructed. Financial leaders evaluate the pros and cons on how installation costs will be recouped. OR managers understand the importance of the technology but base ROI on surgical team confidence and schedule coordination. Smaller facilities say they understand the industry pressure, but there is no way to make the money back from the initial investment.
Thorson said: “Investment in hybrid rooms and their associated technologies is made to achieve specific strategic goals in surgical specialty service lines related to advancing care, to retain surgical and specialist talent, to differentiate the hospital from other service providers, and ultimately to achieve positive financial results for the health system.”
“By evaluating and deciding first which types of advanced procedures will be supported by a particular hybrid room, stakeholders will facilitate the equipment selection and layout. In order to define the high volume usage case for a hybrid room, planners need to identify the surgical/procedural need of catchment area and physician talent/specialty available with a thorough analysis of past and projected utilization rates for each type of procedure.”
“Cons: This takes time, money and people-power to complete the program work and ongoing analysis.”
“Pros: A well-researched, thoughtful analysis will lead to an actionable plan and a highly functioning hybrid room that achieves maximum utilization rates according to case types.”
Inamdar echoed these opinions, but he added cardiac surgeons need to be on board with the transcatheter approaches and be comfortable doing the procedures because that is what patients are increasingly demanding. It takes more than a year to build a hybrid OR and about five months to be proficient at the procedures, he explained. The demand from high risk patients who want these procedures will only increase as the patient population gets older and more high risk from comorbidities, like diabetes and obesity. “If you’re not on it, (the minimally invasive train) is going to pass you by,” he predicted.
Although he reflected this is one positive, he says the financial responsibility for these investments is huge, and facilities need to know how they will get their ROI. Some facilities realize it in two years; for others, it takes more than 10 years.
(Image courtesy of Black Diamond Video)