As the national medical director of robotics for HCA Healthcare, Thomas Payne is on the front lines of the revolution in robotically assisted surgery.
Payne works with HCA’s surgeons to choose which robots will be used in the health system’s facilities, determining the best technologies to acquire from a rapidly expanding field of candidates.
The country’s largest for-profit hospital operator now employs about 20 different robotic platforms across its centers, or a total of 933 robots as of February. The robots have helped perform more than 1 million surgical procedures at HCA facilities, a milestone reached last year, according to Payne.
The surgeon executive spoke to MedTech Dive about the reasons for the increasing use of robots in surgery, why HCA has fully embraced the robot-assisted approach, and how the healthcare provider evaluates new entrants to a market long dominated by Intuitive Surgical.
This interview has been edited for length and clarity.
MEDTECH DIVE: How does HCA think about its investment in robotics?
THOMAS PAYNE: We’re all in. The patient is our mission. The partners are the surgeons. We like to say we don't just buy robots, but we build robotic programs.
When new robotic platforms come out, we'll have a board of physicians or surgeons or experts in that facility give us feedback and say, “Hey, that's a valuable piece of technology. We think that will help us take better care of our patients.” Or, “It's not ready for prime time.”
How do you decide which robots to buy?
Our surgeons pick the winners. There's not an administrator picking the winners or board picking the winners. It's our surgeons that give us feedback.
We do more robotic surgery than anybody in the world. Because the volume is so high, we built our robotic program very methodically. Getting into robotic surgery is expensive, so you have to run a program efficiently to take the best care of your surgeons and your patients and not be too expensive.
We're convinced that the total cost of healthcare comes down with robotic-assisted surgery.
Is robotically assisted surgery better for patients?
All the bad things that you don't want to happen in surgery happen more often with open surgery. Clinically, in some cases, you have to do open surgery. You just have to. There's no choice. But in general, probably 95% of all surgeries out there can be done minimally invasive, if you have the right skill set, the right robot and the right program.
Our goal is to perform almost all minimally invasive surgery. Our surgeons want it because they know it's better for their patients. Things like complications, blood loss, transfusions, readmissions, long lengths of stay in the hospital, infections — all those things are much higher with open surgery than they are with minimally invasive surgery. And robotic-assisted surgery is the most reproducible way to do minimally invasive surgery.
Almost all of our facilities are at somewhere less than 10% open surgery. That's a paradigm shift. As a surgeon or physician, you want to be alive in your career when something exciting happens, like antibiotics, or radiation, or chemotherapy, or something that really is a game changer. In the surgical space, robotic-assisted surgery is that paradigm shift.
And with the new computational powers that are coming into the new systems, now you're talking about cycles of improvement with AI and all the different things that are going to be put on top of that, to keep surgeons optimized in their skill sets. You're going to see more of that come in, and it's just going to speed up and get even more dramatic over the next five to 10 years.
How is the field of surgical robotics evolving?
HCA is in the graduate medical education space as well. We are the biggest trainer of residents in the world. All the surgical residents in HCA hospitals go through advanced robotic courses in their junior year. They get robotic-certified, so when they graduate, they're ready to go.
The change I've had the privilege of seeing in my career, which was taking arrows in the back in the early days when doing robotic surgery was very controversial – now, when I ask those residents for a show of hands: “How many of you are looking for jobs after you graduate in hospitals that don't have robotics?” Crickets. It's almost like they have to have robotic-assisted surgery, or they don't want to go to that hospital. That is their preferred way of operating now.
That's very, very different than when I trained in the 1990s, or very different than even 10 years ago.
There’s a lot of competition coming in surgical robots. How do you assess them all?
I have a PowerPoint slide that has all the company names of all the robots that are either FDA-approved or soon-to-be, and it's literally 100. It's coming so fast and so quick. Not all of them are going to be successful soon. In fact, the majority are not going to be successful. They'll probably never get out and gain traction.
As this country's largest healthcare company, they all want to get in front of us, to show us what they have. When they get a handful of surgeons interested in their product, then we'll start listening.
We get six or 10 experts in robotics to go and look at that new product. If we have surgeons that are interested, we're willing to purchase or place those robots in our hospitals, but then they better be successful, and they better be used, because we're not going to go down the road with the technology that doesn't compete at a high level with what's already established.
We talked to J&J, we talked to Medtronic, we talked to Virtual Incision’s Mira, we talked to Endoquest. We talked to all the different types of robotic platforms — orthopedic, pulmonary, spine, neuro – all those companies we spent a lot of time talking with.
If we have enough surgeons that are interested in that technology, we go kick the tires, so to speak. Then if we get to the next level where surgeons come back super excited, like this is amazing, we really need to have this, then we'll go with that. And then we'll check again right after we buy two or three or four or five. Then we're going to check again and make sure that is consistent.
We're just trying to be good stewards of our resources, because if we waste resources over here, that's just money that we can't use to take care of patients over here. So we're pretty good stewards and pretty frugal, I would say. There's a plan on robotic purchases, and we follow those business plans pretty religiously. And so far, it's been really successful for us.
