Framing the evaluation of new technologies in terms of evolutionary versus revolutionary technologies also has applicability from a practice management perspective. Iterative or evolutionary improvements in surgical technology often have a lower barrier for implementation. They are not significantly changing the practice, and if the accounting makes sense, they should not add significant expense. If the new device or technology is going to help our surgeons perform better in the OR—and there are innumerable metrics with which to gauge that effect—and if it is associated with a modest investment, the evaluation is more straightforward. Other types of innovations are more revolutionary, requiring a significant investment, a big change to our surgeons’ protocols, or both. And if that is the case, justifying the expenditure becomes a little more complicated.
Our practice’s willingness to adopt HYPERVIT was actually predicated on similar thinking: it would improve performance in the OR without requiring a rethink to normal workflow. It became apparent that at least trying it would be a low-risk/potentially high-reward proposition. In the past, we have used a similar framework when evaluating valved cannulas and lighted lasers, examples of technologies that don’t significantly disrupt workflow, but do improve conditions in the OR.
Like most practices, when it comes to revolutionary technologies, we weigh the benefit against the cost, which remains a real challenge and an important question to ask of any new technology being considered for implementation. With technology used in surgery, there is often not the promise of additional billing. Most often, they are making your work better in the OR, and so some of the intangible factors become emphasized in decision-making. For instance, we may be able to make a case for increased volume, if surgical time will go down. Perhaps our surgeons can expand their services using the new technology. The bottom line is that the capital expenditure for new technology may be the most important factor clinics might consider, but it shouldn’t be the only thing.
At the same time, upgrading a practice’s technology is always somewhat of an unknown, as the true effect is not fully known until it is implemented into regular use. We have to use our best prognostic powers to determine what we expect the impact to be, but we always have to be prepared for the unexpected. When we are presented with new technology for use in retina surgery, the evolutionary changes we implement require the same careful scrutiny as the revolutionary ones. With the latter, though, there is an additional challenge in justifying what is often a larger capital investment when confronted with ever-present reimbursement challenges facing our subspecialty and all of medicine (not to mention the investments of time and resources).
What else did our practice consider while evaluating NGENUITY? In fact, several intangible factors helped us make the leap:
1. Good medicine is good business. Our best marketing is being the best clinicians that we can be; this mindset results in always striving for better patient care, which is really what we are about as a medical practice. If we are presented with a technology that offers to improve our chances of doing that, it is something we can consider on the ‘pros’ side of the equation, even if the investment is substantial.
2. Training. One of the well-known benefits of NGENUITY is in how it enhances surgical training. For a private practice group like ours, this may seem less important than it would be compared to academic centers. And yet, we can use NGENUITY as an instrument to educate and teach local community ophthalmologists and optometrists about what we do in the OR. In our network, we still encounter a fair bit of stigma around vitrectomy and a belief that it is still extremely invasive or a last resort option for sick eyes. We have started to make inroads to dispelling these myths using some of the training features traditionally associated with NGENUITY.
3. Ergonomics. We recognized that digital viewing puts our surgeons in a more comfortable and stable position compared to the oculars. Protecting our surgeons with improved posture and ergonomics provides for a more enjoyable surgical day, and I feel it could possibly help them practice surgery for many years longer. There is a huge financial benefit to protecting the health of our physicians.
4. Expansion potential. Getting involved early would give our surgeons the opportunity to participate in the platform’s continued development and to become truly expert in using what we believe will become the surgical platform of tomorrow.
In some respects, our practice was not among the earliest of adopters of NGENUITY. The ‘wow factor’ was evident, but we did not initially accept all of the intangible benefits. To Alcon’s credit, the company continued to develop the technology, making it better at each stage, and representatives kept showing us its potential. Over time, we came to see how it would change the experience in the OR for patients, surgeons, and staff. The many intangible and value-added aspects of NGENUITY soon became obvious to us and have since been realized after adoption.
It is important to us that any new technology added to the OR be fully supported, from onboarding through implementation as well as into the future. And so, that NGENUITY was backed by one of the industry stander bearers was very important in our thinking process. In thinking about intangibles, confidence in the company developing the technology is of utmost importance, because the bigger the investment, the bigger the expectation on the company you partner with.
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