Now Comes the 'Moore Commission' to Corral Growing Herd of Surgical Robots

Friday, August 22, 2014

Senator Dick Moore, Democrat of Uxbridge, has his robotic surgery bill on the verge of enactment, and that’s a good thing.

The Massachusetts Senate, where Moore serves as President Pro Tem, second only to the President herself, passed An Act Relative to Robotic Surgery on July 11. 
The legislature’s Joint Committee on Rules gave the bill, now designated Senate Bill 2261, an “ought to pass” recommendation on August 14 and sent it to the House Committee on Steering, Policy and Scheduling.

Steering Policy and Scheduling placed SB2261 in the Orders of the Day for the session of the House held on Monday of this week, August 18, and the bill went through a quick, ritualistic third reading on that day.
“Third reading” does not mean it was actually read aloud three times on the floor.  Rather, it refers to the step where a legislative body formally considers a measure for a third and final time in public session.  It is a step equivalent to passage: a bill’s third reading and its passage are accomplished in the same motion. 

To become law now, An Act Relative to Robotic Surgery needs only to be engrossed by the House -- a perfunctory step -- and signed by the governor.
SB2261 would set up a 17-member special commission to “investigate and review the use of robotic surgery,” develop a training protocol for each application of robotic surgery, devise an application and certification process for hospitals seeking to perform robotic surgery, and establish guidelines for the training and experience of surgeons who use robots.

Representatives of the Massachusetts Medical Society, the American Urological Society, the Society of Gynecological Surgeons, the Society of Thoracic Surgeons, and the Massachusetts Hospital Association will be among those appointed to the commission.  Three state representatives and three state senators, including, presumably, Dick Moore, will also be put on it.
The robots now widely deployed in U.S. hospitals are operated by surgeons working at consoles.  The surgeon does the directing; the robot does the cutting.  In certain procedures, there are definite upsides to having a robot wield the scalpels and other surgical tools.  For example, they can use tinier instruments and work in tighter spaces than a surgeon’s hands can.  They also often accomplish the desired results with less extensive cutting.  Studies have indicated that many patients recover quicker from robotic surgery because of smaller incisions and fewer disturbances of internal organs and tissues.

Surgical robots, however, are expensive little devils. The initial outlay for what may be considered the top-of-line surgical robot can exceed $2.5 million; the per-procedure instrument costs often approach $2,000; and the annual service contracts run into the tens of thousands of dollars. 
Robotic surgery is also more costly than conventional surgery. As an example, prostate removal by robot will run about $4,500 higher than standard prostatectomy. 

That money is well spent, robotophiles say, because patients who have undergone a robotic procedure experience less post-surgical pain and discomfort, and are able to return to their normal routines sooner.
Perhaps the hardest knock on robotic surgery is that studies to date have not found it to be more effective than standard surgery.  If future studies corroborate that finding, it will mean we’re paying more for robotic surgery to get the same results as from standard surgery. 

Robots in the surgical suite have also been criticized for setting off a new kind of “medical arms race,” with hospitals having no choice but to acquire robots once their competitors have them.
Dr. Marty Makary, director of surgical quality at Johns Hopkins Medical Center in Baltimore, has decried the surgical robot as “a symbol of what’s wrong with American health care: the widespread adoption of expensive new technology with little evidence to support its use – all within the context of a poorly informed, even misinformed, public.”

On my clearest days, I’m barely one notch about “poorly informed, even misinformed” on this topic.
That’s why I’m glad Dick Moore, Beacon Hill’s most knowledgeable person on health care costs, has come up with this special commission idea.  If they get the right persons on it and if they do their jobs energetically, we’ll all become better informed.  And our health care system will end up spending our limited dollars more wisely.

THAT LAID-BACK TIME IN THE LEGISLATURE, POST-JULY 31:  We’re at a point in the 2013-14 legislative session when you might say that only “feel good” measures are on the agenda.  Back in 1995, the legislature adopted Rule 12A obligating itself to conclude “all formal business” no later than the last day of July in the second year of a session; after that, the House and Senate may meet informally.  Only a few legislators from each party show up for these meetings, and no debates are held.  The rules governing “informals” make it impossible to go beyond routine business or to vote on controversial matters.  If even one member present objects to taking a vote on something, that item must be tabled for that entire session.  As the minority party in the legislature, Republicans send at least one member to all informals to prevent Democrats from passing anything momentous or contentious.





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