Creating Value with a da Vinci Surgery Program

Creating Value with a da Vinci Surgery Program
Presenter Name Presenter Title Objective: To explain the top concerns facing hospital administrators and their key surgeons today, and how a da Vinci Surgery program addresses these top concerns. Explain some of the key metrics to think about when making a strategic technology acquisition Highlight the best practices of building a da Vinci Surgery Program and how to leverage your relationship with Intuitive Surgical to ensure success. Opening Probes: Administrator: What are your key initiatives and focus areas this year and next? What are some of your greatest challenges and concerns this year and next? How do you distinguish your hospital from your competitors? How has da Vinci surgery impacted your hospital? Have you had patients asking about this option? When/Where have you had the opportunity to speak to your peers about a da Vinci Surgery program and its associated benefits? What do you know about the potential benefits of initiating a da Vinci Surgery program at your institution? Surgeon: Are you familiar with da Vinci Surgery? How familiar are you with the benefits of a da Vinci Surgery Program to your practice and the hospital(s) you work at? How does the administration at your hospital evaluate and value a capital investment?

Top Concerns Facing Hospital CEOs
Objective: Find out which two or three concerns listed here are also the customer’s key challenges today. Script: Two large surveys were recently conducted with hospital CEOs across the U.S. These surveys asked them to rank the biggest challenges and concerns they are facing today. Second to the economic crisis, the following topics weighed heaviest on their minds… Improving Patient Outcomes and Satisfaction Patient Safety and Quality of Care Attracting Patients Overcoming Capacity Constraints Physician / Hospital Relations Adopting New Technology The purpose of this presentation is to give you an better understanding of how establishing a successful da Vinci Surgery program can help address your pressing concerns…. Throughout this presentation, my hope is that you will understand why more than 930 hospitals worldwide have leveraged a da Vinci Surgery program to help address these concerns and develop a competitive advantage in their marketplace… Questions: Do you agree with this list of concerns/challenges? What are your top concerns today and why?

Why da Vinci® Surgery? Objective:
Segue to an explanation of how da Vinci Surgery offers patients significant value— which in turn increases demand for da Vinci Surgery in the healthcare marketplace— and how hospitals can capitalize on this value creation. Script: … Let’s start with the question “why da Vinci Surgery over other surgical approaches?”

Why da Vinci® Surgery? Value = Efficacy ÷ Invasiveness2
da Vinci Incisions •da Vinci • Open Surgery •Alternative Therapies (radiation) Objective: Explain how da Vinci Surgery offers patients significant value— which in turn increases demand for da Vinci Surgery in the healthcare marketplace— and how hospitals can capitalize on this value creation. Script: With da Vinci, surgeons can offer gold standard treatment with the potential for outcomes that are equal to or better than conventional surgery, but with the benefits of minimally invasive surgery. As a result of this value creation to the patient, we find that patients actively seek and demand the da Vinci solution to surgery, and will search out hospitals and surgeons that offer this modality. Questions: What are your thoughts about this equation? How do you think this applies to surgeries such as hysterectomies, mitral valve repairs, general surgery and sacrcolpopexies? Open Incision

Improving Patient Outcomes & Satisfaction
Objective: Highlight how improved patient outcomes, recovery time and return to normal activities drive patient satisfaction. Highlight multiple specialties for which da Vinci can be used. Script: … Specifically regarding your concern surrounding patient outcomes and/or patient satisfaction, I would like to share examples from published studies that compare open, lap and da Vinci patient outcomes for gynecology, urology, and cardiac cases. Questions: How important do you find … • Clinical outcomes • Recovery time • Return to normal function, activities … to be in achieving excellent patient satisfaction ratings? Later, we’ll be discussing how excellent patient satisfaction ratings can help hospitals attract incremental patients.

In this Section • Improved clinical outcomes • Faster recovery time • Faster return to normal function, activities • Excellent patient satisfaction ratings Conclusion da Vinci Surgery offers the potential benefits of a minimally invasive procedure for complex conditions, with excellent outcomes and fast recovery — across multiple specialties. This results in a very high level of patient satisfaction and a willingness to recommend da Vinci Surgery to others.

Clinical outcomes - Cancer
Hysterectomy Prostatectomy Objective: Highlight how improved patient outcomes drive patient satisfaction. Highlight multiple specialties for which da Vinci can be used. Script: The examples I’d like to discuss are broken down into three key areas: outcomes, recovery time, and return to normal function. Let’s look at clinical outcomes in cancer operations. … [Repeat discussion on prostate cancer surgery and gynecologic cancer from the brochure] Questions: What value do you place on patient satisfaction at your institution? Have you found referral “word of mouth” marketing to be extremely impactful of a hospital’s reputation and subsequent patient admissions? da Vinci Prostatectomy: Patel VR, et al. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int May;99(5): Open prostatectomy: Scardino PT. Open radical retropubic prostatectomy. Presented at the American Urological Association’s Carcinoma of the Prostate Course, San Francisco, CA, Sept. 30 – Oct Lap prostatectomy: Touijer K, et al. Quality improvement in laparoscopic radical prostatectomy for pT2 prostate cancer: impact of video documentation review on positive surgical margin. J Urol Mar;173(3): p. 766 da Vinci Hysterectomy: Boggess JF, et al. A comparative study of three surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am Jrnl of Obst & Gyn. Oct 2008; 360. e1-360e9

Clinical outcomes - Cardiac
Objective: Highlight how improved patient outcomes drive patient satisfaction. Script: … Specifically regarding your concern surrounding patient outcomes, I would like to share an example comparing open and da Vinci patient outcomes for cardiac cases. [Repeat the MVR and bypass discussion in the brochure] Questions: What value do you place on patient satisfaction at your institution? Have you found referral “word of mouth” marketing to be extremely impactful of a hospital’s reputation and subsequent patient admissions? da Vinci Mitral Valve Repair: Murphy D, et al. Multicenter mitral valve study: a lateral approach using the da Vinci Surgical System. Innovations: technology and techniques in cardiothoracic and vascular surgery March; 2(2): 56-6 Sternotomy Valve Surgery: Society of Thoracic Surgeons Adult CV Surgery National Database - Fall 2005 Executive Summary

Return to normal function
For men… post-prostatectomy Objective: Highlight how return to normal function drives patient satisfaction. Script: Once the cancer threat has been addressed and recovery commences, a man’s concern usually focuses on the quickness and completeness of his recovery of urinary and sexual function. [Repeat discussion in the brochure] Questions: What value do you place on patient satisfaction at your institution? Have you found referral “word of mouth” marketing to be extremely impactful of a hospital’s reputation and subsequent patient admissions? Sexual Function: da Vinci: Kaul S, et al. Robotic radical prostatectomy with preservation of the prostatic fascia: a feasibility study. Uro. 2005; 66, Open: Parsons JK, et al. Effect of methylprednisolone on return of sexual function after nerve-sparing radical retropubic prostatectomy. Urology Nov;64(5):987-90 Lap: Su, L.M., et al. Nerve-sparing laparoscopic radical prostatectomy: replicating the open surgical technique. Urology. 2004; 64, 123 Continence: da Vinci: Patel VR, et al. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int May;99(5): Open: Walsh PC. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. J Urol Jul;164(1):242. p.59

Return to normal activities
For women … post-hysterectomy Objective: Highlight how improved recovery time and return to normal activities drive patient satisfaction. Script: Recovery time can be a tremendous consideration for women facing hysterectomy for a benign condition. Women are frequently told their condition is too complex for minimally invasive surgery. As a result, many women will simply live with the symptoms. With da Vinci Surgery, however, today’s gynecologic patients no longer have to choose between a treatment with a long recovery and a compromised quality of life. By enabling a minimally invasive approach to even complex hysterectomy, da Vinci Surgery can expedite women’s return to normal daily activities, to their families and to work. [Repeat Maria Bell study discussion from the brochure] Questions: What value do you place on patient satisfaction at your institution? Have you found referral “word of mouth” marketing to be extremely impactful of a hospital’s reputation and subsequent patient admissions? Bell MC, et al. Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques. Gynecol Oncol Nov;111(3):407-11

Objective: Summarize how improved patient outcomes, recovery time and return to normal activities drive patient satisfaction. Script: Finally, this graph shows the results of a survery we conducted with 154 da Vinci patients who were asked about their satisfaction level post-surgery. 93% said they were either “very satisfied” or “extremely satisfied”, and more importantly, 95% would recommend their procedure to other people in a similar situation. da Vinci Surgery offers the potential benefits of a minimally invasive procedure for complex conditions, with excellent outcomes and fast recovery — across multiple specialties. This results in a very high level of patient satisfaction and a willingness to recommend da Vinci Surgery to others. Questions: What value do you place on patient satisfaction at your institution? Have you found referral “word of mouth” marketing to be extremely impactful of a hospital’s reputation and subsequent patient admissions?

Safety & Quality of Care
Objective: Highlight the specific and measurable safety and quality-of-care outcomes with traditional surgical approaches, and how da Vinci Surgery has proven to meet or exceed these outcomes. Introduce the implication of these outcomes for pay-for-performance policies. Script: Patients’ and hospitals’ priorities overlap when it comes to quality of care and safety. One way to quantify hospital quality and safety is through analysis of operational metrics, including patient blood loss, OR time, postoperative complication rates and conversion rates. Today, many hospitals are increasingly concerned with “pay for performance”— avoiding non-reimbursement for the cost of hospital-acquired conditions and injuries, including: [Repeat list in brochure; repeat discussion from brochure about the balancing act hospitals are engaged in to maximize surgical revenue and minimize hospital acquired conditions] Questions: With increased scrutiny around pay-for-performance, how important are … Reduced blood loss • Shorter OR times • Reduced risk of hospital acquired conditions • Lower complication rates • Lower conversion rates … to your institution?

Safety & Quality of Care
In this Section - • Reduced blood loss • Shorter OR times • Reduced risk of hospital acquired conditions • Lower complication rates • Lower conversion rates Conclusion - da Vinci Surgery has been proven to help minimize risks and complications, as well as rates of conversion to open surgery, maximizing patient safety and quality of care for even the highest-risk patients.

Blood Loss Benign Hysterectomy Objective:
Highlight the blood loss common with traditional surgical approaches, and how da Vinci Surgery has proven to meet or exceed these outcomes. Introduce the implication of these outcomes for patient safety, quality of care and pay-for-performance policies. Script: … Specifically regarding your concern surrounding patient safety and quality of care, I would like to highlight blood loss associated with da Vinci as a key component of safety and quality of care: By enabling surgeons to operate with greater precision through just a few tiny incisions, da Vinci Surgery can greatly reduce blood loss and minimize the need for transfusion. [Repeat the discussion on reduced blood loss in the brochure] da Vinci Surgery has been proven to help minimize risks and complications, as well as rates of conversion to open surgery…this maximizes patient safety and quality of care, for even the highest-risk patients. Questions: With increased scrutiny around pay-for-performance, how important is blood loss to your institution? LEFT: Payne TN, Dauterive F. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol May-Jun; 15(3): RIGHT: Poston RS, et al. Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques. Ann Surg. 2008

Complications Objective:
Highlight the complication rates typical with traditional surgical approaches, and how da Vinci Surgery has proven to meet or exceed these outcomes. Introduce the implication of these outcomes for pay-for-performance policies. Script: … Specifically regarding your concern surrounding patient safety and quality of care, I would like to highlight complication rates as a key component of safety and quality of care: da Vinci Surgery has been proven to help minimize risks and complications…this maximizes patient safety and quality of care, for even the highest-risk patients. [Repeat the discussion on reduced complications in the brochure] Questions: With increased scrutiny around pay-for-performance, how important are these key patient safety categories to your institution? How do you measure the costs of complications from surgery? How does an unexpected conversion from the scheduled procedure (lap to open) affect a patient’s satisfaction? Major & minor complications in prostatectomy (LEFT): da Vinci: Bhandari A, et al. Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol. 174, Open: Brown, J.A., et al. Perioperative morbidity of laparoscopic radical prostatectomy compared with open radical retropubic prostatectomy. Urologic Oncology. 2004; 22, Lap: Guillonneau B, et al. Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. The Journal of Urology. 2002; 167, In hysterectomy (RIGHT): Boggess JF, et al. A comparative study of three surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am Jrnl of Obst & Gyn. Oct 2008; 360. e1-360e9

Conversions Objective:
Highlight the specific and measurable safety and quality-of-care outcomes with traditional surgical approaches, and how da Vinci Surgery has proven to meet or exceed these outcomes. Introduce the implication of these outcomes for pay-for-performance policies. Script: … Specifically regarding your concern surrounding patient safety and quality of care, I would like to highlight one more key components of safety and quality of care: OR time reduction with da Vinci Minimized conversion rates with da Vinci vs. lap da Vinci Surgery has been proven to help minimize rates of conversion to open surgery…this maximizes patient safety and quality of care, for even the highest-risk patients. First, let’s look at reduction in OR time and conversions associated with da Vinci … [Repeat the discussion on reduced OR time and conversions from the brochure] Questions: With increased scrutiny around pay-for-performance, how important are these key patient safety categories to your institution? How does an unexpected conversion from the scheduled procedure (lap to open) affect a patient’s satisfaction? OR Time (LEFT) and Conversion rate (RIGHT): Payne TN, Dauterive F. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol May-Jun; 15(3):

Overcoming Capacity Constraints
Objective: Highlight da Vinci Surgery’s ability to decrease length of stay for a variety of surgical specialties, and meet / surpass existing efficiency benchmarks. Script: Specifically regarding your concern with capacity constraints for post-op patients, let me highlights three key items: The shorter length of stay associated with da Vinci Surgery. The ability to achieve faster OR turnover times and maximize cases per day through da Vinci OR efficiency. Revenue implications of OR efficiency by increasing the number of cases possible per day. As we review these topics, I’d like you to consider … How a significant LOS reduction would affect your institution The ancillary revenue associated with a surgical patient What steps are you currently taking to address OR efficiency

Overcoming Capacity Constraints
In this Section • Shorter length of stay (LOS) • Faster OR turnover time • Maximizing cases per day through OR efficiency Conclusion da Vinci Surgery has a proven ability to reduce length of stay across multiple specialties and to match and surpass existing efficiency benchmarks as surgeons and OR staff become proficient with the system.

Length of Stay Objective:
Highlight da Vinci Surgery’s ability to decrease length of stay for a variety of surgical specialties, and meet / surpass existing efficiency benchmarks. Script: da Vinci Surgery programs have been shown to help overcome capacity constraints by a reduction in LOS. Imagine you have a patient going home in half the time of traditional (open) surgery. If patients are leaving in half the time, you have essentially doubled the number of beds you have. In other words, you could treat roughly twice the number of patients. Another implication of reduced LOS is minimizing risk of hospital-acquired conditions, such as falls, miss-medication, etc. Many would argue that each additional day a patient spends in the hospital increases their risk. [Review the data as presented in the brochure] Questions: How would a significant LOS reduction affect your institution? Hysterectomy (All): Customer proprietary data, hysterectomy admission trends, community hospital. Reference ISI internal document, Prostatectomy (open): Dahl DM, et al. Laparoscopic radical prostatectomy: initial 70 cases at a U.S. university medical center. Urology Nov;60(5): Prostatectomy (da Vinci): Bhandari A, et al. Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol. 174, Hysterectomy (benign): Payne TN, Dauterive F. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol May-Jun; 15(3):

OR Turnover and Efficiency
Objective: Highlight da Vinci Surgery’s ability to decrease length of stay for a variety of surgical specialties, and meet / surpass existing efficiency benchmarks. Script: …Specifically regarding your concern with capacity constraints, let’s look at the documented ability to achieve faster OR turnover times and maximize cases per day through da Vinci OR efficiency. An OR efficiency strategy implemented around a da Vinci Surgery program can rapidly match or even exceed the efficiency of traditional forms of surgery. Questions: What steps are you currently taking to address OR efficiency? Customer proprietary data

OR Turnover and Efficiency
Objective: Highlight da Vinci Surgery’s ability to decrease length of stay for a variety of surgical specialties, and meet / surpass existing efficiency benchmarks. Script: …specifically regarding your concern with capacity constraints, let’s look at the documented ability to achieve faster OR turnover times and maximize cases per day through da Vinci OR efficiency, as well as consider the revenue implications of OR efficiency by increasing the number of cases possible per day. [Review the data as presented in the brochure] Questions: What steps are you currently taking to address OR efficiency? Customer proprietary data

Physician Hospital Relations

In this Section • Attracting innovative surgeons • Surgical residency and fellowship program adoption of da Vinci • Inclusion in national surgical society curriculum Conclusion da Vinci Surgery programs have demonstrated the ability to attract skilled and innovative surgeons, which will become increasingly significant given the prevalence of da Vinci Systems at hospitals with residency and fellowship programs.

Objectives: Show how da Vinci Surgery programs have demonstrated the ability to attract skilled and innovative surgeons. Highlight the implications of more and more surgical residencies and fellowships teaching da Vinci Surgery. Script: … Specifically regarding your concern with physician and hospital relations, let me highlight how da Vinci Surgery programs have demonstrated the ability to attract and retain surgical talent. This attribute will likely become more and more important as residency and fellowship programs increasingly adopt and teach da Vinci Surgery as part of their training. As you can see, 78% of all urology residents programs in the U.S. also have a da Vinci program. Equally compelling, in 2009, every AAGL fellow will receive two days of formal didactic and lab training as part of their fellowship curriculum. Questions: How would a robust da Vinci program affect or help your resident matches? How has technology availability affected surgeon loyalty with your institution in the past? How do you prioritize a capital purchase when surgeons may be demanding different technologies?

Adopting New Technology

In This Section • Best practices • Tools for success Conclusion A commitment to implementing a da Vinci Surgery program by taking full advantage of a strong partnership with Intuitive Surgical, is the fastest path to success.

Six best practices fundamental to building a highly successful da Vinci Surgery program: HOSPITAL: 1) Manage da Vinci Surgery as a key program 2) Coordinate operations 3) Actively market the da Vinci program SURGEON: 1) Create a vision for your da Vinci practice 2) Follow the prescribed clinical pathway 3) Actively market your practice Objective: Drive home the importance of working symbiotically with Intuitive Surgical throughout the development of a da Vinci Surgery program. Highlight the fact that we have significant experience with launching successful da Vinci Surgery programs, and the fastest path to success is to utilize our tools and resources. Script: … Specifically regarding your concern with the potential challenges of adopting a new technology in the OR, I would like to stress the point that simply acquiring a da Vinci System is not enough to ensure the success of your da Vinci initiative. Please notice that I say “initiative and program” when I refer to da Vinci. Reason being, through the implementation of over 930 da Vinci PROGRAMS worldwide, we have developed a solid formula for success for both the hospital and the surgeon. However, success is predicated on treating your da Vinci acquisition as a strategic program, service line, and initiative in your hospital. We have many examples of hospital successes. There is one overriding similarity with all of these accounts: They are true partners with Intuitive Surgical. In other words, these hospitals actively request quarterly business development meetings with representatives from each surgical specialty using da Vinci, the marketing team of the hospital, the executive staff, the OR director and managers, and their Intuitive Surgical representatives. Questions: How have you partnered with vendors to ensure success in the past? When/how in the past have you built a service line around a new technology? Where do you think there are opportunities to increase efficiencies, patient safety, patient outcomes, and economic returns through the adoption of da Vinci?

Tools for Success • Robotic Surgery Program Implementation Whitepaper
• da Vinci Surgery Marketing Toolkit • 24/7, 365 days per year customer service • Reimbursement and Coding information hotline • da Vinci Surgery OR Efficiency Guide • da Vinci OR Specialist Program Objective: Drive home the importance of working symbiotically with Intuitive Surgical throughout the development of a da Vinci Surgery program. Highlight the fact that we have significant experience with launching successful da Vinci Surgery programs, and the fastest path to success is to utilize our tools and resources. Script: Finally, we have a complete suite of promotional and efficiency tools and guides designed to help your program succeed. Questions: How have you partnered with vendors to ensure success in the past? When/how in the past have you built a service line around a new technology? Where do you think there are opportunities to increase efficiencies, patient safety, patient outcomes, and economic returns through the adoption of da Vinci?

Summary of da Vinci Program Benefits
Challenge Solution 1) Improving Patient Outcomes & Satisfaction 2) Safety and Quality of Care 3) Attracting Patients 4) Overcoming Capacity Constraints 5) Physician Hospital Relations 6) Adopting New Technology Objectives: Point out the higher level challenges and da Vinci solutions in summary format. Encourage your administrator/ surgeon to seek out further proof and more detail in each respective section of the brochure. Script: … This is a quick summary of the top \ concerns and challenges that we’ve reviewed. Adjacent to each concern is a descriptive solution that highlights how a da Vinci Surgery program helps to address this challenge. I’m going to leave you with a brochure that covers the same content that we’ve just reviewed. To gather more detail and proof around each of these challenges/concerns, I encourage you to read the respective section of the brochure that concerns [insert customer concerns here]. Questions: How do you see a da Vinci Surgery program immediately affecting your institution? What would be the major benefits of a da Vinci Surgery program at your hospital? What area do you think da Vinci would have the most impact on at your hospital? Why?

Creating Value with a da Vinci Surgery Program

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Creating Value with a da Vinci Surgery Program

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