Hospital Operator Expert Call Takeaways: Volumes Up, Margins Down, Capex Intact

Research evidence excerpt

Hospital Operator Expert Call Takeaways: Volumes Up, Margins Down, Capex Intact

remains an open question.

Our expert has limited detail on ISRG's Extended Use Program and expects ~10% savings. Our

expert noted it understands the program is what underpins the instrument cost reduction and that it

has heard ~10% cost savings, versus ~20% from reprocessing vendors, with no further detail on timing,

procedures, or mechanics. Beyond reprocessing and not converting systems, our expert noted there are

no other initiatives targeting ISRG-related cost.

Our expert is not evaluating competitive robots and would resist a mixed fleet. Our expert

noted Medtronic approached the system on Hugo roughly two years ago and has not been back

since. Physicians are not pushing for an alternative to ISRG, and our expert noted converting a fleet is

extremely difficult given how intertwined the robots are with operations and the teaching program. Our

expert noted she would always push back on a mixed fleet given maintenance complexity, and noted

that when a newly recruited surgeon prefers a competing platform, the system tells them pre-hire that

the robotic fleet is ISRG. Our expert noted the learning curve makes conversion far harder than switching

an instrument or a knee implant and does not see it happening absent a wildly better alternative. The

one caveat: at a new hospital with no installed base, our expert would consider a different platform if

the incoming medical staff wanted it as a group.

Ortho robot penetration is low with no plans to add. Our expert noted the system has three Mako

robots across three facilities, one purchased around November, and that several large ortho-oriented

facilities have none and perform traditional surgery. Our expert noted no plans to purchase additional