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Intuitive Surgical, Inc. Message Board

  • nomorelosses nomorelosses May 11, 2013 11:02 AM Flag

    A Medical Doctor's Perspective: robots are worthless pieces of marketing tools and toys propped up by Medicare lop sided reimbursements

    Yes I am a medical doctor and I can tell you if not for huge marketing value of the robots right now (because it makes any hospital or institution sound advanced and "space-age") and if not for large sums of financial incentives provided by feds, robots would have already been a thing of the past except for a very few docs who like toys.

    Look at it this way: with more and more advances in scope procedures (we now even have aortic valve replacement at places like Cedar Sini using tinny valves deployed through blood vessels and without cracking ones sternum) many procedures (even gastric bypasses) are done using scope and as outpatient (such as cholecystectomy).

    You ask why then Intuitive Surgical continues to have such revenues? Because like many government programs to help lift new ideas currently there are lop sided reimbursement provided by Medicare (and hence many others that are forced to copy Medicare) for robotic procedures that despite the hassle and all the other problems (I know some distresses cases even with simple procedures such as prostate cancer by reputable institutions like City of Hope that don't get publicized ) there is a tendency to use robot (even though in many cases they begin with robots but finish the old fashion way).

    The day that Medicare money flow stops will be the beginning of the end for companies such as Intuitive. And even before that the flow of problems with these "toys" will continue and will make them less and less attractive. Even now around the US medical world the robotics are much less "sexy" than they were a couple of years ago and even those "toy lovers" and profit seekers exhibit alot of anxiety in using them but they feel they have no choice right now because they were advertised and because of the lop sided re-imburment as mentioned above.

    As for the stock, I don't know what ISRG will do short term (I think it will have a delayed response to the latest news about problems and get haircut) but long term watch out!!

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    • So here we have a doctor who logs in as "nomorelosses" Right that sounds more like a doctor than a common basher. And as usual thanks Fish for pointing out this individuals error in his mistaken point of this being somehow government subsidized. That would be the first thing a real doctor who know right?

      erdoc51 returns?

    • fish_discover_water_last fish_discover_water_last May 14, 2013 10:18 PM Flag

      Please explain how robotic surgery is a "government program"? Robotic surgery is reimbursed at the same rate as standard lap surgery by Medicare, there are no lopsided reimbursements. Also standard lap surgery has been around for a long time and adoption had stalled because complex procedures are too difficult for all but a handful of the best lap surgeons to perform. Robotics is gaining in less complex procedures because some of these can now be done as single incision procedures. Some can be done as single incision via standard lap but again, only by a handful of the top surgeons.

      If you are a doctor at all, your use of the phrase "Space Age" would seem to suggest that you are an old dog who is not up to learning any new tricks.

    • Obstet Gynecol. 2012 Apr;119(4):717-24.
      Outcomes and cost comparisons after introducing a robotics program for endometrial cancer surgery.
      Lau S, Vaknin Z, Ramana-Kumar AV, Halliday D, Franco EL, Gotlieb WH.
      Jewish General Hospital, Quebec, Canada.
      To evaluate the effect of introducing a robotic program on cost and patient outcome.
      This was a prospective evaluation of clinical outcome and cost after introducing a robotics program for the treatment of endometrial cancer and a retrospective comparison to the entire historical cohort.
      Consecutive patients with endometrial cancer who underwent robotic surgery (n=143) were compared with all consecutive patients who underwent surgery (n=160) before robotics. The rate of minimally invasive surgery increased from 17% performed by laparoscopy to 98% performed by robotics in 2 years. The patient characteristics were comparable in both eras, except for a higher body mass index in the robotics era (median 29.8 compared with 27.6; P

    • mannymelgoza May 13, 2013 5:35 PM Flag

      Good afternoon, I too am a doctor too!

      I think you're all dummies for coming on here to write about why you think the stock should trade up or down. It doesn't matter what you think or say, the market will do what it's going to do regardless. Good luck doctors.

      ps Academic studies reveal that doctors are by far the worst investors. :) You'll may be good doctors, but most likely you're all #$%$ investors.

      If you weren't in this trade prior to 2010 than you're chasing, don't be a dummy and think that this will go up to 1k anytime soon.

      • 2 Replies to mannymelgoza
      • LMAO @ manny motor mouth "I think you're all dummies for coming on here to write......." And yet here you are. You sound like and "academic" manny. What are you so angry about? Who said we were good investors? Who said we were chasing anything? You seem to assume you know a lot but you appear to be an idiot. Full disclosure manny..... I bought 50 shares @ just under $100/s and have been trading 30-50 shares in and out ever since. Investing? Go back under your rock manny.

      • Well...I'm no doctor but I did sleep at a Holiday Inn last night.

        "Academic studies reveal that doctors are by far the worst investors."

        I've heard this stated before and it always puzzled me - if it's true - because I would think that doctors would be in prime position to know what works and what doesn't work when it comes to new technology in their field. Maybe they just don't have the time to investigate further or maybe they just choose to invest in other things such as their own practice/business or maybe real estate - I don't know. But in my experience, one thing for sure is that I have never run across a poor or dumb doctor.

        "If you weren't in this trade prior to 2010 than you're chasing, don't be a dummy..."

        Anyhow, I would still have to imagine any academic study would validate that doctors' investments are way more fruitful than the average day trader, especially those traders that have been only been on the MB for about a week trying to give advice on how to invest :)

    • @ nomorelosses He is the deal. I am an MD too. I have been involved with more robotic surgeries with more different surgeons than anyone else in my hospital. Your rant is complete bull and reeks of one who has no personal experience doing robotic surgeries. Granted, NOT everyone should be using it but the same caveat applies to any surgery. "There ARE worthless surgeons, (Most OB/GYNs coming forth today can't even do a decent vaginal hysterectomy let alone a robotic one.) In the hundreds of cases I have been involved with, I have NEVER had to convert to an open procedure. Medicare and others reimburse for the procedure, NOT for the use of the robot. The use of the robot has NO impact except for shorter patient stays. I don't believe you have ever seen a robotic prostatectomy let alone been involved in one. If you had, you not be calling them "simple procedures". You refer to the daVinci as "toys" and "sexy". Again, this tells me you have zero experience with any cases and certainly not a difficult dissection which would be an open belly, blood loss nightmare without the advantage of the robot. Finally, if Medicare money stops flowing.....we will have much bigger issues on national scale than whether or not to use a robot for surgery..........

    • I call your bluff.

      " lop sided reimbursement provided by Medicare (and hence many others that are forced to copy Medicare) for robotic procedures"

      you haven't the slightest idea of how Medicare reimbursement works. There is no additional reimbursement for robotics you idiot.

      • 2 Replies to jsmithson124
      • andersongordon May 13, 2013 7:09 AM Flag

        JS I concur with your statement "There is no addional reimbursement", but be civil to Nomorelosses. He is entitled to his opinion, as we all are on this Board. Its what makes for helpful and alternative exchanges.


      • Doctor has a point. Why would any hospital be willing to spend millions on robotics if the reimbursements were the same? I know for a fact that hospitals and even clinics and doctors offices get huge tax breaks ($100,000 last year for medical offices but millions for hospitals) if they purchase medical equipment. The amount was substantially increased to stimulate the economy following the latest recession.

        Also, the reimbursements are at times different if certain equipments are used including the robotics. This specially applies to PPOs but also to Medicare. Historically Medicare has encouraged technical advances by implementing such incentives.

        I am long IRSG but lets don't close our eyes to facts including problems with their equipment (which even the company itself is admitted to) as well as patient injuries settled before any lawsuits are filed which I have also heard about.

        Long or not we may face a little correction this coming week but I continue to believe in this company long term.

    • DIdnt you also say that computers and smartphones were useless pieces of metal.
      How many patients would want surgery from your shaky old hands. You sound like a #$%$!

    • If you are a doctor, I'm an astronaut. Nice spelling by the way (Mt. Sinai?). Have another drink shorty?

    • All the injuries and complaints are settled out of court and before a lawsuit is filled in order to prevent this ridiculously bloated bubble @ $500 from popping. If you were Intuitive would you rather pay a few hundred thousands or even a few million to keep things hush hush or you would risk the publicity that in a single day could cost billions in stock price corrections.

      I believe it is high time that Intuitive would come clean and tell people how many of these hush hush cases they've had over the past years and how fast is the trend increasing.

      • 1 Reply to tom8880031
      • "If you were Intuitive would you rather pay a few hundred thousands or even a few million to keep things hush hush or you would risk the publicity that in a single day could cost billions in stock price corrections."

        Right, yeah sure. You do understand financial disclosures don't you? Oh wait, obviously you don't or you would understand that if there were payouts like you suggest, they would legally have to be disclosed. Wow, the shorts are really getting desperate.

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