$1M orthopedic-surgery robot symbol of LRGHealthcare's drive to provide superior care for locals & attract paying customers from afar

LACONIA — Lakes Region General Hospital is one of some 130 hospitals in the country and the only one in Northern New England to offer MAKOplasty, a surgical procedure for partial knee and total hip replacement performed with the aid of a robotic arm fitted with a small burr. The $1-million investment in robotic medical technology is the most exotic of a handful of programs, including a weight loss center and walk-in clinic, LRGHealthcare has introduced to generate the financial horsepower to support the broad range of medical services the community requires.
Approximately a fifth of the patients at the two hospitals operated by the company — Lakes Region General Hospital and Franklin Regional Hospital — are enrolled in Medicaid, a share likely to rise if the state opts to expand Medicaid enrollment. With reimbursement rates below actual costs, LRGHealthcare incurred $28.9-million in costs providing government-sponsored care in 2012.
Henry Lipman, senior vice-president of LRGHealthcare, said "it's a financial strategy," explaining that the new programs, which feature elective procedures, attract privately insured patients, among them patients from beyond the immediate catchment area, producing the revenue needed to support basic services. At the same time, he emphasized that these same programs enabled patients in the area to receive the treatment they require without leaving it. He likened it to the "buy local" adage of the Belknap Independent Business Alliance and noted that keeping health care expenditures, which have a robust multiplier effect, in the region bolsters the regional economy.
For all its uniqueness, MAKOplasty, Lipman said, is in keeping with the hospital's tradition of orthopedic surgery, especially joint replacement. "It is an advanced technique, which is minimally invasive, raises fewer complications, requires less rehabilitation," explained Dr. Jeremy Hogan, who added that studies indicate it also achieves more long-lasting results than conventional surgery.
Hogan's colleague, Dr, Arnold Miller, who has been performing knee and hip surgery at LRGH for 25 years, said that MAKOplasty enables him to work within fractions of a millimeter, a level precision beyond the power eyesight. He explained that the procedure begins with a CAT scan of the patient's joint, which is fed into a computer to provide a three-dimensional plan for the surgery suited to the unique anatomy of the patient. "It's all in the plan," said Miller.
Partial knee and hip replacements require removing damaged bone and replacing it with an artificial joint. The robotic arm, which is controlled by the surgeon, is connected to the three-dimensional plan displayed on a screen. The surgeon removes the prescribed amount of bone and, like a child with a coloring book, if he stray beyond the beyond the plan, the robot shuts itself off.
Hogan suggested that MAKOplasty returns the initial investment by shortening hospital stays — "I sent one patient home the next day" — and requiring less assistance in the operating room. He said he has operated on patients from Maine, Connecticut and New York as well as New Hampshire.
Andy Patterson, senior vice-president of LRGHealthcare, recalled that the weight loss center originated with the retirement of one of the the four general surgeons at Lakes Region General Hospital. "We could have replaced him with another general surgeon, but we decided to bring in a general surgeon with a speciality."
Dr. Raza Shariff, who heads the Weight Institute of New Hampshire (WINH) at LRGH came to bariatric surgery from his interest in diseases and conditions associated with obesity. Surgery, he explained, is the last step in a comprehensive weight loss program prescribed and overseen by a team of physicians, nurses, nutritionists and others, which includes behavioral changes, exercise regimens and dieting plans.
Shariff said that for some bariatric surgery can be the most effective means of reducing the risks posed by diabetes, hypertension, high cholesterol, sleep apnea and osteoarthritis as well as heart and gallbladder disease. He offers three procedures — gastric bypass, gastric band and gastric sleeve — tailored to the need of the individual patient.
Unlike MAKOplasty, weight loss programs and bariatric surgery are offered at other hospital in New Hampshire. For example, the Obesity Treatment Center of Catholic Medical Center in Manchester is going to be hosting a symposium at the Laconia Public Library. However, Shariff said that a significant share of his patients underwent surgery elsewhere, but have come to his practice for aftercare.
Convenience Care, the walk-in clinic that opened in November, serves as a bridge between primary care and emergency services, by offering an alternative to both at less cost than either. Unlike an office visit, no appointment is necessary and unlike the emergency room, patients are spared long waits for treatment.
The clinic operates from 9 a.m. until 9 p.m. seven days a week, staffed by a physician, nurse practitioner and two nurses, in space a few steps from the main entrance to the hospital — housing a reception area, registration desk and five private treatment rooms as well as laboratory and x-ray services.Treatment will be provided for colds, flu, sore throats, ear aches, allergies, sprains, minor burns, cuts, and aches and pains.
In 2011, 21,199 patients were treated in the Emergency Room, of whom 12,040 were fast-tracked. Those patients are now be treated at Convenience Care, reducing costs for the patients and hospital alike.
Lipman said that the three new programs represented different aspects of financial strategy. Because it is unique, MAKOplasty provides LRGHealthcare with a competitive advantage with potential to draw patients from across the state. Because other hospitals offer similar programs, WINH is intended to make the company competitive by providing residents of the region with a nearby alternative. Apart from managing costs, the walk-in clinic is designed not only to serve local residents but also seasonal visitors with convenient, affordable treatment of common conditions and ailments.

CAPTION: Miller on right and Hogan on left . . . store room near the operating suites . . .