From OR to Office: How Workflow Change and AI Are Reshaping MedTech Adoption

In a conversation with Pharmaceutical Executive, Preceptus Medical CEO Dave Carey and Michael Manavukas, co-founder and CEO of Acuity.MD, discussed the transition of ear tube procedures from operating rooms to offices, highlighting the benefits of convenience and reduced anesthesia risk. The duo also emphasized the importance of AI in medical technology adoption, noting Acuity.MD's platform's role in optimizing sales strategies and market access.

Both executives agreed on the need for comprehensive solutions to facilitate technology adoption, citing the challenges of changing workflows and the necessity of aligning stakeholders and also touched on the impact AI has on decision-making, the importance of data accessibility, and the need for adaptive commercial strategies in the med tech industry.

A transcript of their conversation with Pharmaceutical Executive can be found below.

Pharmaceutical Executive: In shifting a common pediatric procedure into the office setting, what clinical, regulatory, or reimbursement hurdles did Preceptis have to navigate, and which proved most difficult to overcome?
Dave Carey: There's not a watershed moment where you just realize your work is done. It's more of a constant effort, and I would say that the biggest change comes when you're changing venues of care. When you're going from the operating room where a surgeon is paid a certain way, and other stakeholders are reimbursed like the ASC owner for facility fees, or anesthesiologist changing the way care is delivered by moving to an office and no longer requiring general anesthesia, I think those are the biggest challenge that we've had in making sure that from a market access standpoint, we are able to articulate the reasoning, not just the financial, but the patient experience reasoning for this transition.

When we explain it payers, they ultimately understand that in-office ear tube placements are a more cost-effective way for this care to be delivered.The again, serving up those conversations, having them get the right stakeholders, as Mike referenced in the clinical community, to provide support and to ultimately help drive this change is important. However, the biggest challenge is getting that reimbursement. It's one thing to get codes. It's another thing to make sure that those codes are paid well and that ultimately the right incentives arethere for people to take on this effort of transitioning care.

PE: What systemic or economic factors have allowed the traditional Ear Tube model to persist for so long despite its cost and access limitations?
Carey: Workflows are often to healthcare facilities like habits are to people, they're formed over a lot of hard work, experimentation and science, and ultimately, once they're ingrained, they're sometimes hard to change. So, I equate it to a habit in a person, and you know we as a people need to have very good reasons to change our habits. I think that nowadays seeing these ear tubes be reliably placed just as well with the same great outcomes and with the convenience of being able to do it in an office and avoiding all that operating room time and anesthesia risk, the juice is worth the squeeze, so to speak.

It also helps that our ENTs realize that they can have better control of their schedules so they don't have to wait for an operating room and now they can treat children quickly without having to wait for block times with the Ambulatory Surgery Centers (ASCs) that are getting very crowded these days.

Michael Monovoukas: To build off of that great point about workflows and habits, I also think once technologies get absorbed by the healthcare ecosystem, they start to form barriers and frictions in innovation because people are comfortable with the status quo and they get reimbursed and paid based on the status quo. The referral patterns reflect the status quo with dissemination of technology and when I think back on giant leaps forward in medicine, the practice of medicine, and the application of technology into the practice of medicine, I think about the original laparoscopes and minimally invasive surgery, and how that kind of disseminated the medical community.

Robotic surgery is another example here, there's so many others through the years, and they're not just innovations in technology, but they're also innovations in the medical education. There are innovations in the workflow from where the care is occurring, and there are innovations in, how referral patterns manifest. So, there's just a lot that needs to happen to get a new technology out to market in a repeatable way, it's not just about the underlying technology, you have to bring all the stakeholders around. So there's a lot of inertia there, and what I'd love to see more of and why we got started as a company, and core to our mission is making it easier to unblock innovative technologies from taking hold across the healthcare ecosystem and aligning some of those stakeholders, or at least finding the roadmap to align those stakeholders, whether they be, administrators, physicians, payers, distributors, etc., to really align around that innovative way to treat patients.

PE: How is AI changing the way MedTech companies make foundational business decisions earlier in their lifecycle?
Monovoukas: When I see the current wave of AI technologies around large language models, I see the opportunity to present insights in a more flexible and personalized manner that meets the end user where they are in their workflow and in their day-to-day, as opposed to needing to become a data analyst to ring insights out of data.

MedTech companies have started the shift towards applying data and insights to inform their commercial decisions, and what used to be a company building a product launch strategy and setting up territories around this product launch, one and done is now becoming a more adaptive commercial engine, where we're responding to the realities of the market and what's changing in the market and what we're learning in the market. I think that's the real unlock that AI can provide is shortening the cycle time of a launch strategy, learning from it in the market, getting visibility into what's happening, and then adapting to that reality.

Both reimbursement information and referral pathways are great examples of pieces of data that med device companies are turning to at an increased rate to inform their commercial strategies, because it helps them understand the flow of patients and the flow of funds that really govern how healthcare is operated today. That's an important but dynamic element in how they need to go to market that they were not harnessing in the past, and I think AI makes it easier to surface those insights and act on them more than ever before.

PE: What early signals are you seeing from physicians, payers, or families that suggests whether in-office ear tube placement can scale nationally rather than remain a niche alternative?
Carey: In my career in MedTech, no matter what the innovation is or how substantial it is, it's never a light switch moment. It's more of an escalator moment. Adoption curves tend to start trending when you see a critical mass of people starting to talk about the differences that your tech makes in their practice. What I have seen since we first started in this business, is that people would say, we're not going to move all of our cases from the operating room. Then it wasI could see some procedures moving to now we're at this tipping point where most ENTs will tell you that this is a tool they need to have in their bag, and so this is the trend that I've seen f in everything from stents, robotics, spinal fusion cages, all of these things that I've done over 30 years, they all trend along that same line where ultimately it's never a one stop shift from one to the next. It's really a gradual turn of people getting better data and practical experience then figuring out how new tech fits into their workflow.

I think right now, we're in the phase where most ENTs are telling us that someone in their practice needs to do it. ASCs are getting very crowded with new procedures being added in every other month, such as the big push over recent months for cardiac to move into the ASC space. So as those ASCs get crowded, Ents lose control of their schedule and they're at the whim of the ASC itself and the scheduler. With us they have better control over their patient experience, finances, and their schedule, helping to deliver great care when it's needed most. As we move from that niche into the mainstream, it starts with people recognizing this is a tool they need to have, and as their comfort level grows with it, they'll continue to find ways to deploy it.

Monovoukas: To build on Dave’s point, I think the patient experience here is important to double down on. Since you are dealing with toddlers, it’s not just the patient's experience, but it’s their parents or guardians who are making the care decision on their behalf. To build on the point of AI and data and how it's impacting medical device companies, I think it's also having an impact in consumers and patients and how they conduct research to identify the right treatment for their own condition or for their kid’s condition.

It's terrifying for parents to see their vulnerable toddlers have to go through an experience like that. For me, I have a two-year-old at home so be sure that I'm going to do my research identifying if he needed a surgery, what the cutting-edge technologies are out there, and how they impact his experience. I think physicians are always looking to attract new patients into their practice while also being able to market more broadly to a set of potential referrals, and I think having another tool in their tool belt to appeal to an increasingly active and demanding consumer base that wants easier access to new technologies that don't require a hospital visit or an ASC visit and general anesthesia, I think it is paramount.We're going to see more of that, more consumers becoming empowered over their own health, and taking care decisions in their own hands, demanding new technology as opposed to settling for the status quo of how things have been done.

PE: As data-driven tools become more embedded in MedTech commercialization, what risks or limitations should the industry be mindful of to avoid over-reliance on algorithmic decision-making?
Carey: Mike's much closer to this than I am, but I think the bigger risk that we run, and especially in startups, is that look a MedTech startup never has enough time, people, or money, and so platforms like AcuityMD help us to be really efficient at all three of those things. As a guy that's been around startups for a couple of decades, I'm amazed at how much more efficient I am with my time, with my effort, with my investments, and I just make such better decisions knowing that I've got this kind of data at my fingertips.It's also easily accessible to where the platform is specifically designed to get the data I need in about three clicks.

Monovoukas: Human judgment and reasoning is always paramount here. The data is another tool and resource that humans have that can help them make decisions, and I think that will never change. I believe the next generation in the industry, not just med device sellers, but in every industry and every role, is a new kind of level of data fluency that will be required to be excellent in any role.

On the flip side it's now easier than ever to gain data fluency by having access to large language models that can explain data, access to data sets that are explainable and are rooted in real market ontology of how the industry operates. Having the context and understanding to interpret data is super important and those are the safeguards that will help misinterpretation.

PE: With AI platforms increasingly influencing which physicians are engaged and which markets are prioritized, what responsibility do technology providers have in shaping access to new medical technologies?
Monovoukas: Technology is nothing if people can't access it. When I was writing down AcuityMD’s mission statement I kind of frame this hypothetical scenario where let's say aliens came down and dropped off this cutting-edge next generation medical technology that could do a million things and was 100 times better than our status quo. Well, that technology wouldn't do anything, because no one would adopt it, right? So, the technology is only as good as the end users access to it and whether they're comfortable adopting it into their practice. It's no longer good enough to just have an incrementally better piece of technology and marketing it assuming that market access and adoption will pick up to make those big step function changes in innovative technology.

I've mentioned earlier with the laparoscope, and Dave mentioned the stent, robotics, and all these tide shifts in technology, but the only way they're going to happen is if companies also invest in access and adoption which comes with medical education, better training, and better clinical support for those first cases to make sure the surgeon is comfortable with the technology. To Dave's point earlier about providers clamoring for the technology, that tide shifted when they started recognizing their peers and began clamoring for the technology. The medical technology industry is more broadly shifting towards a more comprehensive solution provider to advise on the adoption and access to technology, not just the features and benefits of a medical technology.