Point-of-Care 3D Printing Veteran Shares Experience

3DMEDNET, publisher of the journal 3D Printing in Medicine, produced a webinar with useful information for anyone in the throes of setting up and running an in-hospital 3D printing service.

The presenter was Robert Wesley, a master’s prepared bioengineer and biomedical engineer who runs the 3D printing center at the Washington University Medical Campus in St. Louis, which includes upward of 3,000 patient beds at 15 hospitals. His center focuses on printing anatomic models for planning surgeries and surgical guides and is exploring bioprinting and implantables.

Wesley covered patient privacy, model ownership, QA, regulation, software, hardware, materials, and clerical setups, but his advice for starting up an in-hospital 3D printing service resonated with the audience: get administrative and clinical champions on your side, and don’t make the mistake made by many startups—assuming that clients, in this case surgeons, will flock to your door clamoring for printed models just because you’re there. The flaws in this “build it and they will come” strategy, he said, are:

• There’s no internal marketing plan.
• Surgeons are often satisfied with service from an outside vendor.
• The 3D printing space is located away from heavily trafficked areas.
• There’s no convenient means of submitting requests. (Initially, doctors submitted their requests to Wesley via email, a phone call, text, or a sticky note left on his desk.)
• Physicians are unaware of your QA process.

To make the case for an in-house service bureau, Wesley advises knowing how much your hospital spends on outside 3D printing vendors. “It really helps to know the revenue that can be recovered [from] in-hospital 3D printing,” he said.

For example, in 2017-18, BJC HealthCare, the hospital network Wesley serves, outsourced 136 models, mostly for surgery at St. Louis Children’s Hospital and Barnes-Jewish Hospital, costing
$343,000. Of those, 108 models were for plastic and reconstructive surgery, costing $239,000.

Wesley said the health system could have saved almost $105,000 overall, or roughly 30 percent, by making the models in-house. Savings for the plastic surgery cases alone would have had a greater rate of savings, at 38 percent (the difference may be due to size, complexity and use). “With a greater sample to work from we could capture … 30 to 50 percent,” he said.

CPT Codes to Spur Growth

Also, new this year are CPT codes for 3D-printed anatomic guides and models, which are critical for hospital billing. They’re an implicit acknowledgment of the acceptance of emerging technology by the medical community.

These CPT codes are a huge win for everyone working in a 3D printing program in a hospital space,” Wesley said. “It shows we’re taking the steps to have this service as part of the medical record and another step toward regulation.”

Wesley highlighted three Stratasys printers he uses: an Objet Eden260VS, used primarily for printing the company’s MED610 material, which can be sterilized, as well as RGD525 high-temperature material; a J750 full-color multi-material model (his workhorse) that is Materialise-certified for anatomic models and guides; and a Mojo desktop printer used for small prototypes.

His wish list includes a NewPro3D, a fast, direct light processing printer, for trauma patients who require an under 24-hour turnaround to produce a print. He’s also eying the Formlabs Fuse 1, a desktop SLS printer, for making casts, braces and cranial helmets for infants.

“It seems like a green piece of equipment,” Wesley said, noting that up to half of unused nylon powder can be recycled. He’s pointed out the savings to hospital administrators.