Rural patients face a well-documented paradox in surgical care: they carry a higher burden of chronic disease and experience worse postoperative outcomes, yet are significantly less likely to receive da Vinci surgery procedures, even though those approaches are associated with lower complication rates and faster recovery.For health systems serving these communities, closing that gap requires a deliberate, technology-enabled strategy to distribute it.
During a featured session at Becker’s 16th Annual Meeting in April, sponsored by Intuitive, Lisa Carter, president of Ballad Health’s Southern Region and Elizabeth Jackson, MD, general surgeon and chief medical officer of Johnson City Medical Center at Ballad Health shared how the Tenn.-based system built one of the most expansive rural da Vinci surgery programs in the country.
Below are four takeaways from their conversation.
1. The rural care gap
A foundational assumption Ballad Health had to unlearn was that patients in underserved communities were seeking da Vinci surgery at urban centers. When the system dug into its population health data, the picture was different.“We assumed for a long time that patients were getting care somewhere else,” Ms. Carter said. “But as we started digging into some of our communities and truly understanding the data, we recognized that that wasn’t the case. Patients just weren’t getting care.”The data showed 84% of Tennessee’s da Vinci surgical systems were concentrated in urban areas, while 66% of rural patients in the region were undergoing open procedures — with higher social vulnerability correlating directly to higher conversion rates.Ballad Health’s response was to take the technology to where patients already were rather than waiting for patients to travel to it.
2. A physician-led model
When Ballad Health formed through the merger of two regional systems a decade ago, it established a clinical council run entirely by physicians. They are employed and independent, across all specialties and then partner with administration on care quality decisions. That same dyad structure governed the da Vinci surgery program.Steering committees evaluated which technology went where, what volumes justified console placement and how consoles could be redistributed as the fleet grew. In late 2025, the system acquired five new da Vinci 5 systems, which allowed it to redistribute three existing Xi robots to facilities — Norton Community, Smith County and Sycamore Shoals — that had never had da Vinci surgery access capabilities.Every operating room across Ballad Health’s 20-hospital system now has da Vinci surgical access capability.
3. Why telepresence is crucial
Expanding robotics into rural hospitals means surgeons are sometimes operating without immediate peer support. Ballad Health addressed this early by adopting telepresence — the ability for a surgeon at one facility to remotely observe and provide real-time guidance to a colleague at another.“It took a very large geographical footprint and made it a phone call away,” Dr. Jackson said. The system worked through early questions around liability and coverage and usage has grown steadily since 2023.The technology also proved essential for recruitment as surgeons completing training now expect da Vinci surgery access capabilities and having both the equipment and a connected support network has made Ballad Health’s most rural facilities more attractive to candidates who would otherwise bypass them entirely.
4. Clinical and financial outcomes
Over a four-to-five year period, Ballad Health reduced its open surgery rate from 24% to 9% — against a national benchmark of 27%.The downstream impact has been significant including:
• 625 avoided ICU admissions
• 262 avoided blood transfusions
• 245 avoided readmissions
• 13,600 avoided bed days
The system calculates $42 million in reduced healthcare costs to patients. For a rural system with a North Star goal of reaching a 4% operating margin — itself described as a stretch target — those numbers translate directly to financial sustainability.
“If you can avoid open procedures, you can avoid ICU days,” Carter said. “These are actual things that we can see that are impacting our health system.” Over 29,000 patients have been reached through the da Vinci program since its inception and the program has become one of Ballad Health’s most effective tools for making the case that rural health systems can deliver outcomes that match or exceed urban benchmarks.
Ballad Health’s experience offers a replicable model for rural systems willing to invest in the governance structure and technology distribution strategy that make expansion possible. The clinical and financial returns compound over time and so does the reputational effect of being the system that patients in those communities trust to deliver the care they need close to home.
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