The healthcare industry is constantly looking for ways to improve population health and provider better patient care while cutting costs. With US healthcare costs on the rise, this seems like a nearly impossible task. However, a new type of care model is providing a way for hospitals to provide better care, at lower costs, with the resources they already have.

Perioperative Surgical Home Model

What is the Perioperative Surgical Home (PSH)?

According to the American Society of Anesthesiologists, the Perioperative Surgical Home is, “a patient-centric, physician-led, interdisciplinary and team-based system of coordinated care that spans the entire surgical episode from the decision of need for an invasive procedure (surgical, diagnostic, therapeutic) to discharge and beyond.”

Why Do We Need It?

Current care processes are variable and fragmented among core team members. The need for surgery already disconnects patients from their usual care and new providers likely don’t know the patient’s medical history. Communication lapses can occur during care transitions resulting in duplicate tests and preventable harm. Having caregivers working in silos results in longer stays, delayed/inefficient care, increased risk of complications, and higher costs.

Current care is fragmented resulting in disjointed communication and negative patient outcomes.

What is PSH Supposed to Achieve?

The goal of the Perioperative Surgical Home model is for each patient to, “get the right care, in the right place, at the right time with better patient satisfaction, fewer complications, and decreased costs.”

Physician-led, patient-centric collaborative care is at the core of the PSH model.

Collaboration is critical to achieving this goal. Care must be patient-centric, consistent, seamless, and coordinated among a physician-led team. This care is not intended to replace the traditional post-op recommendations from surgeons but instead ensure recuperation procedures are supported by the abilities of the entire team.

Organizations who have implemented a PSH model have seen:

  • Improved quality and safety
  • Lower readmission rates
  • Fewer complications
  • Reduced surgical costs
  • Enhanced patient and family experiences

What Are the Key Components?

So how can you begin implementing this type of model in your healthcare organization? You must start by:

  • Establishing leadership in the care team
  • Asses the patient’s current condition
  • Understanding “prehabilitation” to optimize the patient’s health status
  • Coordinating all transitions of care

And then you must continuously measure before, during, and after:

  • Patient outcomes: satisfaction, improved or full return to functional status
  • Internal efficiency outcomes: delays, cancellations, length of stay
  • Clinical and safety outcomes: complications, readmissions, post-acute functional status
  • Economic outcomes: total cost of the episode of care, resource utilization
  • Continuous quality improvement: trends over time, satisfaction of stakeholders

How Anesthesiology Plays into the Perioperative Surgical Home Model

The Role of Anesthesiology

Anesthesiologists play a central role in the Perioperative Surgical Home model. An anesthesiologist’s role entails working with the patient before (pre-op), during, and after (pain management) the surgical event. There is a natural evolution in the continuation of care through this position. Anesthesiologists must work closely with surgeons inside the OR and then help transition the patient into the care of the primary perioperative physician. Your expertise and skills can be utilized and applied across the entire PSH model.

Anesthesiologists are central to the continuation of care between pre-op, surgery, and post-op transitions.

How it Impacts Anesthesiologists

Many anesthesiologists are looking for ways to improve patient care and decrease costs within their practices.

The PSH model aligns with many of the goals outlined in various value-based payment models and can be good choice for those looking to truly implement quality rather than “checking the boxes” just to avoid a Medicare penalty. (See our eBook on Quality Reporting Models and if your practice really needs to implement APM or MIPS for financial reasons.)

Interested in learning more about the Perioperative Surgical Home model?

Check out these additional resources:

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