Articles  |   June 2014
Implementing A Perioperative Surgical Home: Start With Why… And Then Start
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Central and Peripheral Nervous Systems / Pain Medicine / Practice Management / Advocacy and Legislative Issues / Quality Improvement / Articles
Articles   |   June 2014
Implementing A Perioperative Surgical Home: Start With Why… And Then Start
ASA Monitor 06 2014, Vol.78, 28-29.
ASA Monitor 06 2014, Vol.78, 28-29.
At the PRACTICE MANAGEMENT 2014 conference, we heard many unsettling presentations about the rapidly changing health care environment. There are new regulatory and economic burdens imposed by health care reform legislation. The drumbeat of value-based purchasing is pervasive. New bundled payment models and formation of accountable care organizations are creating significant financial risks to physicians and other health care providers. While many of us have thus far been insulated from these changes, that respite will not last much longer.
The Perioperative Surgical Home (PSH) is a physician-led, team-based model of care designed to guide patients through the entire surgical continuum, from decision for surgery to discharge and beyond.1  The model encompasses thorough preoperative evaluation and optimization, effective and cost-efficient perioperative and postoperative management, and postoperative care coordination. The current typical practice is individualistic, fragmented, and widely variable in cost and outcome.2  Implementation of standardized, evidence-based best practices, modified for specific patient comorbidities and preferences, will offer a patient-centric surgical experience that provides optimum value to all stakeholders. While the entire model still requires a proof-of-concept of its full implementation, each individual segment of the model has shown promise toward improvement in outcomes and reductions in cost. Implementation of preoperative clinics, procedure-specific standardized care pathways and enhanced recovery after surgery protocols have shown significant promise in this regard. But the implementation of this model involves fundamentally changing the way we practice.
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