Because the model itself is iterative, change has been an integral part of the journey. But through it all, some myths about the PSH model have persisted. Some misconceptions are grounded in where we started while others are built on a genuine misunderstanding of the model’s systems, tactics, and specifics. But with a decade of proven successes behind us, it’s past time to expire some of the most enduring PSH myths.
Myth #1: PSH must be anesthesiologist-led
The belief that PSH must be led by an anesthesiologist was true in 2012, but it’s not true now. Many capable surgeons and other physicians are willing to invest the time to improve the system, so we adapted to accommodate a wider expanse of model leaders. PSH performs particularly well with interdisciplinary co-leaders at the helm, and the society’s aim is to support what works. When that means making a change, we make the change.
Myth #2: PSH only works with orthopedics
The widespread belief that PSH only works with orthopedics may be a result of the model’s early success in that specialty. Several early, high-profile wins were ortho-related. But the truth is that PSH is adaptable to all service lines, and we’ve also enjoyed loads of success in colorectal, urology, and neurospine, not to mention bariatrics, general surgery, and numerous other service lines. We welcome our partnerships with orthopedic surgeons, but we happily embrace other specialties, too. PSH is a team-based model and the bigger the tent, the more robust the team.
Myth #3: PSH and ERAS are the same
One misconception we’ve struggled with since the beginning is the belief that PSH and ERAS are the same. They’re not. Rather, PSH functions as an umbrella structure of coordination under which ERAS protocols come into play. ERAS and PSH are highly complementary and work well in coordination, but they’re also different: PSH views care from a wider lens, for example, and is more modular and iterative.
Myth #4: PSH is expensive and hard to get paid for
The belief that it’s hard to get paid for PSH is another myth that merits busting. There are numerous ways to monetize the PSH model, including co-management agreements, Hospital Quality Efficiency Programs (HQEPs), and gain-sharing programs, to name a few. The PSH model also provides a strategic approach to entering new payment models such as Medicare’s bundled payments or the next-generation Accountable Care Organization (ACO). PSH can be monetized in these models because it is highly adept at driving down costs. It can help organizations decrease, even eliminate, CMS penalties and decrease the cost of care, thereby improving the bottom line through wins like reducing OR delays, surgical cancellations, medical errors, and readmissions, and other efficient tactics supported by the model. PSH is a sensible investment that delivers real dividends for patients, clinicians, and health care organizations.
Myth #5: PSH is too big and unruly
Some believe PSH is too big of an undertaking or that it’s an all-or-nothing proposition. In fact, PSH is modular, which means it’s not only adaptable to all settings, service lines, and sizes, but also can be used to focus on isolated problems – length of stays or improving OR efficiency, for example – or used to tackle broad systemic issues such as clinician satisfaction. Many PSH practitioners started small, earned success, then scaled isolated wins to address more problems or expand to other service lines. As an undertaking, PSH is what you need it to be. We’re giving you the tools, but you personalize and use them to meet your organizational needs.
Myth #6: PSH is only for large medical centers
Finally, the misperception that PSH is only appropriate for large facility settings and academic centers is another misunderstanding we’d like to dispel. Practitioners have successfully employed the PSH model across settings, from academic medical centers and community hospitals to group practices. PSH is essentially a collection of tools, processes, strategies, and methods designed to enable clinicians in any practice setting to optimize their practice. We recognize that medical centers differ in size, character, complexity, and resources. Implementing a PSH offers a lot of flexibility to match the wide range of practitioner needs presented by the complex landscape of American health care.
Myths like these may persist, but they can’t truly dent the model’s achievements – the widespread success of PSH is undeniable. For the society, it has been educational and rewarding to respond to the environment or, in some cases, learn from valid criticisms. We’ve learned a lot since launching the model in 2012. The success of three PSH Learning Collaboratives, for example, convinced us that more practitioners would benefit from the processes and tactics embedded in the PSH model, so we developed The PSH Implementation Guide in 2021 to scale the opportunities for improving patient care, decreasing costs, and advancing patient and provider satisfaction. PSH is a scalable model, after all, so scaling the availability of the model to reach more clinicians seemed an appropriate next step. It’s our belief that the more clinicians are exposed to the truth about PSH, the less likely myths and misperceptions are to dissuade health care workers from implementing the model. And, most importantly, the more a wide array of patients and practitioners will benefit from what the society has learned from 10 years of the Perioperative Surgical Home.