PSH Points of View: 4 Experts Answer One Question

The Perioperative Surgical Home (PSH) is a patient-centered, physician-led, coordinated model of care designed to improve patient and provider satisfaction and population health while reducing the costs of care. It’s adaptable for teams of all sizes, settings, and service lines, and it’s applicable to every stage of the perioperative journey.

In other words, PSH does a lot of heavy lifting. That’s not to say it’s all things to all people, but rather that it is different things to many members of the care team. Some PSH practitioners have used the model to zoom in on a targeted problem, like CMS penalties or high readmission rates. Others have employed the model to tackle broad systemic problems like provider satisfaction and patient experiences. The model is robust, but it’s also modular, scalable, and flexible.

To get a sense of what anesthesiologists who have put a PSH into practice value most about the model, we asked four PSH practitioners one simple question: “What have you found most valuable about the Perioperative Surgical Home model?” Here’s what they told us:

Saied Assef, MD, used the PSH model to decrease length of stay and complication rates and improve his organization’s performance in value-based arrangements:

“PSH expands the scope of our work, making it more meaningful. The PSH model propels us to engage in the totality of the patient experience, so we have an impact on care from the moment a patient decides to undergo an operation to the day they return to their patient-centered medical home. By expanding the scope of what we do as anesthesiologists, PSH elevates engagement. This means our impact on patient outcomes is substantially increased. And it reminds us that we are physicians first – before we are anesthesiologists. As such, we can contribute to the entire perioperative experience beyond just the technical aspects of providing anesthesia in the OR.”

David Brouhard, MD, FASA, used the PSH model to incorporate order sets into the EMR at his organization:

“PSH takes teamwork to the next level. PSH allows care teams – surgeons, anesthesiologists, administrators, nurses, and others – to move past fragmentation and do even better for our patients. Health care professionals who already do great work in silos find powerful synergies with PSH. With more synergy, we realize the best possible outcomes.

“What PSH requires is a team with shared purpose. Fortunately, putting a team together actually comes naturally to PSH practitioners because we’re all focused on what’s best for patients. The fact is, sometimes we can’t accomplish our ambitious care goals by ourselves. An anesthesiologist needs a surgeon. That surgeon needs administration. And so on. But when we come together and unite our ideas, resources, even finances, we achieve the best possible outcomes for patients. PSH gets us dancing to the same beat, and that’s good for everyone, especially patients.”

Marc Koch, MD, MBA, FASA, used the PSH model to reduce mortality, length of stay, and episode of care costs for hip fracture patients:

“The PSH gives anesthesiologists the tools to broaden and underscore our relevance clinically, strategically, tactically, operationally, and financially.

“The model grapples with the drivers of health care economics, complementing new payment models and bringing voice to those that are more nascent. By drilling down on each chapter of the perioperative journey, we can locate and act on areas where best practices and evidence-based methods can be marshaled to improve patient outcomes. The result? Fewer complications, thereby reducing costs for the entire surgical episode of care.

“Working within the PSH model, and by using perioperative medicine precepts, we can deliver the above win-win solutions plus improve facility and systemic financial performance while heightening both patient and provider satisfaction. Meeting these core objectives is a collective calling – it happens one anesthesiologist at a time. Each of us can make a difference. And this differentiation benefits us as individuals and, best of all, benefits the patients we serve.”

James Johnson, MD, CPHQ, used PSH to reduce narcotic requirements by 75%, complications by 50%, and to send patients home five days sooner:

“PSH is the antidote to fragmented care. It helps us create partnerships with our teams and our patients, which leads to better care and outcomes.

The network and structure provided by PSH is invaluable to patient care. It’s an unfortunate truth of our health care system that care is often fragmented. PSH gives us the tools to improve coordination across multidisciplinary teams, before and after surgery. And using a coordinated, team-based approach, we’re better able to partner with the patients, enabling them to participate in their care. This engages patients and their families. And the steps we put in place to better coordinate across the continuum, within the team, and with patients and families, means more patients benefit, so we impact more patients than we personally touch.”