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The Perioperative Surgical Home Initiative: Advances in Team-Based, Coordinated Care

Feb 16, 2018

This innovative model of care considers the entire patient experience—from the decision for surgery until patient recovery

The Perioperative Surgical Home (PSH) is a patient-centric, team-based model of care that helps meet the demands of a rapidly-changing health care landscape that will emphasize gratified providers, improved population health, reduced care costs, and satisfied patients. The PSH initiative was created by leaders within the American Society of Anesthesiologists® (ASA®) who identified the need to transition health care from an emphasis on volume, to an emphasis on providing value.

A strong core feature of the PSH Model is the team. Team work is required for an effective PSH pilot. As such, the ASA has diligently worked to identify key stakeholders that would contribute to the success of implementing a PSH pilot in an institution. In October 2017, the American Academy of Physical Medicine and Rehabilitation (AAPM&R) joined the American Academy of Orthopedic Surgeons (AAOS) and the American Urological Association (AUA) in support of the PSH initiative.  

AAPM&R endorsed the model, noting that as physiatrists are vital in optimizing outcomes and function early and throughout the continuum of patient care, the PSH model, which guides patients through surgery via a system of coordinated care seems like a logical fit for their organization. “With a strong focus on directing rehabilitation and recovery, the PSH will allow physiatrist providers to improve efficiencies, decrease resource utilization, and decrease complications – resulting in higher patient satisfaction,” said AAPM&R Past President, Steve Geiringer, MD, FAAPMR.

AAPM&R has already made a tremendous impact on the PSH initiative not only through its endorsement but also through its strategic leadership. AAPM&R holds 2 seats on the PSH Learning Collaborative Steering Committee, which oversees the activities of the PSH Learning Collaboratives. 

PSH Learning Collaborative—Consultative Support for an Effective and Efficient PSH Pilot

Implementing the PSH model of care is a massive undertaking. As such, ASA partnered with Premier, Inc., a leading health care improvement company, to establish a national learning collaborative to develop, pilot, and evaluate the PSH model. The PSH Learning Collaboratives bring together subject-matter experts and leading organizations from across the country to learn from each other.

The PSH Learning Collaborative 1.0 brought together 44 leading health care organizations to define the model, create a pilot, provide feedback, collect data, and compare the outcomes to conventional perioperative care. The PSH Learning Collaborative 2.0 included 57 participating organizations and provided insight about PSH strategies that are compatible with alternative payment models, including the Bundled Payments for Care Improvement (BPCI), Comprehensive Care for Joint Replacement (CJR), the Medicare Shared Savings Program (MSSP), and Accountable Care Organizations (ACOs).

The nearly 100 institutions and countless health care professionals that have implemented a PSH model, as part of the PSH Learning Collaborative, have enjoyed many successful outcomes including:

  • A regional medical center saved $1.5 million in the first year.
  • A pediatric institution reduced a 30-day readmission rate from 8.33% to 7.5% for laryngeal cleft patients and reduced the average cost of these patients by approximately 20%.
  • An academic center saved an average of $10,000 per cystectomy case compared to pre-PSH cases and reduced length of stay for these cases from 10.5 days to approximately 6 days, creating space in the organization for open beds and additional new revenue.
  • A major health system improved room turnover by approximately 8 minutes, reduced length of stay for hip/knee arthroplasty cases from an average of 110 hours to 51 hours and has cut in half the readmission rate for hip/knee arthroplasty cases.

These outcomes are achieved by the myriad number of resources and tools that the PSH Learning Collaborative provides to its members. These resources include national face to face meetings, an online community, access to clinical protocol repository, newsletters, and implementation best practices and tools. In addition to these resources, members are provided monthly educational webinars and member sharing webinars. 

This month, William A. Adair, MD, FAAPMR, provided an incredibly well received education webinar: Toward the Triple Aim: Improving Post-Acute Care through Physiatrist Participation. The focus of this webinar was to describe:

  • The importance of managing post-acute care as an essential element of achieving the triple


  • The critical elements in implementing a well-designed SNF post-acute network.

After attending the webinar, members of the PSH Learning Collaborative truly learned the impact that physiatrists can make in increasing the value of patient care across the care continuum.

Opportunity to Participate in PSH Learning Collaborative 2020

The recruitment for the PSH Learning Collaborative 2020 just launched. This collaborative will begin May 1, 2018 and run for 2 years. The Collaborative will assist facilities in PSH pilot implementation, optimization, and expansion into new service lines or system-wide conversion.

The upcoming collaborative will also help facilities overcome the challenges they face with making the change to value-based payment. Organizations will be guided through participating in mandatory and elective bundles and understand the impact the Medicare Access and CHIP Reauthorization Act (MACRA), Merit-Based Incentive Payment System (MIPS), and Advanced Alternative Payment Models (APMs) will have on their organization. This effort is important because value-based payment is quickly being adopted by private payers—not only by public payers.

To meet the unique needs of organizations interested in health care redesign, institutions can choose from 2 participation options. The first, the Core Collaborative, is designed for organizations interested in learning more about the PSH model of care and those in the early stages of implementing a PSH pilot. The other, the Advanced Cohort, is designed for organizations that are looking to optimize or expand their PSH pilot. Advanced Cohort participants also can be part of the bundles payment add-on option, which allows them to assess their facility’s benefits and risks in participating in the various bundle payment programs. No matter which learning track an organization participates in, institutions will complete the program with the confidence, tools, and resources to begin the next phase of PSH pilot implementation.

Registration for the PSH Learning Collaborative 2020 is currently underway. Applications are due April 15, 2018. Learn more at or email