Letters to the Editor

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September 1, 2013 Volume 77, Number 9
Letters to the Editor

Implementation of the Perioperative Surgical Home Model

I read with great interest the January 2013 ASA NEWSLETTER article “Selling Your Anesthesiology Practice?”1 As the author indicated, nearly 25 percent of all hospital-based physicians are employed by the hospitals at which they practice, compared to 5 percent in 2000. Anesthesiologists are hospital-based physicians. Anesthesiology practices are the targets of hospital acquisition. Hospital systems are seeking to protect market share, ensure a reliable supply of anesthesiologists and control processes during episodes of care.1

The Perioperative Surgical Home concept of care makes anesthesiologists indispensable to hospitals by improving patient outcomes, controlling costs and maximizing O.R. revenue.2 This model can help anesthesiologists survive under accountable care.

The Medical Home model is the impetus of the idea of the Perioperative Surgical Home. The Medical Home was first introduced to the medical community in 1967. The development and implementation of the Medical Home concept took more than 44 years and received tremendous support from federal, state and local agencies and organizations.3 Now, the Medical Home has become the heart of accountable care organizations.

ASA began talking to legislators around 2007 about the concept of the Perioperative Surgical Home model and it was widely introduced in 2011. Compared to the more-than 44 year history of the Medical Home, it is a new kid on the block. The development and implementation of the Perioperative Surgical Home concept requires tremendous support from all levels of government (federal, state and local) and many organizations. Anesthesiologists need to conduct studies to prove that the Perioperative Surgical Home improves quality outcomes and lower costs. Anesthesiologists have an urgency to implement the Perioperative Surgical Home into practice. Doing so may help to avoid acquisition.

Jeffrey Huang, M.D.
Winter Park, Florida

Response to Dr. Huang

Dear Dr. Huang,

Thank you for your letter and thoughts. Whether develop-ment of the Perioperative Surgical Home (PSH) would slow the pace of anesthesiology practice acquisitions is an interesting question.

You are correct that in comparison to the Medical Home, the PSH is a relatively new concept. ASA began speaking with legislators about the PSH in 2007 and development of the PSH has accelerated since 2011. Currently there are a number of anesthesiology practices around the country that have started to implement part or all of the PSH model. More recently, the ASA Committee on Future Models of Anesthesia Practice is working to a) define the structure and elements of the PSH b) demonstrate that the PSH model reduces costs and improves surgical outcomes and c) develop strategies for implementation of the PSH. The PSH will be featured significantly in future issues of the ASA NEWSLETTER and at PRACTICE MANAGEMENT 2014.

Jay Mesrobian, M.D.
Chair, ASA Committee on Practice Management

The views and opinions expressed in the “Letters to the Editor” are those of the authors and do not necessarily reflect the views of ASA or the NEWSLETTER Editorial Board. Letters submitted for consideration should not exceed 300 words in length. The Editor has the authority to accept or reject any letter submitted for publication. Personal correspondence to the Editor by letter or e-mail must be clearly indicated as “Not for Publication” by the sender. Letters must be signed (although name may be withheld on request) and are subject to editing and abridgement. Send letters to newsletter_editor@asahq.org.



1. Mesrobian J. Selling your anesthesiology practice? ASA Newsl. 2013;77(1):8-9.


2. Young DE, Peters JA. Can anesthesiologists survive under accountable care? ASA Newsl. 2012;76(9):40-41.


3. Longworth DL. Accountable care organizations, the patient-centered medical home, and health care reform: what does it all mean? Cleve Clin J Med. 2011;78(9):571-582.