The value of perioperative surgical home: How scaling a PSH improved surgeon engagement and saved one US hospital up to US$12m in just one year

Perioperative value is the foundation of value-based care delivery. The era of bundled payment models demands standardisation and reliability in perioperative services — which account for 45–60 per cent of a hospital’s expenses — yet many hospitals struggle with high variability in surgical processes, outcomes and costs. Perioperative Surgical Home (PSH) offers an evidence-based strategy to reduce variability and optimise cost-effective patient experiences by aligning multiple specialties in a patient-centred episode of care. Anaesthesiologists, who interface with patients, surgeons, medical staff and hospital administrators, are well positioned to develop and implement a PSH programme in both inpatient and outpatient settings. This paper describes how Novant Health New Hanover Regional Medical Center (NHRMC) developed a pilot PSH programme in orthopaedics that produced outstanding clinical and financial outcomes, inspiring the hospital to expand PSH to 17 service lines. From inception, a co-management agreement structured on an independent valuation motivated and rewarded stakeholders, including physician anaesthesiologists, surgeons and administrators, to build the PSH and participate in standardising protocols. PSH has since produced millions of dollars in annual cost savings and better clinical outcomes, as well as increased surgeon and patient satisfaction.