The article by James Dupree and coauthors (Jun 2014) highlights the lack of emphasis on surgical care in accountable care organizations, which instead focus on hospital admissions or readmissions, the coordination of care for patients with complex conditions, and the use of the emergency department-despite the fact that surgery represents approximately 50 percent of hospital expenditures and ac-counts for an estimated 30 percent of total health care costs. As the authors note, it's a critical issue, and it's one that the American Society of Anesthesiologists (ASA) is addressing with an innovative practice model called the Perioperative Surgical Home (PSH). The PSH is a patient-centered delivery system that aligns with the National Quality Strategy to achieve the Triple Aim1 of improving health, improving the delivery of health care, and reducing the cost of care at all phases of surgery, including preoperative, intraopera-tive, and postoperative. These goals are met through shared decision making and providing seamless continuity of care for the surgical patient, from the moment the decision to have surgery is made, through recovery and discharge, and beyond.
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