Our annual ASA meeting, “ANESTHESIOLOGYTM 2014” may have been misnamed. Perhaps it should have been called, “The Perioperative Surgical Home, and some other stuff.” Everywhere you looked; everywhere you went; everyone you talked to—the Perioperative Surgical Home (PSH) was there.
There were PSH lectures about the PSH as a whole. There were lectures about components of the PSH: preoperative, intraoperative, postoperative, and post-discharge. There were talks about preoperative preparation, goal-directed fluid therapy, Enhanced Recovery After Surgery (ERAS®), and continuous nerve blocks.
There were talks about economics: “How to develop a PSH,” and “Why should we do this?” To me, this is clearly the most significant initiative from the ASA in the last 15 years.
There were questions about why the PSH is necessary. Many groups seem to think they are safe and immune from decreasing payments and decreasing hospital subsidies for services, as well as immune from predatory takeovers and simple economic displacement. Think again. Our Rovenstine lecturer, Dr. Karen Domino, seriously questioned that approach. She pointed out example after example of groups that saw their practice model changed against their will, and found themselves out of jobs.
This is the time for change. Recognize that it is all around us. Dr. Domino clearly showed the audience that economics drives all of this. The word “unsustainable” came up again and again, particularly in reference to government payments and health care as a percentage of Gross Domestic Product. It is unsustainable. And it is going to change.
The trick is to be prepared for change by knowing the alternatives and developing your own plan instead of carrying out someone else’s. That was Dr. Domino’s message about action. We should heed her call.