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ACOs: Should you include a ‘surgical home’?

The American Society of Anesthesiologists (ASA) has proposed a coordinated perioperative, or surgical home, model which would give anesthesiologists a leadership role in the development of an important component of accountable care organizations (ACOs).  This is a counterpart to the medical home model (which focuses on primary care and patients with chronic disease).  ASA envisions that anesthesiologists would evolve into “perioperative physicians” in this model.

Interesting fact: An estimated 60 to 70 percent of hospital expenses are related to patients who have surgery or undergo procedures.

Sources:  American Society of Anesthesiologists.  The Perioperative or Surgical Home, Aug. 21, 2011.  Click here for full text: http://www.saaahq.org/ThePerioperative_orSurgicalHome.pdf;  Warner, M.A.  The surgical home.  Newsletter. American Society of Anesthesiologists;76(5):30-32, May 2012; and, ASA responds to accountable care organization proposed rule.  Press Release, June 3, 2011.  Click here for full text: http://www.asahq.org/For-Members/Advocacy/Washington-Alerts/ASA-Responds-to-Accountable-Care-Organization-Proposed-Rule.aspx  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Laying the foundations for the patient-centered medical home

The patient-centered medical home (PCMH) – sometimes referred to as the primary care medical home – is a health care delivery model often touted as the wave of the future in reforming and revolutionizing primary care service in the U.S.  The Agency for Healthcare Research & Quality (AHRQ) identifies the following as characteristics of the effective PCMH:

  • patient-centered
  • comprehensive
  • coordinated
  • accessible
  • continuously improved through a systems-based approach to quality and safety

To further the development and study of the PCMH model, AHRQ has created the Patient-Centered Medical Home Resource Center, a website that includes descriptions and definitions of the PCMH model, a searchable citations database, and a bibliography, with links, of research, white papers and other documents produced by or through AHRQ on the topic. 

The most valuable part of the website (in this blogger’s humble opinion) is the section on “Foundational Articles” – a bibliography, again with links, of the research that AHRQ found seminal in the development of its own thinking and position on PCMHs.    

Anyone interested in launching a PCMH or just coming to a better understanding of what they are and the role envisioned for them in a healthy health care delivery system should check out this site.


Source: Agency for Healthcare Research and Quality.  Patient Centered Medical Home Resource Center.  http://pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483 (accessed June 30, 2011)




RN case managers embedded in primary care practices

Geisinger Health Plan (Danville, PA), has developed Health Navigator, a medical home model in which nurse case managers are embedded with primary care practices.  The objective of the program is to manage transitions, particularly to avoid unneccessary hospital readmissions; also to address safety issues in the patient’s home, and to help manage chronic conditions.  The salary for an RN case manager is about $80,000 in central Pennsylvania, but the savings generated by the program have covered these costs.

What I like about this article: It’s a concise description of a successful medical home model.

Source: Geisinger’s embedded nurses improve transitionsManaged Care;20(4):26-27, Apr. 2011.  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org