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

Author's Biography

Rob M. Shakar , MD, FASA, is medical director of a 35-physician group that provides anaesthesia services at New Hanover Regional Medical Center (NHRMC) in Wilmington, North Carolina. Dr Shakar also oversees the hospital’s Perioperative Surgical Home (PSH) Project. NHRMC piloted its PSH project with the hip/knee total joints service line in 2015, and it has since expanded the PSH project to 17 surgical service lines. In the initial year, the total joints PSH created more than US$4m in savings by optimising patients for surgery and streamlining their supply chain expenditures. Under Dr Shakar’s leadership, the Wilmington anaesthesia group was the first in the country to monetise their efforts with PSH. In 2016, the American Society of Anesthesiologists (ASA) recognised Dr Shakar’s Wilmington group as an industry-leading innovator in PSH. In 2018, Dr Shakar’s group saved his hospital over US$12m on ten different service lines. He now serves as Chair of ASA’s PSH steering committee and was instrumental in developing ASA’s PSH Implementation Guide. As a national leader in value-based medicine for surgical services, Dr Shakar has lectured on PSH for numerous organisations, including the American College of Healthcare Executives (ACHE). He additionally has broad experience helping other health systems implement standard processes. Dr. Shakar earned his medical degree in 1993 from the University of Florida-Shands Hospital. He completed an internship in the department of Internal Medicine at the Medical University of South Carolina, and performed his residency in Anesthesiology at the University of Florida Health Sciences Center, where he served as Chief Resident of Anesthesiology from 1996 to 1997.

Grant Rush serves as vice president for Cardiovascular and Surgical Services, Novant Health Coastal Market, which comprises four hospital sites: the New Hanover Regional Medical Center (NHRMC) and three ambulatory surgical settings. He joined the NHRMC in 2011; as part of Novant since 2021, this region performs over 50,000 surgical cases annually. In partnership with Dr Rob Shakar and his anaesthesia team, Grant helped establish and expand the Perioperative Surgical Home (PSH) project for the coastal market. He has also developed several collaborative arrangements to partner with different specialties around surgical improvement efforts. Grant serves on Novant’s accountable care organisation (ACO), which, through the efforts of PSH, helps drive high-quality, affordable healthcare. He is also an oversight officer for the health system’s Hospital Quality and Efficiency Programs (HQEP) and Co-management Partnership programmes. Grant earned a bachelor’s degree and a master’s degree in healthcare administration from the University of North Carolina–Chapel Hill. He is a member of the American College of Healthcare Executives (ACHE) and has volunteered for a decade with Habitat for Humanity.