What is Perioperative Care?

January 1, 2023

Intro to surgical care

Modern-day surgery and anesthesia care are nothing short of a modern-day medical miracle. Think about it. It’s now considered routine to receive incredibly complex and specialized care, with the expectation that your surgical problem is safely addressed while feeling little to no discomfort during the experience. Millions of surgeries happen in the US and globally every year, and the care teams that perform surgery are well-trained masters at what they do. 

The current state of safe surgical care

However, despite the marvel that is modern surgical care, surgery itself can still be a messy and scary experience with thin margins for error. Complications do happen, and even with all of the advances in care over the decades, lapses in communication, missed diagnoses and poor care coordination can result in a scenario where the complexity of the care exceeds the capabilities of the health system. Recent studies have shown surgery complications of any cause range from 3-5%, and the risk of death or a major heart problem during or after surgery can be 2-12% depending on your health history. These rates are higher than many people are led to believe before embarking on their surgical journey. Can you imagine if there was a problem with 1 out of every 20 airplane flights? 

Surgery is a cardinal event requiring focus and preparation

From the patient’s perspective, surgery is a rare event that deserves special attention and concierge care. On average, a person will only have surgery 2 or 3 times in their life. These are cardinal events that should receive as much attention and plan as having a child, getting married, or graduating from school. Having surgery is a critical time when you expect everyone to be at the top of their game, and the stakes are high for everything to go right. 

Meanwhile, the time leading up to surgery has often been called a “black hole”, with poor communication and inadequate preparation being the norm. Over 1 in 5 outpatient surgeries are canceled the day of, mainly for logistical errors that could have been caught days in advance. So, how can we identify and prevent potential problems to achieve the best chance for success? Enter perioperative care.

What is perioperative care?

Perioperative, or periop, care means care surrounding surgery. It is a specialized field in medicine encompassing preop, intraop, and postop care with a focus on improving the preparation and recovery phases of surgery. 

First coined in the 1970s, there has been little time or attention placed on coordinating surgical care end-to-end in the intervening years until recently. Anesthesiologists, the specialty most concerned with a patient’s condition leading up to and following surgery, have been at the forefront of this progress largely due to the ASA (stands for American Society of Anesthesiologists). 

The idea is that if care teams and patients fully engage, they can devise a safe plan for surgery while preventing problems and complications. You wouldn’t take a car with a questionable maintenance history on a cross-country trip, and likewise, you should make sure your care team fully understands you and that your health is optimized before surgery. The problem is, health systems and many clinical teams aren’t well-positioned to perform perioperative care well. 

How does it work?

Perioperative care requires coordination and medical guidance that takes a patient from wherever they are in their current state of health, and safely guides them through the surgical journey and back to, or hopefully better, than where they started. In our current fee-for-service health system, there is a strong financial incentive to focus on the surgery and anesthesia care itself, but there are wide gaps in the preparation and recovery phases of surgery. As a result, we are now routinely seeing surgical cases get canceled up to 20% of the time due to poor preparation, and hospital readmission rates and post-surgical infection rates are a stubborn cause of cost and harm. And yet, many doctors accept “barely good enough” as routine. Our attitude at Orchestra is that barely good enough is completely unacceptable.

Who performs perioperative care?

High-quality perioperative care is difficult and expensive to implement because it is complex and no single clinical team or health system is well-positioned to deliver it. Primary care practitioners (PCP) are experts at delivering outpatient and chronic care but are often left out or unequipped to participate in the surgical care journey. Surgeons can work magic in the operating room, but typically lack the resources or incentives to provide high touchpoint preop and postop care. Anesthesiologists are trained to be at the intersection between medical care and surgery, but most anesthesia care teams have little interest in outpatient care coordination and would prefer to stay within the walls of the operating room. Specialists, such as cardiologists, often work completely separate from the surgery system and are unable to coordinate with surgical teams. 

Finally, because perioperative care is a niche service, none of these teams are able or know how to bill for the effort. When there’s no financial incentive, the work doesn’t get done. Ultimately, the end result is care teams that do a poor job of or actively avoid perioperative care altogether.

Orchestra health is democratizing perioperative care

Orchestra is solving these problems and delivering consistent, high-quality perioperative care by guiding all stakeholders through the process from beginning to end, essentially providing the necessary structure for everyone to communicate effectively while allowing them to focus on their individual specialties. Orchestra’s care model communicates directly with surgeons’ offices, facilities, patients, and anesthesia care teams to solve communication and coordination issues. We provide more touchpoints and act as patient advocates to connect with outside teams like PCPs and specialists to make sure the broader health system is coordinated during surgical care. As experts in perioperative business management, we can bill for the medical and coordination service and are contracted with most major payors. Finally, we leverage the latest technology to engage directly with patients to ensure the highest clinical quality and patient experience. 

Please contact us today to learn more about how Orchestra Health can drive top-line revenue while delivering best-in-class perioperative care to your surgical services.