ASA has championed the Perioperative Surgical Home (PSH) model for the past three years, investing a lot of volunteer and staff time and resources on the first PSH Learning Collaborative. Hundreds of articles have been published; all the major anesthesiology journals have devoted an entire issue to the PSH. But we in the United States are late to the game. In 1992, Henrik Kehlet, M.D., Ph.D., a Danish surgeon was talking about some radical ideas to improve surgical outcomes. It was to be 15 years before “Accelerated Recovery” became mainstream in England – and almost 25 years in the United States. Cannesson et al. described the convergence of the PSH and enhanced recovery after surgery (ERAS) initiatives in the British Journal of Anesthesia last year; this article will focus on the financial and political environment that shapes...

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