The 2026 Hospital Outpatient Prospective Payment System (OPPS) proposed rule from CMS outlines new directions for outpatient hospital care. One of the more significant shifts centers on the evolution of perioperative care models, particularly in anesthesia services and surgical optimization.
An August 4 blog post by Coronis Health breaks down the Perioperative Surgical Home (PSH) groundwork and CMS’s focus on potentially moving toward more scalable and streamlined strategies.
Here are four takeaways from the proposed rule’s quality-related provisions:
1. The PSH model’s implementation struggles
Backed by the American Society of Anesthesiologists (ASA), the PSH was introduced as a patient-centered, physician-led model designed to improve coordination across the surgical continuum. It paired anesthesiologists with nurse practitioners and acute pain services to oversee patient care from pre-op to post-discharge.
Early adopters included academic medical centers, which built anesthesia clinics to pre-screen patients and reduce same-day cancellations. While PSH showed promise in improving outcomes and satisfaction, its resource demands and implementation challenges made broad adoption difficult.
2. Barriers limited PSH scalability.
Despite the clinical logic behind PSH, its widespread adoption faced real-world friction.
Many hospitals struggled with staffing, cost, and infrastructure demands. Leadership ambiguity and lack of cross-specialty buy-in further hampered momentum. The resource-intensive nature of the model, requiring dedicated space, experienced personnel and comprehensive coordination, made it difficult to standardize across diverse care settings.
3. PMC as a practical alternative
In response to PSH’s challenges, the ASA shifted its focus to PMCs, a more focused model that aligns well with value-based care initiatives. PMCs emphasize medical optimization, risk stratification, prehabilitation, patient education and care coordination prior to surgery. This preoperative-only structure integrates more easily into existing hospital workflows and better reflects the anesthesiologist’s evolving role in perioperative risk management.
4. The benefits of PMCs
Unlike the full-spectrum PSH, the PMC model focuses on preparing patients medically and operationally before surgery. This leads to fewer delays, improved surgical readiness, and smoother care transitions, all while reducing avoidable utilization. PMCs also contribute to the broader goals of CMS’s outpatient quality programs by offering a model that is both impactful and feasible within current infrastructure.
As CMS refines its approach to outpatient care, the shift from PSH to PMC reflects a balancing act: advancing quality without overburdening providers. The future of perioperative care may not be one-size-fits-all but it will likely be guided by models that are evidence-based, adaptable, and rooted in real-world application.
