Interview with Dr. Thomas Tsai (Harvard Medical School, American College of Surgeons): Recovery Is Now at Home. Is Your Team? (Strategies for Post-Acute Care Under CMS TEAM)

Dr. Thomas Tsai, Associate Professor of Surgery at Harvard Medical School and Medical Director of Health Policy Research at the American College of Surgeons, joins The Surgical Journey to discuss what it actually takes to redesign surgical care around where patients recover today. Drawing on his work leading the first randomized controlled trial of home hospital for surgical patients at Brigham and Women's Hospital, and an enhanced recovery initiative that achieved same-day discharge rates above 90 percent for bariatric surgery, Tsai makes the case that better outcomes require more coordination, not less, and that the infrastructure most hospitals rely on was built for the team, not the patient. He addresses the counterintuitive reality of CMS TEAM: that reducing utilization requires more effort and more investment, not less. And he lays out what it takes to move a protocol from pilot to sustained execution at scale, including a year-long culture and buy-in effort that he describes as the real secret sauce. Topics covered include pre-habilitation, workflow redesign, gain-sharing under bundled payment, patient-reported outcomes, and the growing gap between where care happens and where the infrastructure to support it currently exists. EPISODE CONTENTS 00:00 Introduction and guest background 02:22 Redesigning surgical workflow around the patient, not the team 03:35 Why clinical workflows are built for the medical team, not the patient 05:02 Team-based and technology-enabled approaches to home recovery 08:24 How bundled payment models align incentives across the episode 09:55 Pre-habilitation and setting shared expectations before surgery 11:18 The counterintuitive reality: less utilization requires more effort 12:55 Achieving 90 percent same-day discharge for bariatric surgery 14:55 The year-long culture and buy-in effort behind protocol adoption 16:20 What it takes for digital health tools to move beyond a pilot 19:20 Redesigning the full surgical patient journey end to end 21:18 The burden of recovery shifts to patients and caregivers at discharge 23:24 Patient connection to the surgical team does not end at discharge 24:10 Patient-reported outcomes and the future of post-acute measurement