Transforming Episode Accountability Model (TEAM)
The Next Step Forward In Bundled Payments
The Centers for Medicare & Medicaid Innovation (CMMI) just announced a new mandatory model via the Hospital Inpatient Prospective Payment System (IPPS) proposed rule, the Transforming Episode Accountability Model or TEAM. TEAM is the next iteration of episodic models for CMMI and is set to begin in 2026 following the expiration of its predecessor models, the Comprehensive Care for Joint Replacement (CJR) Model and BPCI-Advanced in 2024 and 2025 respectively.
What’s Included
TEAM focuses on ensuring high-quality, coordinated care for Medicare beneficiaries undergoing the following five high-cost, high-volume surgeries: lower extremity joint replacement, surgical hip fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedures. Episodes are triggered on the day of admission to the hospital or outpatient procedure and include additional services (including, but not limited to, primary care, outpatient therapy, skilled nursing facilities) for 30 days following discharge.
How it Works:
Under this mandatory model, hospitals located in specifically chosen geographic regions will be financially accountable for the cost and quality of care provided during each episode. The geographic regions will be selected Core-Based Statistical Areas (CBSAs) across the United States. This approach ensures a representative sample of hospitals; however, CMS may oversample CBSAs with no or limited exposure to similar previous models and those with safety net hospitals.
Hospitals will receive a target price for each episode, encompassing all Medicare-covered expenses from surgery to post-discharge care. Hospitals performing well and staying below the target price can earn incentive payments from CMS. Conversely, hospitals exceeding the target price may owe CMS a repayment amount, with adjustments based on quality performance.
TEAM includes a tiered participation structure with varying levels of risk:
Track 1: Designed for familiarization, this track offers no downside risk for the first year, allowing for a smoother transition into the model.
Track 2: Aimed at safety-net hospitals and others seeking a moderated approach, Track 2 features lower levels of risk and reward for years 2-5.
Track 3: This track is aimed at hospitals comfortable with taking on higher levels of risk and reward throughout the five-year program.
Initiatives within TEAM: Equity and Environment
TEAM prioritizes health equity by offering flexible participation tracks with lower risk/reward structures for safety-net hospitals. Recognizing the additional needs of underserved populations, TEAM will also adapt target prices for hospitals caring for a higher proportion of these patients.
As part of an optional Decarbonization and Resilience Initiative, participating hospitals can voluntarily report greenhouse gas emissions to receive feedback and recognition for their efforts to promote environmental sustainability. This aligns with a growing movement towards environmentally responsible health care practices. CMS aims to address the link between climate change and threats to public health and the health care system via this initiative.
What’s Next
The Transforming Episode Accountability Model (TEAM) is scheduled for launch in January 2026 and continue for 5 years. CMS is currently accepting comments on the proposed model through the IPPS Notice and comment process until June 10, 2024.
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