Just When We Thought It Was Safe to Go Back in the Water: The Transforming Episode Accountability Model (TEAM) Has Been Finalized!
- Amy Pritchett and Kristen Taylor
- Aug 26
- 3 min read
Updated: Aug 27
The Transforming Episode Accountability Model (TEAM) was first proposed by the Centers for Medicare and Medicaid Services on April 10, 2024, and finalized July 31, 2025, which included 188 geographical regions and over 700 hospitals. In this article we will break down the rule set forth by the Center for Medicare and Medicaid Innovation (CMMI); which is a program that allows policymakers to establish and test new payment delivery and reimbursement models for both Medicare and Medicaid.
As previously noted within the initial release for comment, TEAM will now be a mandatory Alternative Payment Model (APM), based on episodes of care within acute care hospitals. Coordination of care will allow the initiation of an episode (procedure) to be followed and assumed responsibility for not only the cost of the procedure but, the quality of care the patient receives. The model tracks patients from the surgical procedure (initial episode) through the first thirty (30) days after the patient leaves the hospital.
Based on geographic regions, if the hospital is paid under the Inpatient Prospective Payment Service (IPPS), and hospitals can obtain buy-in from other providers to agreed shared savings payments, the participants would be selected. You may ask yourself, “What does this mean for me?” We have your answer. This model is following the same cadence as the CMMI released two years ago stating they wanted all traditional Medicare patients under some type of Accountable Care Organization (ACO) by 2030. The release of this model is aligning with that goal and will follow some of the same initiatives released in prior years.
The ACO Conundrum
CMMI also implemented the regulation that even if beneficiaries are aligned with another model, the episodes are still mandated to be captured under the TEAM model. This means if hospitals are currently participating in an ACO (or other care model), they would still be required to participate. There have been many questions raised on timing during the initial comment period. One of the main concerns addressed has been, “Is it too soon to start initiating an additional mandatory model when hospitals and other organizations are still actively participating in reporting models and periods for CJR and BPCI-A models?” As with any new implementation, there are additional considerations solely for the ACO-based participants (hospitals) under the proposed model. Additionally, in connection with implementing tracks of participation, there are also numerous other considerations under this model.
Preparation & Implementation
To properly prepare for implementation, hospitals are going to require a multidimensional approach. The main focus should be on analytics, staff coordination and engagement, and leveraging advanced technologies. Baseline performance including analysis of past data performance on the identified surgical episodes will assist in identifying greatest strengths and weaknesses across cost and quality metrics. Remember, the model strongly focuses on readmissions, complications, and patient satisfaction scores. In the upcoming months, it is going to be of the utmost importance to determine volumes and identify financial impact under the new model. Clear goals must be defined early and should focus on measurable goals and its impact to patient outcomes, quality, and cost of services.
Care coordination will be the driving factor of the model. It is crucial to establish communication not only with providers directly involved in patient care but, inclusion of inpatient teams, primary care providers, post-acute care providers, and even home health services and durable medical equipment services. Use of claims data, patient and physician-level costs, and established CMS benchmarks are going to be critical in sourcing and analyzing bundled payment performance. The use of predictive modeling is going to be imperative as the model pushes the envelope between retrospective reporting and simultaneous capabilities to complete performance monitoring along with financial exposure.
Education and engagement is going to be crucial post-implementation. Everyone from clinical to administrative and revenue cycle needs to understand the model, implications, and driven goals towards improvement of patient care, quality outcomes, and cost efficiencies.
We are going to continue to see additional models released. If you are having difficulties keeping up with the changes or would like to know how the changes will affect your organization, please contact Amy Pritchett (APritchett@AskPHC.com) or Kristen Taylor (KTaylor@AskPHC.com) for a consultation.
Check out the full article by Amy Pritchett and Kristen Taylor of Pinnacle. It contains a quick overview to TEAM that can assist in communication throughout your organization regarding TEAM and strategies to consider.
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