activemandatoryepisode-based

TEAM

Transforming Episode Accountability Model

In the Transforming Episode Accountability Model (TEAM), selected acute care hospitals coordinate care from surgery through 30 days post-hospitalization for people with Original Medicare undergoing one of five surgical procedures. The model aims to improve the patient experience and reduce avoidable readmissions and emergency department use.

Active Since2026-01-01
Application Deadline2025-01-31

Innovation

TEAM offers a glide path to participation in downside risk for all hospitals, including safety net and rural hospitals, and requires participants to include in hospital discharge planning a referral to an established supplier of primary care services.

The Problem

People who undergo surgery may experience fragmented care, which can lead to complications, prolonged recovery, or potentially avoidable acute care.

The Solution

TEAM aims to improve the patient experience from surgery through recovery by supporting the coordination and transition of care between providers. Participants must refer patients to primary care services to enable continuity of care and positive long-term health outcomes.

Expected Outcomes

Successful outcomes include reducing both avoidable hospital readmissions and emergency department use.

Strategy

TEAM aligns with the CMS Innovation Center strategy of empowering patients by supporting their navigation from surgery through recovery and aims to protect taxpayers by reducing unnecessary care and avoidable hospitalizations.

Model Goals

  • Benefit Medicare patients through improving the coordination of items and services paid for through Medicare fee-for-service (FFS)
  • Encourage provider investment in health care infrastructure and redesigned care processes
  • Incentivize higher value care across the inpatient and post-acute care settings

Patient Eligibility

People with Original Medicare undergoing one of five included surgical procedures.

  • Enrolled in Original Medicare
  • Undergoing one of five surgical procedures: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, or major bowel procedures
  • Meets beneficiary inclusion criteria during the entire 180-day lookback period

Provider Eligibility

Acute care hospitals paid under IPPS and OPPS located in selected mandatory Core-Based Statistical Areas (CBSAs), or eligible hospitals that voluntarily opted in.

  • Acute care hospital that initiates episodes and is paid under the IPPS and OPPS
  • Has a CMS Certification Number (CCN) primary address located in one of the mandatory Core-Based Statistical Areas (CBSAs)
  • Or made a voluntary opt-in participation election and was accepted by CMS
  • Excludes Indian Health System (IHS)/Tribal hospitals
  • Excludes all acute care hospitals in Maryland

Care Categories

Surgery

Lower extremity joint replacement (LEJR)Surgical hip and femur fracture treatment (SHFFT)Spinal fusionCoronary artery bypass graft (CABG)Major bowel procedure

CMS Benchmarks & Thresholds

eligibility

Eligible DRG ListMS-DRG 469,MS-DRG 470,MS-DRG 521,MS-DRG 522,HCPCS 27447,HCPCS 27130,HCPCS 27702,MS-DRG 480,MS-DRG 481,MS-DRG 482,... (total 37 codes across 5 surgical procedures)
New Hospital Deferment Effective Date CutoffDecember 31, 2024
Safety Net Hospital Dual Eligible Percentile0.75
Safety Net Hospital Part D LIS Percentile0.75
Low Volume Threshold Episodes31
New Hospital Deferment Years1

financial

Track 1 Stop-Gain Limit0.1%
Track 2 Stop-Gain Limit0.05%
Stop-Loss Limit (Track 2)0.05%
Stop-Loss Limit (Track 3)0.2%
Track 1 Positive Reconciliation Quality Adjustment0.1%
Spinal Fusion Discount Factor0.02%
Baseline Year 1 Weight0.17%
Baseline Year 2 Weight0.33%
Baseline Year 3 Weight0.5%
High-Cost Outlier Cap Percentile0.99
CABG Discount Factor0.015%
LEJR Discount Factor0.02%
Major Bowel Discount Factor0.015%
SHFFT Discount Factor0.02%
Track 2 Negative Reconciliation Quality Adjustment0.15%
Track 3 Stop-Gain Limit0.2%
Track 3 Positive/Negative Reconciliation Quality Adjustment0.1%
Track 2 Positive Reconciliation Quality Adjustment0.1%

operational

Episode Duration30
Model Performance Years5
Number of Surgical Procedures5
Voluntary Opt-In Period Days31
Baseline Data Years3
Data Sharing Agreement Frequencyannually
Reconciliation Process Start Months After Performance Year End6
Risk Adjustment Lookback Days180

quality

Insufficient Quality Measure Score50

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