New Specialty Care Payment Model: Transforming Episode Accountability Model (TEAM)
A new CMS episode-based model for surgery — including several common orthopaedic procedures — may be promising or problematic for orthopaedic surgeons. You have an opportunity to comment.
What
As part of the annual Medicare hospital inpatient prospective payment system (IPPS) proposed rule, CMS included a new reimbursement model for specific surgical procedures called the Transforming Episode Accountability Model (TEAM). It is an episode-based alternative payment model designed to incentivize hospitals and post-acute care facilities to coordinate care for 30 days after surgery in Traditional Medicare beneficiaries (that is, those not those enrolled in Medicare Advantage plans). The goal is to reduce postsurgical complications, prolonged recovery, unnecessary care, and preventable readmissions. Notably, the model is mandatory. All acute care hospitals in selected (but as-yet unspecified) geographic regions would be required to participate in the model. CMS developed the TEAM model using insights from a 2023 request for information and previous episode-based payment models like the Bundled Payments for Care Improvement Advanced and the Comprehensive Care for Joint Replacement models.
