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If you work at or with a hospital and that hospital’s CBSA was chosen for TEAM, the mandatory acute episode of care program beginning January 1, 2026, they may have received notification from CMS about their mandatory inclusion in the model.
In one year, CMS has put out two value-based care mandatory programs for hospitals. The other is the Increasing Organ Transplant Access (IOTA) Model, impacting half the organ transplant in the hospitals in the country with goals of maximizing the use of deceased donor kidneys, improve the quality of care during the kidney transplant episode, identify and support living donors through the process, improve coordination of care, and increase equitable access to donor kidneys.
This is Not a Threat to Accountable Care Organizations
On the contrary, it’s a step in the right direction. When managing total cost of care, it can be challenging to find meaningful levers for hospitals to pull based on the incentive structure. An acute episode of care can look like this:
Identifying the barriers and what it will take to get someone successful transitioned home with follow-up care and/or with home health and support rather than inpatient post-acute care. (Re-prioritize the role of the discharge team and empower and resource staff.)
Early and frequent mobilization unless medically contraindicated. (Invest in hospital mobility programs.)
Evaluating adherence to evidence-based practice and efficient use of resources in every step of the anchor part of the episode, including standardization of surgical practices, pain management, etc.
Optimizing transitions of care, warm hand-offs, consistent patient and care partner education and engagement
Effective communication about selected preferred providers for post-acute care, either on an inpatient or outpatient basis, while maintaining patient choice
TEAM FAQs
Can my hospital opt out of TEAM?
No, it’s mandatory if your CBSA was selected.
If we participate in MSSP, will our patients be excluded?
No. There is a broad overlap policy of TEAM with total cost of care models.
Is the hospital allowed to shift the risk to providers or conveners?
No, acute care hospitals bear the financial risk.
What happens if a patient dies during the 30 days post-anchor period?
The episode is still counted in the program unless the patient dies during the hospital stay.
What costs are included in the target price?
All Medicare Parts A and B spending are included, except for some specific exclusions like admissions for trauma, oncology, and organ transplant.
Healthcare Professionals: If you Understand the Incentives, you can Spot the Career Growth Opportunities
By putting the risk and reward on hospitals, not providers, hospitals have a chance to re-think how they have staffed what are historically thought of as “cost centers” because of the inpatient payment model.
As many readers know, most healthcare professionals who bill for services in the community don’t bill for them in the hospital. The hospital must provide comprehensive care to meet conditions of participation, but there is no incentive to provide more than what’s needed to meet requirements.
Hospitals bill one Diagnostic Related Group (DRG) in Medicare Part A for the inpatient stay. Physicians bill Medicare Part B with acute care hospital as the place of service. But the professional services of rehab professionals, dieticians, social workers, and more are not billable.
Enter the TEAM Model
It will take a different approach to the typical discharge planning and length of stay management to be successful in TEAM. It’s not too early to put together a strategic plan for TEAM success.