All You Need To Know About The CMS Team Model

Healthcare organizations struggle daily with delivering better care while watching the bottom line. The CMS Team Model marks a major change in Medicare payments, pushing providers away from charging for each service toward being paid for overall value. This mandatory program hits hospitals, doctors, and after-hospital providers who must quickly adapt or lose money.

Behind The CMS Team Model

The Team Model (Transforming Episode Accountability Model) changes how providers get paid for certain surgeries. This mandatory model makes selected hospitals responsible for coordinating care from the operating room through a month after discharge. Financial responsibility now extends outside hospital walls, forcing new working relationships with doctors, nursing homes, home health agencies, and outpatient providers.

Hospitals in the Team Model receive single payments covering entire treatment periods instead of billing for each service. This basic change puts the financial risk on providers who now must control both costs and quality results to stay profitable.

Surgeries Under The Program

The CMS Team Model targets common, expensive surgical procedures where better coordination can make a difference:

• Hip and knee replacements
• Hip fracture surgical treatments
• Back fusion operations
• Heart bypass surgeries
• Major intestinal procedures

These surgeries typically involve multiple providers across different settings, creating numerous handoff points where care often becomes fragmented. The Team Model CMS approach requires active management of these transitions to help patients recover better.

Money Matters That Worry Leaders

Hospital executives have good reason to worry about the financial impacts of the Team Model. The program creates real money risks:

• Hospitals spending too much face payment cuts
• After-hospital providers may get fewer patients if their costs run high
• Patients coming back to the hospital directly hit the bottom line
• Complications push costs beyond what the bundled payment covers

Organizations not ready for these financial changes face serious revenue problems. Successful hospitals build strong data tracking systems to watch spending patterns and find improvement opportunities before penalties hit.

Operational Hurdles Needing Quick Action

Putting the TEAM in place demands fundamental operational changes:

• Care Coordination Staff: New roles focused on managing patient transitions
• Provider Partnership Building: Strategic relationships with good, cost-effective after-hospital providers
• Information Sharing Systems: Technology enabling data flow between organizations
• Patient Support Resources: Tools helping patients actively participate in recovery

Many hospitals lack these capabilities and must build them quickly while keeping normal operations running. This implementation challenge puts significant pressure on both clinical and administrative resources.

Quality Measures Driving Results

The Team model CMS program evaluates performance across several quality areas:

• Complication rates after surgery
• How often do patients return within 30 days
• Patient-reported outcome scores
• Death rates for applicable procedures
• Patient satisfaction ratings

Organizations performing poorly on these measures face payment cuts beyond the cost targets. This dual accountability for both money and quality forces careful balancing between efficiency and patient outcomes.

Winning Approaches That Work

Forward-thinking organizations use several tactics to succeed under the CMS Team Model:

• Standard care paths reducing unwanted variation
• Preferred provider networks based on quality and cost results
• Early spotting of high-risk patients needing extra support
• Remote monitoring extends clinical oversight after discharge
• Regular doctor performance feedback with specific improvement suggestions

These approaches require investment but typically pay off through better clinical outcomes and lower episode spending.

Timeline Creating Pressure

The TEAM follows an aggressive schedule:

• Selection notification period
• Data gathering and baseline setting
• Initial performance period start
• First payment adjustments

This tight timeline leaves little room for planning. Organizations must adapt quickly or face financial consequences affecting their broader operations.

Tech Tools For Team Model Success

Persivia offers complete solutions specifically designed for CMS Team Model participants. Our platform brings together clinical, financial, and operational data to deliver practical insights driving performance improvement. With Persivia, hospitals gain the tools needed to coordinate care effectively, track spending patterns, and spot improvement opportunities before they hurt financial performance.