CMS proposes mandatory payment model for five types of surgical procedures

See updated details in Ready, set, TEAM: Prepare your hospital for mandatory surgical episode payments.

The centers for Medicare and Medicaid services (CMS)announced the Transforming episode accountability model (TEAM) on April 10, 2024. This proposed mandatory model will provide episode-based payments for five types of surgical procedures for five years.

TEAM aims to hold hospitals accountable for the quality, cost, and outcomes of care for Medicare beneficiaries undergoing certain high-cost and high-volume surgical procedures in both inpatient and outpatient settings. Acute care facilities will be responsible for the total cost of care during and for 30 days following the procedure.

TEAM participants will be expected to coordinate the patient’s care by referring patients to primary care providers, improving patient care transitions, and reducing avoidable readmissions. This will help ensure better and more equitable outcomes for all patients by decreasing fragmentation of care, as well as reducing duplicative use of resources and avoidable utilization of services.

CMS is soliciting feedback on the proposed fiscal year (FY) 2025 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) rule, which includes TEAM.

Model requirements and participation

CMS will determine which acute care hospitals will participate in the model based on selected geographic regions, Core-Based Statistical Areas (CBSA), from across the United States. Hospitals located within the selected CBSAs will be required to participate in TEAM. The model will run from Jan. 1, 2026, through Dec. 31, 2030.

The following surgical procedures will initiate an episode included in the model: