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New update: CMS releases mandatory TEAM hospital participants

CMS releases mandatory TEAM model hospital list

Is your hospital one of the 741 acute care hospitals mandated? 

On Sept. 5, the Centers for Medicare and Medicaid Services (CMS) took another significant step in transforming healthcare delivery by releasing the list of mandatory participants for the Transforming Episode Accountability Model (TEAM).  

If you’re a part of the 741 acute care hospitals selected for mandatory TEAM participation, here’s what you need to pay close attention to, as it marks a pivotal shift in how care is managed and Medicare costs are reconciled across the United States. 

Two highlights from the CMS announcement 

Mandatory participants announced 

CMS’ list of acute care hospitals selected for mandatory participation in the TEAM model includes hospitals located within Core-based Statistical Areas (CBSAs) chosen by CMS. If your hospital is among those listed, it's imperative to understand the implications and prepare for upcoming changes. 

Call to action for participating hospitals 

CMS has requested that each hospital on the list complete the online TEAM Primary Point of Contact Identification Form. This form designates representatives who will receive critical TEAM-related communications. Properly identifying these contacts will help facilitate smooth and effective communication between hospitals and CMS.   

Understanding the implications 

For hospitals included in the mandatory list, participating in the TEAM model presents both opportunities and challenges. It's an opportunity to leverage Medicare bundled payment models to improve care coordination and the quality of care delivered. However, hospitals must also grapple with the challenges of adapting to new processes, complying with reporting requirements and adjusting to a new payment landscape. 

Preparing for the transition 

Steps for mandatory acute care hospitals 

Hospitals required to participate in the TEAM model should begin preparing immediately.  

  1. Review the mandatory participants list: ensure your hospital is aware of its inclusion and understands the specific requirements. 

  1. Identify key contacts: quickly designate and register your TEAM primary points of contact using the CMS-provided online form to ensure seamless communication. 

  1. Educate and train staff: implement training programs to familiarize staff with the TEAM model’s objectives, processes and reporting requirements. 

  1. Assess current practices: evaluate current care delivery practices and identify areas for improvement to align with the TEAM model's goals. 

  1. Engage in open dialogue: foster open communication with other hospitals, downstream care providers and stakeholders involved in the TEAM model to share insights, challenges and best practices. 

  1. Lean on simulated TEAM shadow bundle data: this analysis helps accountable care organizations, clinically integrated networks and other individual healthcare providers gain valuable insight into episodes of care for their patient populations. 

What is the TEAM model? 

Quick TEAM overview: CMS frequently asked questions 

As described in our comprehensive TEAM white paper, the CMS TEAM model is a five-year mandatory, episode-based alternative payment model (APM) starting in Jan. 2026. As described on CMS’ TEAM frequently asked questions page, it's a comprehensive approach designed to improve patient outcomes and reduce healthcare costs by bundling payments for specific episodes of care. By participating in this model, hospitals will work closely with CMS to enhance efficiency and ensure effective care delivery. 

Hospitals required to participate are based on selected geographic regions, CBSAs, across the United States. Additionally, hospitals that participate until the last day of the last performance period of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) model or the last day of the last performance year of the Comprehensive Care for Joint Replacement (CJR) model will be eligible for a one-time opportunity to voluntarily opt into TEAM, encouraging these hospitals to maintain their momentum in value-based care. TEAM will cover five different surgical procedures:    

  • lower extremity joint replacement;  

  • surgical hip femur fracture treatment;  

  • spinal fusion;  

  • coronary artery bypass graft; and  

  • major bowel procedure. 

TEAM timeline: important updates 

  • April 10, 2024: New mandatory, five-year, episode-based APM introduced. Comments, questions and feedback on the proposed rule were due by 5 p.m. EDT on June 6, 2024. 

  • Aug. 1, 2024: Transforming Episode Accountability Model finalized in the federal fiscal year 2025 IPPS final rule. 

  • Sept. 5, 2024: CMS published the list of acute care hospitals located in one of the CBSAs selected for mandatory participation in TEAM. 

  • Jan. 31, 2025: Deadline for non-mandatory hospitals that are current CJR or BPICA participants to voluntarily elect to participate in TEAM. 

  • Q4 2025: CMS makes baseline data and prospective target price adjustment factors available for participating hospitals to estimate TEAM performance, which DataGen’s TEAM Performance Data Monitoring Platform can model. 

  • Jan. 1, 2026: TEAM launches and will run for five years, ending Dec. 31, 2030. 

TEAM model: episode-based payment structure 

The TEAM model is an episode-based payment model. An episode of care is a patient's entire treatment for an illness or condition, including all services provided to treat a clinical condition or procedure. In TEAM, an episode will be triggered by a surgical procedure performed in an inpatient or outpatient hospital setting. The episode will end 30 days after the inpatient admission discharge date or outpatient procedure date.  

TEAM utilizes an episode-based payment approach where a single price is assigned for the full spectrum of healthcare services that occur during the specific period of care. CMS’ goal is to promote holistic patient care through payments that are structured around a patient's entire episode of care rather than individual services. 

3 TEAM care transformation priorities

  1. Enhanced care coordination: By focusing on episodes of care, the TEAM model encourages better coordination among healthcare providers across the continuum of care, leading to improved patient outcomes. 

  1. Cost efficiency: Bundled payments incentivize efficient care delivery, reducing unnecessary expenditures while maintaining high-quality care. 

  1. Innovation in care delivery: Hospitals have the opportunity to innovate and implement new strategies that align with CMS' goals of improving care while reducing costs. 

Top CMS TEAM Model challenges 

The selected mandatory acute care hospitals need to start preparing now for the financial risk of value-based payments. Our white paper details what you need to know: TEAM: Transforming Episode Accountability Model – Overcoming 3 Key Challenges. To save you some time, here are the highlights.  

Challenge 1: Understanding complex program rules 

Navigating the intricate program rules and methodologies is a common hurdle, particularly for hospitals with limited experience in value-based care. Overcome this challenge by identifying key roles and deploying education and training that covers program rules, surgical procedures and standardized care protocols. 

Challenge 2: Data analysis support 

Access to Medicare claims data offers significant advantages under the TEAM model. However, interpreting and using these data for meaningful insights can be challenging. You’ll need to address this by understanding your internal analysis resources and partnering with data experts. 

Challenge 3: Cost consideration and investment 

Financial implications are a major concern for hospitals adopting the TEAM model. Potential losses and perceived high investments can hinder engagement. You’ll need to mitigate this challenge by depending on and regularly reviewing your data and responding to results with effective care interventions. 

The wrap-up: final thoughts for TEAM model participants 

CMS’ release of the TEAM model mandatory participants list is a call to action for acute care hospitals across the nation. By engaging with this initiative, hospitals can play a pivotal role in advancing healthcare quality and efficiency. The best way to stay ahead of this model: Stay informed about further updates from CMS and take proactive steps to ensure your hospital is prepared for this new era in healthcare delivery. 

Need help preparing for TEAM? 

DataGen offers the analytics and expertise needed to guide hospitals through the complexities of TEAM. Our boutique services are designed to optimize performance and ensure your incentives align with value-based care goals. Together, we’ll help you get the analytics you need now to stay ahead, ensuring your hospital thrives in the new healthcare landscape with DataGen’s high-touch support. 

Use shadow bundles to get ahead of CMS models 

DataGen is more than a healthcare analytics company: We’re here to support your success as you navigate emerging CMS value-based payment initiatives. Rely on DataGen’s shadow bundle data analytics to effectively meet your clinical, quality and financial goals. In addition, discover future opportunities while getting the assistance you need to determine your risk, maximize your aptitude for value-based payment arrangements and explore data measures that impact your performance. 

Reach out today to discover how we can assist you in navigating TEAM, shadow bundles and achieving success in value-based care. 

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