Readiness checklist: CMS Transforming Episode Accountability Model (TEAM)

The Transforming Episode Accountability Model (TEAM) is a mandatory, episode-based alternative payment model developed by the Centers for Medicare and Medicaid services (CMS).   

It requires selected acute care hospitals to coordinate care for Medicare beneficiaries undergoing specific surgical procedures, assuming responsibility for the cost and quality of care from surgery through the first 30 days post-discharge.  

To prepare for participation in the TEAM model, we’ve put together this blog that hospitals can leverage to ensure model success.  

TEAM readiness checklist breakdown 

1. Complete preparation steps: Assess participation status and more 

• Mandatory participation: Determine if your hospital is located within one of the Core-based Statistical Areas (CBSAs) selected for mandatory participation. CMS has published a list of acute care hospitals in these areas.  

• Voluntary opt-in: If your hospital participated until the last day of the last performance period in the Bundled Payments for Care Improvement Advanced (BPCI Advanced) model or the last day of the last performance year in the Comprehensive Care for Joint Replacement (CJR) model, assess eligibility for the one-time voluntary opt-in opportunity.  

• Technical preparation: If your hospital has not already done so, establish a process to begin collecting outcomes data for patients who undergo total hip arthroplasty and total knee arthroplasty procedures.  Both preoperative and postoperative data elements will be required.   

• Sign CMS’ data request and attestation form: This will grant your hospital access to the baseline, performance year and reconciliation claims data files for the episodes your hospital initiates throughout the model. 

2. Establish points of contact and identify a physician champion 

Designate a primary point of contact for TEAM-related communications by completing the online TEAM primary point of contact identification form.   

Also, identify a “physician champion” within your hospital. In CMS’ words, this is someone who will engage with fellow physicians to make collaborative decisions on clinical approaches and create buy-in and support for the care redesign processes, as stated in its strategies for success in bundled payments infographic. 

 

3. Understand financial responsibilities 

Review the episode payment and target pricing methodology. TEAM episodes will include most Medicare spending during an episode of care, encompassing the surgery and post-discharge services for 30 days. Ensure your financial team comprehends the implications of assuming responsibility for these Medicare costs in the context of reconciliation.  

4. Assess care coordination capabilities 

Evaluate your hospital's care coordination processes for the surgical procedures included in TEAM: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft and major bowel procedure.  

Develop or enhance systems to ensure seamless transitions from surgery through the 30-day post-discharge period. 

5. Enhance patient referral processes 

• Implement procedures: Connect patients to the most appropriate post-acute care setting, if needed, and primary care services, facilitating accountable care relationships and supporting optimal long-term health outcomes.  

• Assess your post-acute network: Specifically, look at which providers your patients are discharged to, the average length of stay or number of visits, and any rehospitalizations that occur. 
  
  

6. Prepare for health equity initiatives 

Familiarize yourself with TEAM’s health equity provisions, such as the availability of a track with lower levels of risk and reward for safety net hospitals and pricing adjustments accounting for underserved individuals.  

7. Plan for decarbonization and resilience 

Consider participating in the voluntary decarbonization and resilience initiative, aimed at addressing climate change-related threats to patient health and the healthcare system.  

8. Review participation tracks and risk levels 

Understand the three participation tracks: 

1. Track 1: no downside risk and lower levels of reward for the first year, or up to three years for safety net hospitals. 

2. Track 2: lower levels of risk and reward for certain participants, such as rural hospitals, for TEAM years 2 through 5. 

3. Track 3: higher levels of risk and reward for years 1 through 5.  

Decide which track aligns best with your hospital's designations, capabilities and risk tolerance. 

9. Develop staff training programs 

Organize training sessions for clinical, operational, financial and administrative staff to ensure understanding of TEAM requirements and effective implementation of care coordination strategies. 

10. Engage with CMS and DataGen resources 

Regularly consult the CMS' TEAM webpage for updates, resources and guidance to stay informed about model developments.  Before the launch of the model, hospitals will need to complete CMS’ data request and attestation form to gain access to claims data for their TEAM episodes of care.   

You can also check out the following DataGen TEAM resources for more information about the model, participants, simulated TEAM episodes of care and preparation strategies: 

• A white paper detailing the TEAM model and its main components: What is TEAM? The essential CMS TEAM model brief by AAMC 

• A white paper describing the three main TEAM challenges and how to overcome them: Unpacking the mandatory CMS TEAM model: overcome new rules & challenges 

• A webinar with the Association of American Medical Colleges (AAMC) on what data to use now to prepare for TEAM: Using shadow bundle data to prepare for the transforming episode accountability model.
  
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• Frequently asked questions inspired by a recent webinar: CMS TEAM model Q&A: your concerns addressed in partner webinar 

Ready to tackle TEAM? Contact DataGen 

By systematically addressing each item on this checklist, your hospital can enhance its readiness for successful participation in TEAM, with the goal of improving patient care and outcomes. 

If you’d like more information on how to put this readiness checklist into action, contact DataGen today. Our TEAM solutions empower hospitals to take control of their data through opportunity analysis, performance monitoring and reconciliation validation. Tackle mandatory CMS TEAM model participation with ease.