Additional TEAM technical FAQs (PDF) are also available.
General
What are the Transforming Episode Accountability Model (TEAM)’s goals?
The intent of TEAM is to improve beneficiary care through financial accountability for TEAM participants that initiate at least one of the included episode categories that begin with one of the following procedures: coronary artery bypass graft (CABG), lower extremity joint replacement (LEJR), major bowel procedure, surgical hip and femur fracture treatment (SHFFT), and spinal fusion.
TEAM focuses on improving quality of care and reducing Medicare expenditures for five surgical episode categories. These episode categories represent high-expenditure, high-volume care delivered to Medicare beneficiaries and are evaluable in an episode-based payment model. CMS anticipates that TEAM will:
- Benefit Medicare patients through improving the coordination of items and services paid for through Medicare fee-for-service (FFS)
- Encourage provider investment in health care infrastructure and redesigned care processes
- Incentivize higher value care across the inpatient and post-acute care settings
- How did CMS develop TEAM?
CMS created TEAM using lessons learned from earlier CMS Innovation Center episode-based payment models such as the Bundled Payments for Care Improvement Advanced (BPCI Advanced) and Comprehensive Care for Joint Replacement Models, feedback from a July 2023 Request for Information, and consultation with several stakeholders, including providers, health systems, and thought leaders in the field. Additionally, CMS will use public comments received during the rulemaking process to inform any modifications to future policies.
How will CMS address policies not yet finalized in a proposed rule for TEAM or make changes to policies in the future?
There may be times that a proposed policy is not finalized or requires a modification, such as needing to further analyze a proposed policy before it is finalized. CMS finalized the majority of TEAM’s policy proposals in the FY 2025 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment Systems (PPS) Final Rule as proposed in the notice of proposed rulemaking and finalized others in the FY 2026 Hospital IPPS/LTCH PPS Final Rule. Additionally, any potential changes to finalized policies before or during the model performance period are subject to undergo notice and comment rulemaking.
How can we get involved in TEAM if we are not a participant?
We recommend visiting the TEAM website and signing up for updates on TEAM using the TEAM's listserv.
Please note that only TEAM participants are given access to the TEAM Participant Portal and Data Portal. Only acute care hospitals paid under the Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS) can be TEAM participants. Other types of providers and suppliers may participate in TEAM as TEAM collaborators, collaboration agents, or downstream collaboration agents, as applicable, if a financial arrangement has been established with a TEAM participant.
Are there any specific quality reporting requirements for TEAM?
TEAM does not require participants to report additional quality data beyond those they already submit to CMS for other programs. The TEAM Composite Quality Score (CQS) will be calculated using data already submitted to other CMS programs.
Why is participation in TEAM mandatory for selected hospitals?
Mandatory models can improve the generalizability of model findings and capture a wider variety of providers from across the country, including many who have not participated in value-based payment models. Mandatory models also address participation challenges inherent in voluntary models, namely provider attrition and selection bias. As an episode-based payment model that builds on previous voluntary CMMI models, TEAM is well positioned to advance testing and evaluation with a mandatory episode-based payment model and aligns with recommendations from federal partners.A TEAM participant is defined as an acute care hospital that (1) initiates episodes and is paid under the IPPS and Outpatient Prospective Payment System (OPPS) with a CMS Certification Number (CCN) primary address located in one of the mandatory Core-Based Statistical Areas (CBSAs) selected for participation in TEAM in accordance with § 512.515; or (2) Makes a voluntary opt-in participation election to participate in TEAM in accordance with § 512.510 and is accepted to participate in TEAM by CMS.
Is there a list of hospitals selected for TEAM participation?
CMS published a list of acute care hospitals (XLSX), identified by CCN, located in one of the mandatory CBSAs selected for participation. This list also includes eligible hospitals that voluntarily opted in to TEAM participation. CMS will periodically update this list to accurately capture acute care hospitals in the mandatory CBSAs.
How are TEAM’s preliminary target prices constructed?
Target prices will be calculated using 3 years of baseline data, trended forward to the performance year, at the level of MS-DRG/HCPCS episode type and region, where region is defined by the U.S. Census Divisions, with updates to be made using the performance year data during the reconciliation process. Episode spending will be capped using the high-cost outlier cap at the level of MS-DRG/HCPCS episode type and region, resulting in 261 benchmark prices.
Benchmark prices are calculated using all hospitals in a region, regardless of TEAM participation status. CMS will apply a prospective trend factor, constructed from five years of data, and a discount factor to benchmark prices, as well as a prospective normalization factor to calculate preliminary target prices. More information about preliminary target prices is available in § 512.540(b) as well as the target price specifications shared with participants via email and the TEAM eDFR platform.
During preliminary target price dissemination, CMS will provide TEAM participants with resources, such as target price and episode construction specification documents, to help support TEAM participants' understanding of the pricing methodology.
How will TEAM impact Medicare FFS payments?
Episode-based payment models such as TEAM aim to move away from a FFS payment structure by including pay-for-performance methodologies that incentivize improvements in patient outcomes while lowering Medicare spending. TEAM participants and all Medicare providers and suppliers associated with an episode will continue to bill Medicare FFS. All the spending for items and services that are included in an episode attributed to the TEAM participant will be included in an annual reconciliation process.
TEAM may benefit Medicare beneficiaries by improving the coordination of items paid for through Medicare FFS payments, encouraging provider investment in health care infrastructure and redesigned care processes, and incentivizing higher value care settings for the episode.
Please explain TEAM's reconciliation process?
CMS will reconcile, on an annual basis, all the episode spending from the episodes attributed to a TEAM participant against the reconciliation target price. TEAM participants that spend less than the reconciliation target price may earn a reconciliation payment from CMS, which is subject to quality and other adjustments. TEAM participants that spend more than the reconciliation target price may owe CMS a repayment amount, which is subject to quality and other adjustments.
The reconciliation process will begin approximately 6 months after the end of each performance year. Each performance year will undergo one reconciliation cycle.
What is included in the TEAM episode?
CMS will provide hospitals participating in TEAM with a target price that will represent most Medicare spending during an episode of care, which will include the surgery (including the hospital inpatient stay or outpatient procedure) and items and services in the 30 days following hospital discharge, such as skilled nursing facility stays or provider follow-up visits.
As described in § 512.525(e), episodes include but are not limited to, the following items and services: physicians’ services, inpatient hospital services (including services paid through IPPS operating and capital payments), inpatient psychiatric facility (IPF) services, long-term care hospital (LTCH) services, inpatient rehabilitation facility (IRF) services, skilled nursing facility (SNF) services, home health agency (HHA) services, hospital outpatient services, outpatient therapy services, clinical laboratory services, durable medical equipment (DME), Part B drugs and biologicals, hospice services, and Part B professional claims date in the 3 days prior to an anchor hospitalization if a claim for the surgical procedure for the same episode category is not detected as part of the hospitalization because the procedure was performed by the hospital on an outpatient basis, but the patient was subsequently admitted as an inpatient.
Which patients are eligible for inclusion in TEAM?
Patients must meet the following criteria throughout the episode window and in the 180-
day lookback period to be eligible for inclusion in TEAM:- Are enrolled in Original Medicare Fee-for-Service (FFS) Parts A and B.
- Are not eligible for Medicare on the basis of having end stage renal disease
- Are not enrolled in any managed care plan (for example, Medicare Advantage,
health care prepayment plans, or cost-based health maintenance organizations). - Are not covered under a United Mine Workers of America health care plan.
- Have Medicare as their primary payer.
How can I sign up for updates about TEAM?
CMS will share updates regarding TEAM via the listserv. If you are not already subscribed, please use this link and input your email address to receive updates about the model.
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