FAQs by Topic:
- General
- Eligibility
- Point of Contact
- Voluntary Opt-In Opportunity
- Care Delivery / Quality Strategy
- Episodes/Payment
- Model Overlap
- Learning System/Technical Assistance
General
- How did CMS develop TEAM?
TEAM is informed by lessons learned from earlier CMS Innovation Center episode-based payment 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, final policies were also informed through public comments received during the rulemaking process.
- How does TEAM support the CMS Innovation Center’s Strategic Direction?
TEAM would help to advance several policy goals outlined in the Innovation Center’s 2021 Strategy Refresh, including having all Medicare beneficiaries and most Medicaid beneficiaries in an accountable care relationship by 2030. TEAM is also a component of the Center’s comprehensive specialty care strategy, launched in 2022, a plan that prioritizes testing models and policy innovations supporting access to high-quality, integrated specialty care across the patient journey. Among the goals of the specialty care strategy is to advance lessons learned from episode-based payment models and support care transformation following acute medical events.
Where will TEAM be tested?
CMS will implement TEAM in certain selected geographic areas to evaluate the effects of an episode-based payment approach on patient outcomes and Medicare expenditures. CMS used a stratified random sampling method to select approximately 25% of eligible Core-Based Statistical Areas (CBSAs) to participate in TEAM.
CMS has published a list of the selected mandatory CBSAs in section X.A.3.a.(4) of the preamble of the FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule. All acute care hospitals, with limited exceptions, within selected CBSAs are required to participate in TEAM. Certain CBSAs, such as those with limited previous exposure to CMS’ bundled payment models and those with a larger number of safety net hospitals, were oversampled to expand the reach of value-based care in TEAM.
TEAM may also be tested in CBSAs that were not required to participate in the model. CMS will allow a one-time voluntary opt-in opportunity for hospitals not located in a mandatory CBSA. To be eligible for this opportunity, the hospital must be participating until the last day of the last performance period in the BPCI Advanced model, or the last day of the last performance year in the CJR model, to participate in TEAM.
How will CMS address policies not finalized in the most recent final rule for TEAM or make changes to policies in the future?
CMS finalized the majority of TEAM’s policy proposals in the FY 2025 Hospital IPPS and LTCH PPS Final Rule as proposed in the notice of proposed rulemaking and finalized others with modifications. However, there are certain proposals that were not finalized, and CMS intends to undergo additional notice and comment rulemaking to propose new policies in the future before the model start date. Additionally, any potential changes to finalized policies before or during the model performance period would also undergo notice and comment rulemaking.
Eligibility
- 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.
What CBSAs have been selected for TEAM participation?
CMS has published a list of the selected mandatory CBSAs in section X.A.3.a.(4) of the preamble of the FY 2025 Hospital IPPS and LTCH PPS Final Rule. By using CBSAs as the unit of selection, CMS is ensuring that the model represents a wide range of markets and requires the participation of many hospitals with diverse characteristics.
Is there a list of hospitals selected for TEAM participation?
On September 5, 2024, CMS published a list of acute care hospitals (XLSX), identified by CMS Certification Number (CCN), located in one of the mandatory CBSAs selected for participation. CMS will periodically update this list to accurately capture acute care hospitals in the mandatory CBSAs. After the voluntary opt-in period (January 2025), the webpage will also list hospitals that opt-in to TEAM participation.
Will there be updates to the initial TEAM participant list?
CMS may update the TEAM participant list to reflect changes in hospital status (e.g., closures, mergers, and other reorganization events) and accurately capture acute care hospitals in the mandatory CBSAs. Further, CMS intends to update the list to identify which hospitals satisfy the definition of a safety net hospital in TEAM, as defined in 42 CFR 512.505.
When will hospitals select a participation track?
TEAM participants are required to notify CMS of their track selection prior to the start of Performance Year 1 on January 1, 2026. CMS will provide TEAM participants with additional information about the track selection process and deadline, as well as safety net hospital status, in 2025. Please note that participants’ track selections are subject to eligibility review and approval by CMS.
TEAM participants who fail to notify CMS in advance of the deadline will be automatically assigned to Track 1 for Performance Year 1.
Starting Performance Year 2, TEAM participants will be required to notify CMS of their track selection prior to each performance year in a form and manner specified by CMS. TEAM participants may switch tracks between Performance Years; however, for Performance Years 2 to 5, if a TEAM participant fails to notify CMS of their election to participate in Track 1 or Track 2 by the selection deadline for a given performance year, the TEAM participant will be assigned to Track 3 for that performance year by default.
What are the safety net hospital criteria for the purposes of TEAM?
For the purposes of TEAM, a safety net hospital is defined as an IPPS hospital that meets at least one of the following criteria:
- Exceeds the 75th percentile of the proportion of Medicare beneficiaries considered dually eligible for Medicare and Medicaid across all PPS acute care hospitals in the baseline period. The numerator and denominator are as follows:
- Numerator: Number of Medicare beneficiaries considered fully eligible for Medicare and Medicaid.
- Denominator: Total number of Medicare beneficiaries across all Inpatient Prospective Payment System (IPPS) acute care hospitals that bill Medicare in the baseline period.
- Exceeds the 75th percentile of the proportion of Medicare beneficiaries partially or fully eligible to receive Part D low-income subsidies across all PPS acute care hospitals in the baseline period.
- Numerator: Number of Medicare beneficiaries partially or fully eligible to receive Medicare Part D low-income subsidies.
- Denominator: Total number of Medicare beneficiaries across all Inpatient Prospective Payment System acute care hospitals that bill Medicare in the baseline period.
CMS will update the TEAM participant list to identify hospitals that satisfy the definition of a safety net hospital prior to the track selection period ahead of Performance Year 1.
CMS will make redeterminations of safety net hospital qualifications under TEAM annually, meaning that hospital safety net status could vary over the model’s duration. However, we do not expect a significant number of hospitals will experience status changes year over year.
- Exceeds the 75th percentile of the proportion of Medicare beneficiaries considered dually eligible for Medicare and Medicaid across all PPS acute care hospitals in the baseline period. The numerator and denominator are as follows:
Will CMS publish a list of hospitals that meet the safety net hospital criteria outlined?
CMS will update the TEAM participant list to identify hospitals that satisfy the definition of a safety net hospital prior to the start of Performance Year 1.
Interested organizations can subscribe to TEAM’s listserv to stay up to date on model resources as they become available.
What is the definition of a rural hospital in TEAM?
For the purposes of TEAM, ‘rural hospital’ refers to an IPPS hospital that is located in a rural area as defined under 42 CFR 412.64 or is located in a rural census tract defined under 42 CFR 412.103(a)(1).
Point of Contact (POC)
Is there a deadline to complete the Primary Point of Contact Form for hospitals located in CBSAs selected to participate?
A Primary Point of Contact Form is available on the TEAM web page. We are requesting that a representative from each hospital selected for mandatory TEAM participation complete this form by January 1, 2025. Beginning in early 2025, CMS will conduct additional outreach to establish contact with participant hospitals for which no points of contact have been submitted.
Is it possible to add a third POC to the Primary Point of Contact Form?
At this time, CMS is requesting no more than two primary points of contact per acute care hospital. Additional individuals who are interested in TEAM may subscribe to the TEAM listserv to receive updates about model-related events and resources.
Can hospital systems designate the same POC for multiple hospitals within a system?
Yes. CMS is requesting at least one Primary Point of Contact for each hospital participating in TEAM. Multiple hospitals that are affiliated with each other may select the same Primary Point of Contact for TEAM-related communications as appropriate.
How can I update the Primary Point of Contact for our hospital after completing the form?
TEAM participants who wish to update their Primary Point of Contact should submit an email to CMMI_TEAM@cms.hhs.gov with the subject line “Primary Point of Contact Form”, that contains hospital information (e.g., name, CCN), and the contact information (e.g., name, email address, phone number) of the individuals to be added, removed, or changed. It may take up to two weeks for requests to be reflected in TEAM-related communications.
Voluntary Opt-In Opportunity
Who is eligible to voluntarily participate in TEAM?
Hospitals not located in a mandatory CBSA that participate 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 of the Comprehensive Care for Joint Replacement (CJR) Model (December 31, 2025, and December 31, 2024, respectively) will be eligible to opt-in to TEAM.
Can hospitals eligible to voluntarily participate in TEAM join at any point during the model?
No, the voluntary opt-in period is a one-time opportunity; hospitals must notify CMS of their intent to participate during the voluntary participation election period between January 1, 2025 and January 31, 2025.
How can eligible hospitals notify CMS of their intention to opt-in to TEAM participation?
Eligible hospitals interested in voluntary opt-in will be required to submit a written participation election letter to CMS as directed by CMS during the voluntary participation election period of January 1, 2025-January 31, 2025. We anticipate in December 2024, prior to the voluntary election period, CMS will notify eligible hospitals via email and provide them with a copy of the voluntary participation election letter. The voluntary participation election letter will serve as the participation agreement, which will bind and subject the eligible hospitals to the same terms, conditions, and requirements in TEAM as hospitals mandated to participate. This includes being required to participate for the full model performance period and being accountable for all episode categories tested in the model.
Can BPCI Advanced participants who currently participate under one surgical episode category opt-in to participate in TEAM?
Hospitals not located in a mandatory CBSA that participate until the last day of the last performance year BPCI Advanced (December 31, 2025) can opt-in to participate in TEAM regardless of how many or what type of episode categories they are currently participating in. However, it is important to note that hospitals participating in TEAM, either through required participation or through voluntary opt-in, must participate in all five surgical episode categories (lower extremity joint replacement (LEJR), surgical femur and fracture treatment (SHFFT), spinal fusion, coronary artery bypass graft (CABG), and major bowel procedure).
CMS has not finalized a low volume threshold and intends to propose policies and alternatives in future notice and comment rulemaking.
Can previous CJR or BPCI Advanced participants opt-in to participate in TEAM (e.g., BPCI Advanced participant for Model Year (MY) 1-3)?
Hospitals or participants that exited the BPCI Advanced or CJR Model before the end of the last day of the last performance period or performance year of the model are not eligible to opt-in to TEAM.
Only hospitals that are not located in a mandatory CBSA selected for TEAM participation and that participate in the BPCI Advanced or CJR Model until the last day of the last performance period or last performance year of the respective model may opt-in to model participation. For the BPCI Advanced model, the last day of the last performance period is December 31, 2025. For the CJR model, the last day of the last performance year is December 31, 2024.
When will CMS make the Voluntary Participation Election Letter template available?
CMS will provide further information on voluntary opt-in participation among BPCI Advanced and CJR participants outside the mandatory CBSAs prior to the voluntary election period in January 2025.
Can acute care hospitals who opt-in to TEAM participation opt out of the model after implementation begins?
No. Once an eligible hospital submits its voluntary participation election letter and is accepted by CMS, that hospital will be required to participate until the end of the model on December 31, 2030. However, they may modify their participation track selection, as applicable, annually.
Care Delivery / Quality Strategy
Will TEAM qualify as an Advanced Alternative Payment Model (APM)?
Yes, TEAM will qualify as an Advanced APM. TEAM will have two APM options — an Advanced APM option, in which TEAM individuals can attest to meeting the Certified Electronic Health Record Technology (CEHRT) criteria for Qualifying APM Participant (QP) determinations, and a non-Advanced APM option, for those TEAM individuals who do not meet the CEHRT criteria. Since Advanced APMs must also have financial risk, TEAM will qualify as an Advanced APM for TEAM individuals in Track 2 and Track 3 who participate in the Advanced APM option.
What are the codes that would initiate an episode for each of the included TEAM surgical procedures?
Lower extremity joint replacement (LEJR):
- MS-DRG 469, 470, 521, 522
- HCPCS 27447, 27130, 27702
Surgical hip and femur fracture treatment (SHFFT):
Spinal fusion:
- MS-DRG 402, 426, 427, 428, 429, 430, 447, 448, 450, 451, 471, 472, 473
- HCPCS 22551, 22554, 22612, 22630, 22633
Coronary artery bypass graft:
Major bowel procedure:
Any changes to the codes that would initiate a clinical episode would be updated through notice and comment rulemaking.
Will TEAM’s quality measures include only beneficiaries attributed to TEAM episodes?
CMS calculates the quality measures used to evaluate hospitals’ participating in TEAM performance using Medicare claims data or patient-reported outcomes data that hospitals report under the Hospital Inpatient Quality Reporting (IQR) Program and the Hospital-Acquired Condition Reduction Program.
During Performance Year 1, hospitals will be evaluated using:
- All episode categories: Hybrid Hospital-Wide All Cause Readmission Measure with a CY 2025 CQS baseline period.
- All episode categories: CMS Patient Safety and Adverse Events Composite with a CY 2025 CQS baseline period.
- For LEJR episodes: Hospital-Level Total Hip and/or Total Knee Arthroplasty (THA/TKA) Patient-Reported Outcome-Based Measure with a CY 2025 CQS baseline period.
During Performance Years 2 through 5, hospitals will be evaluated using:
- All episode categories: Hybrid Hospital All-Cause Readmission Measure with a CY 2025 baseline period.
- All episode categories: Hospital Harm-Falls with Injury with a CY 2026 CQS baseline period.
- All episode categories: Hospital Harm-Postoperative Respiratory Failure with a CY 2026 CQS baseline period.
- All episode categories: Thirty-Day Risk-Standardized Death Rate among Surgical Inpatients with Complications (Failure-to-Rescue) with a CY 2026 CQS baseline period.
For LEJR episodes: Hospital-Level Total Hip and/or Total Knee Arthroplasty (THA/TKA) Patient-Reported Outcome-Based Measure with a CY 2025 CQS baseline period.
What policies or flexibilities are available to safety net hospitals that participate in TEAM? Will the policies apply to rural hospitals?
TEAM offers a glide path to participation in downside risk for safety net hospitals. Safety net hospitals will be permitted to participate in Track 1 for Performance Years 1 through 3, based on their timely notification of participation track selection before the start of each performance year. Track 1 limits upside risk with a 10% stop-gain limit, adjusts positive reconciliation amounts for quality performance up to 10%, and offers no downside risk for hospitals as they implement care redesign tactics and build capacity to use data to deliver high-quality care.
Safety net hospitals are also eligible to participate in Track 2 for Performance Years 2 through 5, based on their timely notification of participation track selection before the start of each performance year. Hospitals participating in Track 2 will have upside and downside risk, with a stop-gain and stop-loss limit of 5%. Positive reconciliation amounts will be adjusted for quality performance up to 10%, and negative reconciliation amounts will be adjusted for quality performance up to 15%. The higher adjustment for negative reconciliation amounts results in a lower repayment amount.
Rural hospitals will be able to participate in Track 1 for Performance Year 1, and during Performance Years 2 through 5, rural hospitals may select between Tracks 2 and 3, based on their organizations’ readiness to take on financial accountability for included episodes.
The following hospital types are eligible to participate in Track 2 for Performance Years 2 through 5: Medicare Dependent Hospitals, Rural Hospitals, Safety Net Hospitals, Sole Community Hospitals, and Essential Access Community Hospitals. Hospitals that do not fall into one of these categories will be required to participate in Track 3 for Performance Years 2 through 5. Hospitals participating in Track 3 will have upside and downside risk, with a stop-gain and stop-loss limit of 20%. Positive and negative reconciliation amounts will be adjusted for quality performance up to 10%.
What is the financial impact on TEAM collaborators performing the procedure or coordinating care if funds are owed?
Hospitals participating in TEAM may choose to enter into financial arrangements with certain providers and suppliers participating in TEAM activities to share their reconciliation payment amount or repayment amount resulting from participation in TEAM. Specifically, TEAM participants may enter into a sharing arrangement with a TEAM collaborator in order to make a gainsharing payment and/or receive an alignment payment. The board or other governing body of the TEAM participant must have responsibility for overseeing the TEAM participant’s participation in the model, its arrangements with TEAM collaborators, its payment of gainsharing payments, its receipt of alignment payments, and its use of beneficiary incentives in the model. The TEAM participant and TEAM collaborator must document this agreement in writing and, as part of the model’s monitoring and compliance activities as described in (42 CFR 512.590), this agreement must be made available to CMS upon request.
Practitioners will continue to bill Medicare as normal under fee-for-service. At the end of the performance year, episodes will enter reconciliation, during which total episode spending will be compared against the retrospectively adjusted final target price. Reconciliation amounts are also adjusted for quality performance and capped by stop-gain and, for Tracks 2 and 3, stop-loss limits.
A TEAM collaborator in a sharing arrangement with a TEAM participant may enter into a distribution arrangement with a collaboration agent in order to distribute any gainsharing payments it receives. A collaboration agent in a distribution arrangement with a TEAM collaborator may enter into a downstream distribution arrangement with a downstream collaboration agent in order to distribute any distribution payments it receives. Additional details about eligibility requirements and restrictions for financial arrangements in TEAM can be found in the final rule in § 512.565 (b)-(c).
Please explain TEAM’s data-sharing process.
CMS will make certain beneficiary-identifiable claims data and regional aggregate data available to hospitals in TEAM regarding Medicare FFS beneficiaries who may initiate an episode and be attributed to them in the model for the purposes of evaluating their performance, conducting quality assessment and improvement activities, conducting population-based activities relating to health or reducing health care costs, or conducting other health care operations. For the baseline period, hospitals will only receive beneficiary-identifiable claims data for beneficiaries that initiated an episode in their hospital or hospital outpatient department in the 3-year baseline period, and data will be limited to items and services included in the episode.
Hospitals participating in TEAM may request to receive summary or raw beneficiary-identifiable claims data for a 3-year baseline period prior to the performance year as well as on a monthly basis during the performance year to help them engage in care coordination and quality improvement activities for TEAM beneficiaries in an episode.
To receive beneficiary-identifiable data from CMS, TEAM participants must annually submit a data sharing agreement and a data request and attestation form. More information and instructions for completing these requirements will be provided in early 2025.
Episodes/Payments
What is included in TEAM episodes?
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.
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.
What items or services are excluded from TEAM episodes?
TEAM will exclude from episodes all Part A and B items and services, for both the baseline period and performance years, for hospital admissions and readmissions for specific categories of diagnoses, such as oncology, trauma medical admissions, organ transplant, and ventricular shunts determined by MS-DRGs, as well as all the following excluded Major Diagnostic Categories (MDC):
MDC 02 (Diseases and Disorders of the Eye)
MDC 14 (Pregnancy, Childbirth, and Puerperium)
MDC 15 (Newborns and other neonates with conditions originating in perinatal period)
MDC 25 (Human immunodeficiency virus infections)
Additionally, there are exclusions of new technology add-on payments for drugs, technologies, or services approved for add-on payments from episodes. Drugs or biologicals that are paid outside of the MS-DRG, specifically hemophilia clotting factors, identified through HCPCS code, diagnosis code, and revenue center on IPPS claims for episodes in the baseline period and performance years.
How were episodes chosen for the model?
Based on the feedback received from its 2023 Request For Information (RFI), CMS selected episodes with sufficient volume that are clinically similar, have well-defined beginnings and endings, and have demonstrated success in reducing episode payments and achieving net Medicare savings (for instance, in BPCI Advanced). While the episodes that will be included in TEAM are surgical, CMS may explore adding additional episode categories to TEAM in the future. Any episode categories added to TEAM would be done through notice-and-comment rulemaking.
How are TEAM’s target prices constructed? Will more resources become available?
CMS will use three years of baseline episode spending to calculate benchmark prices for each MS-DRG/HCPCS episode type, trended toward the most recent year of the baseline period. TEAM participants will receive target prices for each MS-DRG/HCPCS episode type and region based on 100 percent regional data before the start of performance year 1.
Hospitals participating in TEAM will complete a TEAM Data Sharing Agreement and a TEAM Data Request and Attestation form before the start of performance year 1 to obtain the baseline data.
We anticipate sharing additional resources with TEAM participants, before and during the model implementation, including resources to help support TEAM participants' understanding of the pricing methodology.
What types of data will CMS share with hospitals participating in TEAM?
CMS will share preliminary target prices and baseline data with hospitals in TEAM, pursuant to a request and TEAM data sharing agreement. This will allow hospitals to understand their preliminary target price in advance of the performance year as well as increase transparency on historical performance. Additionally, certain beneficiary-identifiable claims data and regional aggregate data will be available.
When will CMS share baseline period data with hospitals participating in TEAM?
Baseline period data will be shared annually at least 1 month prior to the start of a performance year and available for episodes for each of the following performance years:
Performance year 1: Episodes that began January 1, 2022, through December 31, 2024.
Performance year 2: Episodes that began January 1, 2023, through December 31, 2025.
Performance year 3: Episodes that began January 1, 2024, through December 31, 2026.
Performance year 4: Episodes that began January 1, 2025, through December 31, 2027.
Performance year 5: Episodes that began January 1, 2026, through December 31, 2028.
Please explain TEAM’s reconciliation process.
In general, CMS completes the following reconciliation process to establish a reconciliation payment amount or repayment amount for each TEAM participant. Additional details can be found in 42 CFR 512.550.
- CMS determines the performance year spending for each episode included in the performance year using claims data that is available six months after the end of the performance year.
- CMS calculates and applies the high-cost outlier cap for performance year spending and applies adjustments to the preliminary target price.
- CMS aggregates the reconciliation target prices for all episodes included in the performance year.
- CMS subtracts the performance year spending amount from the aggregated reconciliation target price amount to determine the reconciliation amount.
- CMS adjusts the reconciliation amount based on the Composite Quality Score to create the quality-adjusted reconciliation amount.
- CMS applies stop-loss and stop-gain limits to the quality-adjusted reconciliation amount to create the net payment reconciliation amount.
- CMS calculates the post-episode spending amount.
- CMS subtracts the post-episode spending amount that exceeds the limit, as applicable, from the NPRA to create the reconciliation payment or repayment amount.
- CMS issues reconciliation reports to TEAM participants.
In general, the following are the appeals and reconsideration review processes. Additional detail is found in 42 CFR 512.560 and 42 CFR 512.561.
TEAM participants may review their reconciliation report and notify CMS in a timely manner (within 30 days of the report being issued) if they believe there is a calculation error involving a matter related to payment, reconciliation amounts, repayment amounts, the use of quality measure results in determining the CQS or application of CQS.
CMS will respond in writing within 30 calendar days to either confirm or refute the calculation error, although CMS reserves the right to an extension upon written notice to the TEAM participant.
TEAM participants may request reconsideration of a determination made by CMS within 30 days of the initial determination, as applicable.
The reconsideration official issues the reconsideration determination to CMS and the TEAM participant within 60 days of receipt of timely filed documentation, unless the reconsideration officer requested an extension.
Either the TEAM participant or CMS may request that the CMS Administrator review the reconsideration determination made by the reconsideration official within 30 days of the reconsideration determination.
The CMS Administrator may grant or deny the request. If granted, the CMS Administrator issues a written determination which is deemed final and binding.
How will TEAM impact Medicare fee-for-service (FFS) payments?
Episode payment models such as TEAM aim to move away from Medicare FFS payments 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 Traditional Medicare FFS, and all 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.
How can hospitals manage gainsharing or alignment payments with TEAM collaborators that are not tied to the volume of episodes?
TEAM is designed to encourage participants to make primary care referrals and engage with a patient’s aligned total cost of care (or shared savings model), if applicable. In determining the amount of any gainsharing payments, a TEAM participant’s gainsharing methodology may take into account the amount of such TEAM activities provided by a TEAM collaborator relative to other TEAM collaborators, however, gainsharing payments and alignment payments should not be based directly on volume or value of referrals. CMS believes this requirement allows flexibility in the determination of gainsharing payments to TEAM collaborators, who have differing contributions to TEAM activities. We understand that this may result in greater differences in the funds available for gainsharing payments and believe that this allows for gainsharing payments to be made appropriately, without tying them directly or indirectly to the volume or value of referrals.
Model Overlap
- How would TEAM overlap with other CMS models or initiatives?
TEAM would not overlap with the CMS Innovation Center’s current episode-based payment models because they are scheduled to end before the start of TEAM. Specifically, the Comprehensive Care for Joint Replacement (CJR) Model is scheduled to end in December 2024, and the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model is scheduled to end in December 2025.
TEAM would allow provider and individual overlap with most CMS models and initiatives, including advanced primary care models and ACO initiatives. For example, a person with traditional Medicare receiving care from (aligned to) providers in an ACO may be in an episode if they receive one of the surgeries included in TEAM at a hospital required that is selected to participate in TEAM. CMS would not perform any adjustments to a TEAM participant’s reconciliation payment amount or repayment amount when there are patients who overlap TEAM and ACO initiatives. Allowing model overlap provides an opportunity for an ACO and TEAM participant to collaborate on shared patients and ensure a smooth transition of care between the TEAM participant and the ACO.
How does TEAM impact the shared savings of a Medicare Accountable Care Organization (ACO) initiative when there is model overlap? Specifically, how does TEAM impact the ACO Realizing Equity, Access, and Community Health (ACO REACH) Model and the Medicare Shared Savings Program?
A hospital that participates in a Medicare ACO initiative, such as ACO REACH or the Medicare Shared Savings Program, and that also participates in TEAM will be accountable for the quality and cost of care for ACO-aligned beneficiaries who have surgeries that would initiate an episode tested in TEAM. TEAM will not adjust a TEAM’s participant’s target prices or reconciliation payment amounts and repayment amounts based on model overlap with ACO REACH or the Medicare Shared Savings Program.
TEAM will not include ACO REACH or the Medicare Shared Savings Program’s shared savings payments or shared loss recoupments when determining episode spending and target pricing calculations.
ACO REACH and the Medicare Shared Savings Program will not take into consideration TEAM’s reconciliation payment amounts or repayment amounts when determining ACO REACH or the Medicare Shared Savings Program’s benchmarks or performance year spending because the timing of TEAM’s reconciliation process occurs after ACO REACH and the Medicare Shared Savings Program conducts their calculations.
Learning System/Technical Assistance
How can I sign up for updates about TEAM?
To subscribe to TEAM’s listserv, click on CMS Listserv – TEAM. The link directs viewers to a web page where you can enter your email address to receive updates about TEAM. CMS will share additional information about TEAM in the coming months.
What education or learning resources will CMS provide to selected hospitals? Is there a calendar of learning resources that will be available?
CMS is taking multiple steps to assist hospitals participating in TEAM with understanding both the TEAM pricing methodology, and how they can use data to help them succeed in the model.
Additionally, hospitals will have approximately 17 months to prepare before the model start date. During this time, CMS anticipates engaging with hospitals and providing learning resources and opportunities to help them further understand TEAM policies, including the construction of target prices.
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