From OR to 30 Days: A Practical Playbook for Hospitals, Surgeons & ACOs to Win Under CMS’s New Episode Bundles
- SolvEdge
- 6 mins read
MS’s Transforming Episode Accountability Model (TEAM) fundamentally changes how Medicare pays for several high-volume surgical episodes by shifting financial accountability to hospitals for care from the index admission through 30 days post-discharge. TEAM is mandatory for selected hospitals and begins Jan 1, 2026 — a change that makes standardized pathways, post-acute networks, and aligned incentives business-critical. Centers for Medicare & Medicaid Services
1. Start with governance and clear ownership
Create an Episode Governance Council (CFO, CMO, lead surgeons, case management, ACO rep, legal). This body must own the reconciliation targets, sign off on pathway changes, and allocate capital to risk mitigation. Accountability at the leadership level avoids turf wars and speeds decisions.
2. Build episode-level financial models and “what-if” scenarios
Use historical Medicare claims to model each episode’s total allowed cost under CMS’s methodology, and stress-test scenarios across glidepath risk levels. That clarity tells you whether your primary levers should be readmission reduction, shorter length of stay, or shifting PAC mix toward home-based care.
3. Align surgeons with clear, compliant incentive contracts
Surgeons must be partners, not adversaries. Move beyond ad-hoc conversations to signed performance agreements that share upside for quality improvements and savings while protecting metrics that matter to surgeons (outcome quality, complication rates). Ensure legal compliance; structure pooled incentives and quality thresholds.
4. Standardize clinical pathways and measure adherence
Variation drives overspend. Create evidence-based pathways — preop optimization, ERAS protocols, discharge criteria, and mandatory PCP referral at discharge — and embed them in the EHR. Track adherence and give clinicians fast feedback via surgeon scorecards.
5. Build a preferred post-acute network and active transitions
Post-acute utilization is the biggest lever for 30-day episodes. Contract with high-performing SNFs, HHAs, and home-care providers using outcome-based KPIs. Require scheduled post-discharge contact and remote monitoring to catch complications early.
6. Integrate ACOs into episode strategy
If an ACO operates in your market, integrate episode analytics and care management to avoid misaligned incentives — share dashboards, care managers, and attribution protocols. ACOs can help with preop optimization by engaging primary care.
7. Invest in episode analytics and operational dashboards
You can’t manage what you don’t measure. Implement an episode intelligence stack that ingests claims + EHR, produces surgeon- and facility-level drilldowns, and runs CMS-style reconciliation simulations. Real-time insights let you test interventions and measure ROI quickly.
8. Plan for legal, compliance, and workforce change management
Confirm all incentive arrangements meet Stark/AKS rules, and ensure documentation will stand up to audits. Train clinicians, discharge teams, and PAC partners on new flows — adopt rapid PDSA improvement cycles.
Conclusion
TEAM is not just a payment change — it’s a forcing function for hospitals, physicians, and ACOs to work together around patient outcomes and episode efficiency. Organizations that move quickly to align governance, financial modeling, clinical pathways, post-acute networks, and data will protect margin and be rewarded for better, more coordinated care.
