FAQs

The Transforming Episode Accountability Model (TEAM) is a significant new initiative designed to enhance the quality of care while controlling costs within the Medicare system. Scheduled for implementation on January 1, 2026, this model is mandated by the Center for Medicare and Medicaid Innovation (CMMI) and will be administered by the Centers for Medicare and Medicaid Services (CMS).

The TEAM model marks a significant step in Medicare's shift toward value-based care, with hospitals being held more accountable for the cost and quality of care they provide throughout the entire surgical episode. It will drive changes in how hospitals approach patient care, focusing on long-term recovery and preventive measures to ensure the best possible outcomes for patients.

There are 741 selected TEAM participants, which include a diverse set of hospitals with distinct features. These hospitals must meet the following criteria to participate in the model:

Location - TEAM participants must be located within a selected Core Based Statistical Area (CBSA). A CBSA may include urban or rural areas, which means hospitals from a broad range of geographic settings can participate in TEAM. Only acute care hospitals located within a selected CBSA and paid under the Inpatient Prospective Payment System (IPPS) are eligible.

Types of Hospitals - TEAM participants may belong to a variety of hospital categories: Safety Net Hospitals, Rural Hospitals, Medicare Dependent Hospitals (MDH), Sole Community Hospitals (SCHs), Essential Access Community Hospitals, and Hospitals that Participated in BPCI Advanced or CJR Models.

You can view the full list of participating hospitals at the CMS website. Use our search tool on the TEAM Model page to check if your hospital is on the list of 741 mandated facilities.

TEAM is specific to Medicare Part A & B beneficiaries where Medicare is their primary insurance. It does not apply to beneficiaries enrolled in a managed care plan, with end stage renal disease, or covered under United Mine Workers of American health plan.

TEAM will initially focus on 5 high-cost, high-volume surgical episodes:

• Coronary artery bypass graft surgery (CABG) — includes coronary revascularization by CABG
• Lower extremity joint replacement (LEJR) — includes hip, knee, and ankle replacements but excludes arthroplasty of the small joints in the foot
• Major bowel procedure — includes major small or large bowel surgery
• Surgical hip/femur fracture treatment (SHFFT) — includes hip fixation procedure in the presence of a hip fracture with or without fracture reduction but excludes joint replacement
• Spinal fusion — includes spinal fusion procedures for cervical, thoracic, or lumbar

A distinctive feature of TEAM is the "30-day post-discharge episode." Hospitals will be held responsible for patient outcomes during this window, creating a financial incentive for them to prioritize follow-up care and recovery management after the patient leaves the hospital.

The model continues CMS's push toward value-based care, moving away from fee-for-service reimbursement. Under TEAM, hospitals are financially responsible for the entire episode of care starting with a surgical procedure and extending for 30 days post-discharge. Hospitals will now be accountable for the costs and outcomes associated with the entire episode, including any complications or readmissions within the 30-day window.

The primary objective of the model is to reduce costs associated with surgical episodes while simultaneously improving patient outcomes. Hospitals participating in TEAM must meet specific quality performance measures, which influence financial reconciliation.

The Composite Quality Score (CQS), a new measurement specific to TEAM, applies to TEAM beneficiaries. Specific Quality Measures evaluated at the hospital level include: Hybrid Hospital-Wide Readmission, THA/TKA PRO-PM (LEJR specific), HH-Falls with Injury, HH-Post Respiratory Failure, Failure to Rescue, and HAC Reduction Program for the quality measure PSI 90.

Hospitals will be rewarded for providing high-quality care within the episode at a lower cost, but penalties may be levied for poor outcomes or high costs that are not justified by the complexity of care.

TEAM offers three distinct participation tracks:

Track 1: No Downside Risk with Medium Reward — Designed to help hospitals ease into the new model, offering them time to adjust without bearing financial risk in the first year (or up to three years for safety net hospitals).

Track 2: Lower Risk and Reward (Years 2-5) — Available for specific hospital types starting in years 2 through 5. Hospitals assume some risk at a lower level than Track 3, with reduced potential financial rewards.

Track 3: Highest Risk and Reward (Years 1-5) — For hospitals fully committed to taking on the highest level of financial risk and reward throughout the full 5-year period. If costs are managed well while maintaining quality, hospitals can earn substantial rewards.

If your hospital is a mandated facility, here's a three-step readiness plan:

1. Assess Your Episode Risk — Identify if your hospital performs TEAM-targeted procedures, review historical episode costs and quality scores, and determine gaps in care coordination or documentation.
2. Strengthen Partnerships Across the Continuum — Formalize referral pathways with high-performing post-acute providers, align clinical teams on discharge protocols and patient handoffs, and begin collaboration with primary care and ACO partners.
3. Deploy Technology to Track Performance — Implement tools to monitor episode costs, quality, and patient movement in real time, ensure interoperability with external providers, and automate compliance reporting workflows.

Hospitals participating in TEAM will require robust systems to manage both clinical quality and financial performance across extended care episodes. R.A.I.N. Compliant™ by Rainfall Health provides:

• Real-time episode tracking from surgery to post-acute recovery
• Cross-provider data sharing and EHR integration
• Automated compliance documentation
• Analytics dashboards to monitor risk-adjusted cost and quality

Hospitals can monitor episodes in real time with predictive analytics, automate quality reporting and documentation workflows, identify and close compliance gaps before they affect reimbursement, and reduce readmissions by optimizing care transitions and discharge planning.

To ensure the R.A.I.N. Compliant™ platform is grounded in real-world hospital needs, Rainfall Health is advised by a committee of nationally recognized healthcare leaders:

• Robert Bart, MD (CMIO, UPMC)
• Scott Cooper, MD (Regional Physician Executive, Mercy)
• Cora Han (Chief Health Data Officer, UC Health)
• Manu Nair (Head of Corporate Development, Mayo Clinic)
• Tametha Stroh, MSN, RN (Risk Management Lead, Kaiser Permanente)
• Junaid Syed, MD (CMIO, Avera Health)

This council guides product strategy, helping Rainfall Health stay ahead of regulatory shifts and support providers on the front lines.