The CMS TEAM Model: What It Is And How Hospitals Maximize Revenue

Key Facts About CMS TEAM

• • Program Name: Transforming Episode Accountability Model (TEAM).
• • Administering Agency: Centers for Medicare & Medicaid Services (CMS) via the Center for Medicare and Medicaid Innovation (CMMI).
• • Start Date: January 1, 2026.
• • Duration: 5 performance years through 2030.
• • Participation: Mandatory for 721 selected acute-care hospitals.
• • Eligibility: Acute-care hospitals paid under the Inpatient Prospective Payment System (IPPS) located in selected Core Based Statistical Areas (CBSAs).
• • Episode Definition: Day of qualifying surgery through 30 days post-discharge.
• • Episode Types: CABG, LEJR, major bowel, SHFFT, spinal fusion (5 total).
• • Patient Population: Medicare Part A & B fee-for-service beneficiaries.
• • Excluded: Beneficiaries in Medicare Advantage / managed care plans, those with end-stage renal disease, and those covered by the United Mine Workers of America health plan.
• • Tracks: Track 1 (no downside risk, medium reward), Track 2 (lower risk and reward, years 2–5), Track 3 (highest risk and reward, all five years).
• • Safety-Net Hospital Flexibility: Up to three years in Track 1.
• • Quality Measurement: Composite Quality Score (CQS) including Hybrid Hospital-Wide Readmission, THA/TKA PRO-PM, HH-Falls with Injury, HH-Post Respiratory Failure, Failure to Rescue, and PSI-90 under the HAC Reduction Program.
• • Revenue Impact: The five TEAM episodes typically represent ~15% of a hospital's Medicare revenue.
• • Hospital Categories Eligible: Safety Net Hospitals, Rural Hospitals, Medicare Dependent Hospitals (MDH), Sole Community Hospitals (SCH), Essential Access Community Hospitals (EACH), and prior BPCI Advanced / CJR participants represented in the roster.

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