Some acute care providers are gearing up for CMS’ newest accountable care model by looking for post-acute partners, and agencies that get involved could see reduced costs and smoother transitions for patients that undergo certain surgical procedures.
The Transforming Episode Accountability Model (TEAM) will require acute care providers to coordinate care for several key surgical procedures throughout the hospital stay and for 30 days after discharge, including home health. It’s set to start in January 2026, with over 700 hospitals in certain Core-Based Statistical Areas (CBSAs) mandated to participate.
TEAM highlights CMS’ increased focus on value and efficiency, says Angela Huff, senior managing consultant at Forvis Mazars in Springfield, Mo. Agencies that participate could have a chance to help shape the future of care coordination, but many providers aren’t aware of the model or the role that post-acute care will play, she notes. “At a minimum, lean in and see if this is something that you can really leverage,” she adds.
The key surgical procedures included in TEAM are coronary artery bypass grafts, lower extremity joint replacements, major bowel procedures, spinal fusions and surgical hip femur fractures. CMS has noted that these surgeries are “clinically similar, have well-defined beginnings and endings and have demonstrated success in reducing episode payments and achieving net Medicare savings.”
By emphasizing care coordination, CMS hopes to improve outcomes and lower costs for Medicare patients. This includes tackling unnecessary costs or risks that occur when a patient moves from one healthcare setting to another, Huff says. For instance, the increased collaboration under TEAM could provide agencies with new opportunities to target and prevent common care transition issues such as duplicated labs and procedures, gaps in patient information or delays in care, she notes.
The model could also drive new referral opportunities, Huff adds. (HHL 10/28/24)
What to know about participation
Participating hospitals will likely partner with agencies that are good at communicating and can provide quality care while reducing costs, says Maureen Kelleher, senior manager of SimiTree Healthcare Consulting in Hamden, Conn. “As outcomes will be critical to the hospitals, they will seek out collaborators within the community who will be able to provide the best care for their patients,” she notes.
High quality measure scores, positive outcomes and sufficient staffing levels will also be taken into consideration, Kelleher adds.
CMS has encouraged hospitals to consider gainsharing agreements with their TEAM partners, meaning an agency could see increased payments for positive outcomes, Huff says.
Home health agencies are in a good position to help participating hospitals control their cost of care, Huff explains. But entering into these agreements also means that you’d be sharing the risk, she notes. “You are on the hook to provide value and to be part of that solution.”
TEAM is only one instance of CMS’ increased movement toward value-based and accountable care approaches, Huff says. Even if your agency can’t get involved, it’s still something to keep an eye on, she notes.
Providers outside of the relevant TEAM locations need to be aware of which hospitals are participating, Huff says. “It’s really important for those agencies to understand that, even if they don’t choose to aggressively pursue this, they can actually end up with TEAM patients,” she stresses.
For example, she notes that an agency located outside of the relevant CBSAs could receive a referral for a patient who lives nearby but traveled to a TEAM hospital to undergo one of the key procedures.
Providers who partnered with acute-care facilities under the Comprehensive Care for Joint Replacement models may also be able to get involved, as past participating hospitals have been given the option to volunteer for TEAM.
If TEAM isn’t an option, your agency could still work with other Accountable Care Organizations (ACOs) in your area, Kelleher says. For instance, she notes that these agencies may consider the REACH (Realizing Equity, Access and Community Health) Model, which attempts to coordinate care and minimize costs.
Steps toward getting started
Care coordination around the key surgical procedures in TEAM may be burdensome for some providers, especially if agencies have to report on patient outcomes to the leading facilities, Huff says. But it could also be an opportunity to improve your care coordination and communication, she notes.
The following tips may be helpful for agencies that are considering whether to partner with TEAM participants:
Consider challenges. When caring for patients who underwent one of the key surgical procedures, it’s important to remember that some patients have a higher risk factor than others, Kelleher says. Understand the three different tracks in the TEAM model and their different levels of risk and reward. For example, if your acute care partner selects Track 3, your agency is likely to see more complex cases, she notes.
Staffing is and will remain a challenge for all areas of health care, including TEAM participation, Kelleher says. Agencies that face staffing difficulties or shortages could struggle to accept a high volume of referrals for high-risk patients, she notes.
Contact potential partners. Providers in the chosen CBSAs should reach out to the TEAM participants in their area, Kelleher suggests. Come to the table prepared to demonstrate your agency’s ability to provide the necessary care, quality outcomes and cost-savings for the patients under this model, she says.
Negotiate your rate. It’s important to keep the cost of care in mind when negotiating any gainsharing contracts, Kelleher says. Agencies should also consider their staffing levels, the expected complexity of patients and what other medical needs patients may have related to the procedure, including physician services, durable medical equipment, medications and lab services, she notes.
Leverage your successes when negotiating your agency’s role in these agreements, Huff suggests. Using publicly reported outcomes like Home Health Value-Based Purchasing (VBP) scores or data that showcase your agency’s outcomes around TEAM’s key surgical procedures can help your agency craft an argument as to why you will be a good partner, she notes.
Review your contracts. Providers must have a written agreement with the acute-care facilities they’re collaborating with, Kelleher says. Read through the agreement carefully, she recommends. Ensure you understand what, if any, payments your organization would be expected to make to the TEAM participants, as well as the methodology and accounting formulas used to determine the amount of gainsharing and alignment payments, she notes.
More info: To learn more about the TEAM model and access the list of participating hospitals, visit https://www.cms.gov/priorities/innovation/innovation-models/team-model.