Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
The Transforming Episode Accountability Model (TEAM), Medicare’s new mandatory bundled payment model, began in January 2026 and will run through December 2030. Under TEAM, more than 700 acute care hospitals in 188 markets are required to assume financial risk for five surgical episodes from admission to 30 days post-discharge. These covered episodes include:
Joint replacement of the lower extremity (LEJR)
Surgical hip and femur fracture treatment (SHFFT)
Spinal fusion
Coronary artery bypass graft (CABG)
Major bowel procedure
Hospital target prices are based on average risk-adjusted spending per episode in each of the nine US census divisions during a 3-year baseline period, with an adjustment for quality. One early analysis showed that up to two-thirds of hospitals could lose an average of $1,350 in revenue per case based on 2023 Medicare claims.* Succeeding in bundled payment requires actively managing the continuum of care to increase efficiency and avoid costly emergency visits and complications.
The Surgeon’s Role
Surgeons have an important role to play in improving efficiency and quality.
Improve processes. To succeed in models like TEAM, hospitals should invest in clinical redesign for internal efficiencies, including coordination for greater pre-surgical care (e.g., nutritional and physical therapy, smoking cessation, and primary care coordination) to prepare patients for a successful procedure and recovery. Surgeons can play a leading role in advocating for processes that not only improve efficiency but help patients achieve their desired outcomes.
Monitor outcomes. TEAM will be a Merit-based Incentive Payment System (MIPS) Alternative Payment Model (APM) for all participation tracks, and the model allows for gainsharing opportunities with clinicians.
Keys to Success in TEAM
Surgeons caring for patients in TEAM-participating sites can take several steps to help achieve systemwide success.
Learn the model. In addition to this webpage and other ACS materials, the Institute for Accountable Care (IAC) has summary resources with more details on how the model works.
Assess your hospital’s surgical performance. Learn about surgeries within your hospital/system, including both quality and efficiency metrics.
Review your TEAM performance report. The ACS has created hospital-specific TEAM performance reports for more than 2,000 facilities based on modeling developed with the IAC. These reports show how your hospital would have performed had the model been in place for 2024, including the financial impact of complications and emergency department visits. Request yours today.
Familiarize yourself with any ACS Quality Programs that your hospital may already have in place. These programs implement standards and processes to avoid complications and leverage data from risk-adjusted registries to identify root causes of adverse events.
Analyze opportunities for improvement. For hospitals or surgery programs seeking additional information, the IAC has developed opportunity analysis reports that summarize episode cost and utilization data across many levels, including by region, market, hospital, care setting, diagnosis-related group, and surgeon. Contact IAC at analytics@institute4ac.org for a complimentary briefing with policy experts.
Strengthen post-acute care partnerships. ACS verification programs have been shown to help get more patients discharged to their homes after surgery** but for those patients who do need post-acute care, improving transitions and partnering with efficient, high-quality facilities are vital. Post-surgical care management with partner providers and accountable care organizations can help to ensure that patients achieve their goals of care as efficiently as possible.
Develop clinical redesign strategies across the continuum of care. Collaborate with teams across the care continuum, including primary care, rehabilitation, and other post-acute services to improve care coordination and efficiency. Efficient redesign can serve not only as a means of improving performance on current TEAM episodes, but also as a strong foundation for potential expansion of TEAM or future payment models.
Request Your Hospital's TEAM Report
Fill out our request form to receive your hospital's personalized TEAM report.
TEAM target prices incorporate a discount factor intended to ensure that the model saves money for the federal government. Early analysis from the IAC indicates that the way TEAM target prices are structured will likely result in significant revenue loss for some hospitals if they fail to take appropriate action to prepare, especially once the model is fully implemented with greater bidirectional risk. While most cases will fall below the target price, the cost of outlier cases that exceed the target is projected to outweigh these savings leading to losses for up to two-thirds of hospitals.
In Figure 1, the map displays all TEAM hospitals selected for the model, with their average revenue impact per qualifying episode (gain = green or loss = red/orange), based on 2023 Medicare fee-for-service (FFS) data. Bubble size corresponds with 2023 case count. Hospitals in gray (N/A) have fewer than 100 qualifying cases in 2023.
Figure 1. Average Revenue Impact per Episode In TEAM Hospitals - 2023
Table 1 looks at individual FFS cases from hospitals selected for TEAM using Medicare data from 2023. Here we see case count by TEAM episode category and a breakdown in case count and average financial impact by revenue “winners” and “losers.” As shown in the table, there are more winners than losers, but the losers lose more on average. In other words, this model promotes large volumes of small wins paid for by a small volume of large losses. Note that these calculations include the CMS discount rates, but not the stop-gain/stop-loss caps, since this is not at the hospital level.
Financial Impact of TEAM (2023)
Gain
Loss
TEAM Surgical Episode
Total Cases
# Cases
Average Gain/Case
# Cases
Average Loss/Case
Lower Joint Replacement (LEJR)
118,155
74,626
$2,637
43,529
($6,133)
Spinal Fusion
30,689
18,317
$7,833
12,372
($14,188)
Hip & Femur Procedures (SHFFT)
25,427
13,281
$7,970
12,146
($10,046)
Major Bowel Procedure
19,723
13,282
$6,092
6,441
($13,726)
Coronary Artery Bypass Graft (CABG)
10,020
6,580
$6,927
3,440
($15,142)
Total
204,014
126,086
77,928
Table 1. National Summary: Revenue Impact of TEAM by Surgical Episode (2023)
Financial Impact of TEAM (2023)
Gain
Loss
TEAM Surgical Episode
Total Cases
# Cases
Average Gain/Case
# Cases
Average Loss/Case
Lower Joint Replacement (LEJR)
118,155
74,626
$2,637
43,529
($6,133)
Spinal Fusion
30,689
18,317
$7,833
12,372
($14,188)
Hip & Femur Procedures (SHFFT)
25,427
13,281
$7,970
12,146
($10,046)
Major Bowel Procedure
19,723
13,282
$6,092
6,441
($13,726)
Coronary Artery Bypass Graft (CABG)
10,020
6,580
$6,927
3,440
($15,142)
Total
204,014
126,086
77,928
Figure 2 looks at the financial impact at the hospital level - of the selected hospitals with at least 300 qualifying Medicare FFS cases in 2023, one-third would earn revenue while two-thirds would lose revenue under the TEAM model, given current spending. This graph shows the distribution of the average financial impact per case, with some hospitals earning as much as $3,000 and others losing over $5,500 in revenue per qualifying episode.**
Figure 2. Financial Impact of TEAM for Hospitals with 300+ Qualifying Cases: Average 2023 Revenue Gain or Loss per Episode
Table 2 summarizes the largest markets selected for TEAM participation, based on the volume of qualifying Medicare FFS cases in 2023 (i.e., all 5 episode categories in the model). These 20 markets account for over two-thirds of 2023 cases across the 188 TEAM regions. The full list of selected facilities can be accessed on the CMS TEAM website.
*Based on Institute for Accountable Care analysis of 2021–2023 Traditional Medicare claims data. Target prices calculated with 2021–2023 Medicare claims data by census division and trended, wage-adjusted, and risk-adjusted for all qualifying US hospitals with at least 11 TEAM episodes in 2023 using specifications from the final 2025 IPPS rule.
***These calculations also account for stop-gain/stop-loss caps, assuming safety net/rural hospitals will be in Track 2, while all others will be in Track 3.
