Massachusetts Health & Hospital Association Medicare’s New Mandated Transforming Episode Accountability Model
January 8, 2025 | 10:00 am – 12:00 pm
In August 2024, CMS finalized the Transforming Episode Accountability Model (TEAM), a mandatory episode-based “bundled payment” model. Thirty-eight hospitals in Massachusetts are required to participate in this program, starting just over a year from now. The five-year TEAM model will begin on January 1, 2026, affecting payments for five surgical procedures: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedures. CMS aims to improve the quality of care while reducing Medicare spending for beneficiaries undergoing these high-expenditure, high-volume surgical procedures, which together account for more than 11% of inpatient prospective payment system payments.
The TEAM model shares similarities with previous CMS bundled payments, such as the Comprehensive Care for Joint Replacement Model. Providers will be at risk financially for episodes of care during a hospital inpatient stay or outpatient procedure and for post-discharge services, such as skilled nursing facility stays and follow-up visits. Participants will continue to bill Medicare under the fee-for-service model but will receive risk-adjusted target prices based on episode category and region. Payments will be adjusted for quality performance, determined by historic Medicare episode spending and a 1.5–2% discount factor.
Now is the time for hospitals to understand and prepare for the effects of this program.
During the webinar, MHA’s data partner, DataGen, will:
· Present an overview of the TEAM model.
· Discuss strategies for preparing for TEAM implementation.
· Share resources hospitals can use to begin preparation now.
