TEAM Model APM – Transforming Episode Accountability Model for Acute Care Hospitals
In the recently released Inpatient Prospective Payment System Final Rule (IPPS, August 2024), CMS finalized a new alternative payment model for
acute care hospitals.
The MANDATORY Transforming Episode Accountability Model (TEAM) will advance the Innovation Center’s prior work on episode-based alternative payment models, including the Bundled Payments for Care Improvement Advanced and Comprehensive Care for Joint Replacement Models.
This model will also satisfy the Advanced APM requirements for the Quality Payment Program.
CMS selected acute care hospitals in 188 core-based statistical areas to participate, and many Kentucky hospitals will be required to participate, specifically hospitals located in Bowling Green, Corbin, Glasgow, Lexington-Fayette, and Middlesboro. This model is a 5-year project beginning January 1, 2026, and ending December 31, 2030.
The list of hospitals selected was provided in the IPPS final rule. Other hospitals can voluntarily participate provided requirements are met.
The TEAM APM is a 30-day episode model for:
- Coronary Artery Bypass Grafting
- Lower Extremity Joint Replacement (LEJR)
- Major bowel procedures
- Surgical hip/femur fracture treatment
- Spinal fusion
An episode starts with the Anchor stay or procedure and includes Medicare FFS payments made in the following 30 days for services applicable to the anchor stay or procedure. This includes physician services, additional IP/OP stays for the original procedures, therapies both inpatient and outpatient, home care, laboratory testing, DME, medications, and hospice.
Program Year 1 of the Model quality measures includes a Hybrid Hospital-wide all-cause readmission measure and the Patient Safety and events composite measure (CMS 90).
LEJR episodes also include patient-reported outcome measures for total hip/total knee arthroplasty cases. In program year 2 additional quality measures are added related to hospital harm measures falls with injury and post-operative respiratory failure, and a thirty-day death rate amount surgical inpatients with complications.
All episode models will contain a health equity component which includes not only data collection, but also infrastructure investments, and an additional requirement for decarbonization efforts. CMS lists beneficiary incentives as well, including a waived origination site (patient location can be the home) for beneficiaries receiving telehealth services and a waived 3-day IP stay requirement for skilled nursing care.
This model has 3 possible participation tracks, similar to what is seen in Medicare Shared Savings Plans.
Track 1 has no financial risk, only a 10% stop-gain limit. Tracks 2 and 3 have gain and loss limits.
CMS completes the payment reconciliation annually six months after the program year is completed and payments to and from the organization are in lump sums.
For organizations with eligible clinicians meeting the Low-Volume Threshold, TEAM satisfies the definition of an Advanced Alternative Payment Model (Advanced APM) and clinicians meeting the APM volume thresholds for payment and beneficiary enrollment could be determined a Qualifying Participant (QP) and be exempt from Merit-based Incentive Payment System (MIPS) reporting requirements.
Updates for the TEAM APM will come through future rule-making, including the Physician Fee Schedule updates, so stay connected to the Kentucky Regional Extension Center for more information.
For details and more information on TEAM from CMS, visit HERE.
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