Hospitals face a pivotal moment as the Centers for Medicare & Medicaid Services (CMS) rolls out the Transforming Episode Accountability Model (TEAM). This initiative fundamentally shifts financial risk for complex surgical episodes, demanding proactive strategies to enhance patient outcomes and avoid potential penalties. The stakes are high: hospitals failing to adapt could find themselves owing Medicare substantial sums.
While TEAM introduces significant financial accountability, it simultaneously presents a rare opportunity to forge genuine collaboration with specialists – a component often lacking in traditional value-based care arrangements. The model’s design allows hospitals to align incentives through Collaboration Agreements, distributing both the benefits of cost savings and the consequences of exceeding targets. The success of TEAM hinges on the ability of hospitals, specialists, and primary care physicians to work in concert.
Historically, value-based care initiatives have frequently relied on physician scoring systems, attempting to drive down costs through comparative rankings. While framed as feedback, these approaches often feel punitive, fostering resistance rather than partnership – a tactic borrowed from payer reporting rather than collaborative improvement. Under TEAM, this mindset risks derailing participation before it even begins.
If specialists perceive Collaboration Agreements as one-sided or primarily focused on cost reduction, they may choose to opt out, leaving hospitals to shoulder the financial burden or experience a decline in surgical volume. This outcome benefits no one. The true drivers of surgical episode costs extend beyond any single physician’s control, encompassing factors like patient preparation, hospital processes, and post-acute care coordination.
A more effective approach centers on shared inquiry. By leveraging integrated, trustworthy data to pinpoint the sources of cost variation and understand the underlying reasons, hospitals and physicians can collaboratively refine processes, prevent complications, and optimize care coordination – particularly in the pre-surgical phase. Collaboration Agreements built on transparency, continuous learning, and shared accountability will allow TEAM to function as intended: a framework for partnership, not control.
Building Win-Win TEAM Collaboration Agreements: Six Essential Strategies
The TEAM model necessitates a collaborative ecosystem involving the hospital, the surgical team, the patient, and the patient’s primary care physician. Research consistently demonstrates that cost variations within TEAM procedures are largely attributable to complications leading to prolonged hospital stays, readmissions, or escalated levels of care. A patient’s pre-existing medical conditions significantly influence their risk of complications, underscoring the critical importance of robust communication between primary care physicians and the clinical team.
The following best practices, reflected in effective Collaboration Agreements, will pave the way for successful partnerships:
- Comprehensive Team Inclusion: Ensure Collaboration Agreements encompass the entire clinical team – surgeons, anesthesiologists, and all consulting medical specialists. Focus on physician groups and involve practice administrators to facilitate physician engagement.
- Data Integration is Paramount: Prioritize the full aggregation and integration of Electronic Health Record (EHR) data (from both physicians and the hospital) alongside CMS claims data to provide a complete view of surgical episodes of care. This data-sharing capability is the most powerful tool for cost control and should be a cornerstone of every Collaboration Agreement. Relying solely on CMS claims data is insufficient, as it lacks crucial patient risk and clinical details.
- Invest in Data Aggregation: Where permissible by CMS, consider financially supporting the aggregation of specialty data for collaborating practices. Private practices often lack the resources for this independently, and access to their data is essential for building trust and ensuring the validity of analytics.
- Focus on the Episode, Not the Individual: Avoid “scoring” physicians based on cost or creating analytics that appear to do so. Instead, utilize cost variation curves to solicit feedback on process improvements and collaborative solutions.
- Proactive Patient Preparation: Facilitate advance referrals to primary care physicians to address potential complications before surgery, including pre-treatment when appropriate. While this may involve scheduling adjustments, the benefits of a medically prepared patient far outweigh the delays.
- Embrace Enhanced Recovery After Surgery (ERAS): Leverage Collaboration Agreements to overcome operational and cultural barriers to adopting ERAS principles. Evaluating performance at the episode level provides valuable insights into how standardized care pathways impact both cost and quality outcomes.
TEAM isn’t about hospitals dictating terms to specialists; it’s about forging genuine partnerships. Collaboration Agreements that prioritize transparency, shared learning, and joint problem-solving create the conditions for sustained cost control and improved patient outcomes, without eroding physician trust. When hospitals shift their focus from attribution and scoring to a holistic understanding of the entire episode of care, TEAM realizes its full potential as a framework for collective accountability and coordinated improvement.
What innovative data-sharing strategies are proving most effective in your organization? And how can hospitals best address the cultural shifts required to embrace a truly collaborative approach to value-based care?
The hospitals that embrace TEAM as a relationship model – not merely a reimbursement model – will be best positioned to thrive in this evolving healthcare landscape.
Learn more about the broader landscape of value-based care from the American Health Insurance Plans.
Explore recent research on episode-based payment models from Health Affairs.
Frequently Asked Questions About CMS TEAM Collaboration Agreements
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What is the primary goal of CMS’s Transforming Episode Accountability Model (TEAM)?
The primary goal of TEAM is to improve the quality and efficiency of care for complex surgical episodes by holding hospitals accountable for both cost and outcomes, while fostering collaboration with specialists.
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Why is data integration so crucial for successful TEAM Collaboration Agreements?
Data integration, specifically combining EHR data with CMS claims data, provides a comprehensive view of the entire surgical episode, enabling hospitals and specialists to identify cost drivers and opportunities for improvement that would otherwise be missed.
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How can hospitals avoid creating a punitive environment with Collaboration Agreements?
Hospitals should focus on analyzing episode-level cost variations rather than individual physician performance. Using data to invite feedback on process improvements, rather than assigning blame, fosters a collaborative atmosphere.
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What role do primary care physicians play in the TEAM model?
Primary care physicians are vital for ensuring patients are medically prepared for surgery, addressing pre-existing conditions, and coordinating post-acute care, ultimately reducing the risk of complications and improving outcomes.
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How can Collaboration Agreements support the adoption of Enhanced Recovery After Surgery (ERAS) protocols?
By incorporating ERAS expectations into Collaboration Agreements, hospitals can address operational and cultural barriers that have historically hindered the implementation of these evidence-based standards, leading to improved patient recovery and reduced costs.
About Theresa Hush
Theresa Hush is a healthcare strategist and change expert with extensive experience across the healthcare spectrum. Terry’s broad range of health care experience includes executive positions in public, non-profit and private sectors, from both payer and provider sides of the business, complemented by expertise in health care public policy and regulation. She is co-founder and CEO of Roji Health Intelligence, established in 2002 to empower providers in implementing Value-Based Care through technology and data-driven services.
Disclaimer: This article provides general information and should not be considered medical or legal advice. Consult with qualified professionals for personalized guidance.
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