As the Centers for Medicare and Medicaid Services moves forward with Transformative Episode Accountability Model (TEAM)Hospitals are assuming financial responsibility for Medicare’s most complex and expensive surgical episodes. Hospitals that don’t take steps to achieve better outcomes for patients could find themselves owing money to Medicare.
While TEAM transfers significant risk to hospitals, it also creates an opportunity that is often missed in value-based care: true collaboration with specialists. TEAM’s design allows hospitals to align incentives with physicians through collaborative agreements, either shifting negative or positive payments based on the cost of the target surgical episode. TEAM’s success (or failure under pressure) will depend on how specialists, hospitals and primary care physicians work together.
Too often, value-based care efforts rely on physician ratings as a lever to reduce variation in costs per provider. Comparative cost or quality rankings may be formulated as feedback, but they are rarely collaborative. Rather, they point out flaws and create resistance, an approach taken from payer reporting rather than association. Under TEAM, this mentality risks undermining participation before it begins.
If specialists view collaborative agreements as punitive or unilateral, they may opt out entirely, leaving hospitals to absorb financial risk or lose surgical volume. That result is of no use to anyone. The costs of surgical episodes are driven by factors across the spectrum, from patient preparation and hospital processes to post-acute services, many of which are outside any physician’s control.
A more effective way forward is shared research. By using reliable, integrated data to understand where variation occurs and why, hospitals and physicians can focus on improving processes, preventing complications, and coordinating care, particularly before surgery. When collaborative agreements are built around transparency, learning, and shared responsibility, TEAM can function as intended: a framework for collaboration, not control.
Six tips for TEAM collaboration agreements with mutually beneficial specialists
The hospital, the surgical team, the patient, and the patient’s primary care physician are the central actors of TEAM. Studies show that cost variation among TEAM procedures is largely due to complications leading to prolonged hospital stays, readmissions, or higher levels of service. Some patients enter surgery with medical conditions that increase the risk of complications, making strong communication between primary care and the clinical team essential to the TEAM’s success. The following best practices in collaboration between hospitals and medical specialists should be reflected in collaboration agreements.
1. Ensure your collaboration arrangements include the full complement of the clinical team, including surgeons, anesthesiologists and consulting medical specialists.. You should focus on the physician group and include practice managers as part of the implementation to support physicians.
2. Plan for complete aggregation and integration of EHR data (both medical and hospital) and CMS claims data to view complete episodes of surgical care.. Your ability to share data is the most important tool you have to control costs, and data sharing should be part of every specialist collaboration agreement. Why is EHR data essential? Can’t you just use CMS claims data? No, and here’s why: Claims data will be free of patient risk and other clinical elements essential to your cost inquiry.
3. As permitted by CMS, consider funding specialized data aggregation for your collaborating practices.. Most private practices will not be willing to do this themselves, and the inclusion and evaluation of specialists’ own data will be essential to confidence in the analysis of the surgical episode. There will be limits to negotiate.
4. Do not “grade” doctors by cost or create analyzes that appear to do this. Analyzes that focus on specialists rather than the episode itself and its particular cost drivers will feel punitive. Instead, use your cost variance curve to solicit feedback on improved processes and other solutions.
5. Facilitate prevention of patient complications before surgery through early referrals to primary care physicians (and pretreatment, when possible). This is your best opportunity to ensure that the patient is medically prepared for surgery. The possible delay in surgery will be worth the effort.
6. Use collaborative agreements to overcome barriers to the adoption of ERAS principles.
Incorporating enhanced recovery expectations after surgery (ERAS) into collaborative agreements may help address long-standing operational and cultural challenges that have limited implementation of these evidence-based standards. Assessing performance at the episode level allows hospitals and specialists to better understand how standardized care pathways influence both cost and quality outcomes.
TEAM does not require hospitals to “manage” specialists, but rather to partner with them. Collaborative agreements that emphasize transparency, shared learning, and joint problem-solving create the conditions for sustained cost control and improved outcomes, without eroding clinician trust. When hospitals focus less on attribution and scoring and more on understanding the entire episode of care, TEAM becomes what it was intended to be: a framework for collective responsibility and coordinated improvement. Hospitals that approach TEAM as a relationship model, not just a reimbursement model, will be better positioned to succeed.
About Teresa Hush
Teresa Hush is a healthcare strategist and change expert with experience across the healthcare spectrum. Terry’s broad range of healthcare experience includes executive positions in the public, nonprofit, and private sectors, on both the payer and provider sides of the business, peppered with experience in public policy and healthcare regulation. She is co-founder and CEO of Roji Health Intelligence, was formed in 2002 to help providers implement value-based care with technology and data-driven services.
