On January 1, 2026, the landscape of surgical reimbursement in the United States underwent a fundamental shift, when the Centers for Medicare & Medicaid Services (CMS) Transforming Episode Accountability Model (TEAM) initiative became mandatory for over 700 hospitals across 188 metro areas.
For hospital executives, this represents a structural change to how they are evaluated on and reimbursed for certain surgical procedures. TEAM effectively monetizes perioperative readiness, care coordination, and discharge planning—areas that have historically been operational challenges rather than direct financial drivers. As we approach this transition, the distinction between hospitals that view TEAM as a compliance burden and those that leverage it as a strategic opportunity will likely be measured in millions of dollars in reconciliation payments.
Understanding the Stakes: From Volume to Value
Historically, Medicare’s fee-for-service model rewarded volume: more tests, more visits, and more procedures equated to higher revenue. TEAM inverts this incentive structure by paying for the “value” of a surgical episode. Under this model, CMS will hold hospitals accountable for the total cost and quality of care.
The “episode” is comprehensive, extending from the procedure itself through 30 days post-discharge. This means that for the first time in a mandatory national model, your hospital is financially responsible not just for what happens in the Operating Room, but for readmissions, skilled nursing facility (SNF) utilization, and post-acute complications that occur weeks after the patient has left your facility.
The financial mechanics are straightforward but unforgiving. CMS sets a target price for each episode. If your hospital’s actual spending is below this target and quality metrics are met, you receive a bonus. If spending exceeds the target, you may owe a repayment to CMS. This risk is further modulated by a Composite Quality Score (CQS), derived from metrics such as readmission rates, patient safety events, and patient-reported outcomes (PROs). In this environment, disorganized perioperative pathways are no longer just an operational nuisance; they are a direct liability.
The Operational Challenge: Why Traditional Methods Fall Short
For many health systems, the greatest barrier to TEAM success is the fragmentation of the perioperative journey. In the traditional workflow, pre-admission testing (PAT), anesthesia, surgery, case management, and post-acute care often operate in silos. This fragmentation creates “blind spots” where patients can deteriorate financially and clinically.
Consider a typical scenario: A patient scheduled for a total knee replacement arrives for surgery with undiagnosed anemia or poorly controlled diabetes. In a fee-for-service world, the surgery may very well proceed, perhaps with an increased risk of an extended length of stay, a readmission for infection, or an unplanned stay in a rehabilitation facility. Medicare pays for each of these events separately. Under TEAM, however, this sequence represents a catastrophic financial loss. The readmission and extended post-acute care devour the bundled payment, resulting in a negative reconciliation.
Most Electronic Health Records (EHRs) are designed to document care encounters, not to manage the complex, longitudinal logistics of the entire surgical episode. They often lack the automated intelligence to flag at-risk patients weeks before surgery or to track their recovery trajectory after they leave the hospital walls. To succeed under TEAM, leaders must bridge the gap between their EHR’s capabilities and the demands of value-based care.
Setting the Stage for Success: The Role of Perioperative Care Coordination
To turn TEAM from a risk into a profit center, hospital leaders must focus on three critical levers: preoperative optimization, discharge readiness, and post-acute coordination.
- Preoperative Medical Optimization: The most effective way to reduce episode cost is to prevent complications before they happen. This requires identifying, and taking action on, modifiable risk factors—such as anemia, hyperglycemia, or frailty—weeks before the scheduled procedure.
- Discharge Readiness: Planning for discharge must begin the moment surgery is contemplated. Ensuring patients have clear instructions and necessary support systems in place significantly reduces the likelihood of avoidable emergency department visits and readmissions.
- Post-Acute Coordination: Under TEAM, the hospital’s accountability does not end at the exit door. Systems must have visibility into where patients go and how they are recovering to prevent costly “failure to rescue” events.
Implementing these levers manually is labor-intensive and prone to error. This is where advanced technology becomes an essential force multiplier.
Leveraging Qventus Perioperative Care Coordination
At Qventus, we view the TEAM model as a validation of the modern perioperative strategy. Our Perioperative Care Coordination (PCC) Solution is designed to automate the very workflows that TEAM rewards, providing “AI teammates” that help clinical staff manage the complexity of surgical episodes.
Automating Readiness and Risk Identification
Qventus PCC utilizes AI and machine learning to flag patient-specific risk factors early in the scheduling process. Rather than relying on manual chart review, our system can identify patients who are likely to drive higher TEAM-related exposure—such as those at high risk for readmission or post-op complications. This allows optimization clinics to intervene proactively, ensuring patients are physiologically ready for surgery, which directly protects the Composite Quality Score.
Streamlining Care Coordination
Our solution acts as a digital connective tissue between the disparate parts of the perioperative team. By automating administrative tasks—from requesting medical records to confirming appointments—PCC frees up high-value clinical staff to focus on patient care. This improved efficiency is critical for maintaining high throughput while ensuring that no patient “falls through the cracks” of a busy surgical schedule.
Extending the Continuity of Care
Crucially for TEAM, Qventus PCC supports the management of the patient journey beyond the hospital stay. By automating follow-up communication and tracking patient-reported outcomes, we help hospitals detect potential issues early in the 30-day window. This capability is vital for avoiding readmissions and reducing unnecessary utilization of high-cost post-acute services, both of which are primary drivers of negative reconciliation under the new model.
The Leadership Imperative
The implementation of CMS TEAM is a clear signal that the era of accountability is here to stay. Hospital leaders have a choice: wait for the penalties to accrue in 2027, or begin building the infrastructure for success today.
The timeline for action is shorter than it appears. With the model launching in January 2026, hospitals effectively have a 6-to-9-month window to implement the necessary analytics and workflows to be ready for the first performance year. Systems that act now to integrate intelligent care coordination will not only mitigate their downside risk but will position themselves to capture significant financial rewards.
At Qventus, we are committed to partnering with health systems to navigate this transition. By combining clinical expertise with powerful automation, we help you protect your margins while delivering the high-quality, coordinated care your patients deserve. The TEAM model is mandatory, but success is a choice. Request a demo to learn how our Perioperative Care Coordination Solution can help you improve perioperative efficiency and ensure you’re well-positioned to exceed TEAM targets.
