Navigating the surgical journey: CMS’s new TEAM and the power of coordinated care
February 24, 2025Share:
In this month’s column I hope to address, as some say, “the elephant in the room”.
Patients and their caregivers facing surgical procedures often encounter a fragmented healthcare landscape. I know this well as a caregiver myself, and one who has spent most of my career in leadership roles in care management and care transitions, creating coordinated systems of care to help smooth a patient’s surgical journey.
Last week, I had the privilege of presenting a NAHQ Learning Lab on the CMS Transforming Episode Accountability Model (TEAM). In this month’s column, I’d like to share some key takeaways with you, highlighting the crucial roles of care coordination and care transitions, connecting them to the NAHQ Healthcare Quality Competency Framework™ and sharing some NAHQ resources available to you for developing a robust population health approach.
What is TEAM
“The Transforming Episode Accountability Model (TEAM) will be a mandatory, episode-based, alternative payment model, in which selected acute care hospitals will coordinate care for people with Traditional Medicare undergoing one of the surgical procedures included in the model (initiate an episode) and assume responsibility for the cost and Quality of care from surgery through the first 30 days after the Medicare beneficiary leaves the hospital.” - CMS
Juggling multiple physicians, navigating insurance complexities and understanding the intricacies of recovery can be a daunting task. TEAM aims to address this fragmentation, fostering collaboration among healthcare providers to ensure seamless transitions of care, optimized care coordination and effective discharge planning, all while focusing on Quality and cost reduction.
TEAM’s core purpose is to provide coordinated, high-Quality care, initially focusing on five surgical procedures. It emphasizes smooth transitions between providers, mitigating fragmented care, linking Quality to financial performance and establishing accountability for spending from the episode's initiation through 30 days post-discharge from the anchor hospitalization, or post anchor procedure in the hospital outpatient setting This comprehensive approach aims to streamline the patient experience, redesign care processes and foster collaboration among hospitals and physicians. The model incentivizes these stakeholders to achieve established Quality outcomes, improve patient experience, reduce readmissions, decrease Medicare spending and minimize emergency department utilization.
Currently, 741 acute care hospitals are mandated to participate, with a voluntary option available for hospitals meeting specific criteria. These criteria include, but are not limited to, prior participation in the Comprehensive Care for Joint Replacement (CJR) Models or Bundled Payments for Care Improvement (BPCI) Advanced models.
CMS selects participating hospitals based on Core Based Statistical Areas (CBSAs), using stratified random sampling. CBSAs, defined by the Census Bureau, encompass metropolitan and micropolitan statistical areas, providing a framework for understanding urban clusters. CMS also defines custom CBSAs for its specific needs.
Success in the TEAM Model hinges on achieving Quality measure goals.
And here’s where NAHQ can play a vital role.
NAHQ is a linchpin in supporting this success through educational programming, data-driven intelligence, and the Certified Professional in Healthcare Quality® (CPHQ) credential. The Framework, comprising eight domains, 29 competencies, and 486 skills, provides a structured approach to Quality improvement. If you’re not familiar with the Framework, I encourage you to learn more at NAHQ's Framework page.
Effective care coordination and seamless care transitions are paramount in TEAM and healthcare in general. Case management should be a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual's health needs across the continuum of care. NAHQ, along with the American Case Management Association (ACMA), the Commission for Case Management Certification (CCMC), and the Case Management Society of America (CMSA), are leading professional societies providing resources for workforce development in case management, population health, and care transitions.
With all the changes taking place in our healthcare ecosystem today, the road ahead may be unclear, a winding one, and dare I say, scary. But the solutions my colleagues at NAHQ have laid out for the workforce are clear, strategic and in time, we hope laying a proven path for reskilling and upskilling the healthcare professional for better patient outcomes -- something we all hope for and, as colleagues in care, expect for our patients.
Patricia (Patty) Resnik, MJ, MBA, RRT, FACHE, CPHQ, CHC, CHPC
NAHQ President
There is a roadmap to healthcare Quality excellence. NAHQ can help you follow it.
The NAHQ Healthcare Quality Competency Framework™ serves as the industry-standard, defining the Quality Safety competencies, skills and behaviors required to advance Quality & Safety excellence across the healthcare continuum.
This expert-created, data-informed framework is continuously validated and updated by NAHQ to ensure it provides the most up-to-date information, guiding professionals, organizations, and the healthcare industry to create a competent, coordinated workforce prepared to deliver healthcare excellence.
