Spilling the tea in Transforming Episode Accountability Model: unanticipated consequences of Medicare's Transforming Episode Accountability Model.

Abstract

The Transforming Episode Accountability Model (TEAM), implemented in January 2026, represents Medicare's most expansive bundled payment model for surgical services, extending mandatory 30-day episode-based accountability to spinal fusion. While prior bundled payment initiatives demonstrated improved efficiency for more standardized procedures such as lower extremity joint replacement, their effects in more heterogenous fields have been mixed. Spine surgery, characterized by substantial variation in pathology, operative strategy, implant utilization, and postoperative care, presents distinct challenges for uniform episode-based reimbursement. This review examines potential unintended consequences of TEAM in spine surgery, drawing on evidence from predecessor bundled payment models. Three domains are emphasized: patient selection, shifts within and across bundles, and site-of-service impacts. As TEAM is implemented, ongoing evaluation will be essential to ensure that bundled payment reform promotes efficiency while preserving equity, clinical discretion, and long-term value in spine care.