Real-World Implementation Strategies and Preparation for Transforming Episode Accountability Model (TEAM): Academic, Community Hospital-Employed, and Private Practice Perspectives.".

Abstract

The Centers for Medicare & Medicaid Services (CMS) Transforming Episode Accountability Model (TEAM) is the largest mandatory bundled payment program in Medicare history. The program covers five high-cost surgical episode categories across 188 selected Core-Based Statistical Areas (CBSAs) from January 1, 2026 through December 31, 2030. Spinal fusion is among the most clinically heterogeneous and financially consequential of the five TEAM episode types, subject to a 2.0% mandatory discount factor and a 30-day post-discharge episode window. This manuscript reviews current CMS policy guidance and available evidence to provide setting-specific implementation strategies that include: cost containment, care coordination, outpatient episode migration, post-acute network development, and surgeon engagement. Review METHODS: Literature review performed to comprehensively describe how the implementation strategy for TEAM will vary by practice model to account for financial risk while also preserving patient care and access. While TEAM establishes a unified policy framework, real-world implementation will vary substantially across academic medical centers, community hospital-employed practices, and private practice environments, each of which faces distinct operational constraints, incentive structures, and levels of financial risk exposure. Spine surgeons who engage proactively through formal collaborator agreements, hospital governance participation, and pathway development will be best positioned to preserve clinical autonomy, maintain access for complex patients, and deliver high-quality, equitable care within the value-based landscape that TEAM now mandates.