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The CMS “TEAM” Model Is Coming. Are You Ready?

In January 2026, the Centers for Medicare & Medicaid Services (CMS) will debut the Transforming Episode Accountability Model (TEAM): a new mandatory bundled payment program that will significantly reshape financial accountability for surgeries. Under TEAM, participating facilities will be held responsible for patient outcomes and costs for 30 days following surgery, no matter where care is delivered.

In practice, hospitals will still be reimbursed for the surgery and related inpatient stay. Afterward, CMS will evaluate the total cost of care for the 30 days following surgery, including post-acute services such as rehabilitation, home health visits, follow-up appointments, and durable medical equipment, against a set “target price.” If overall spending comes in below that target while meeting quality standards, the hospital keeps the difference. If total costs exceed the target or outcomes fall short, the hospital must repay CMS for the overage.

What TEAM Covers

The model applies to high-cost surgical procedures, including:

• Lower extremity joint replacement (LEJR)
• Surgical hip and femur fracture treatment (SHFFT)
• Spinal fusion
• Coronary artery bypass graft
• Major bowel procedures

The bundled “target price” encompasses both the surgery and inpatient stay, and post-acute care, follow-up visits, and a wide range of related post-discharge services. These include outpatient therapy or home health services, durable medical equipment, physician visits, labs, and Part B drugs.

According to ATI Advisory, as much as 21–53% of spending for TEAM covered care occurs after patients leave the hospital. This means effective post-discharge care coordination will determine whether hospitals earn shared savings or face financial penalties. However, many TEAM-related surgeries may not occur at the hospital closest to a patient’s home. If a patient experiences pain-related hypertension, constipation, or other post-surgical complications and seeks care at their local emergency department, the original surgical hospital remains financially responsible for that episode under TEAM. This reality makes coordinated, multi-geography care partnerships essential to success.

Balancing Risk and Reward Under TEAM

CMS will calculate each hospital’s bundled payment targets using three years of historical claims data. This baseline helps determine a realistic “target price” for each type of surgery based on past performance and regional averages; so hospitals do not need to submit new data before the program begins.

If, during the program, the total cost of care for a patient’s 30-day recovery comes in below the target price and the hospital meets CMS-defined quality metrics (such as readmissions, complications, patient experience, and timely follow-up), the hospital keeps the difference as a shared savings payment. If spending exceeds the target or quality scores fall short, the hospital must repay CMS a portion of the difference, up to the program’s maximum downside risk.

The model includes three risk tracks that hospitals select when participating:

• Track 1 is upside-only: no risk of payback, with gains capped at 10%.
  Track 2 includes both upside and downside risk:
  • Gains capped at 5%
  • Losses capped at 5%
  • (CMS will adjust negative repayment amounts by care quality metrics up to 15%)
• Track 3 also carries two-sided risk, but with wider caps:
  • Gains capped at 20%
  • Losses capped at 20%
  • Quality metrics adjustment applies to both positive and negative reconciliation amounts (up to 10%)

The TEAM model allows hospitals to share reconciliation payments with other providers across the care continuum, enabling partners to share in both the upside and downside risk. Ultimately for health systems, selecting the right post-discharge partners will be a critical decision.

Why DocGo Should Be On Your TEAM

DocGo’s hybrid in-home and virtual care model is designed to align perfectly with the demands of TEAM. Our approach addresses the two most pressing challenges for health systems: engaging hard-to-reach patients and ensuring coordinated, high-quality care beyond a hospital’s four walls. And our TEAM-ready model can help hospitals effectively manage both cost and quality of care in a number of ways:

1. Epic Integration: Staff place orders for discharge and post-discharge services directly in Epic, one of the most widely used electronic health record (EHR) systems, via DocGo’s Dara software.
2. Discharge Coordination: DocGo facilitates EMS transport, the setup of remote patient monitoring (RPM) equipment, and warm handoffs to schedule a Transitional Care Management (TCM) visit.
3. In-Home TCM Visit: Within 48 hours, our mobile health clinician visits the patient at home, under the guidance of a remote Advanced Practice Provider (APP), to review vitals, reconcile medications, and initiate any needed follow-up.
4. Ongoing Coaching: Telephone or video visits provide education, coaching, and RPM-supported monitoring.
5. Additional Visits: Based on patient needs, additional visits can be scheduled for in-home, telephonic or electronic outreach as needed.
6. Data & Reporting: Real-time dashboards, EHR integration, and leadership check-ins ensure visibility into outcomes and KPIs.

The Bottom Line

With TEAM’s financial stakes hinging on what happens after discharge, hospitals will need stronger partnerships and better tools to manage care beyond their walls. Success will depend on engaging patients early, coordinating post-acute services, and maintaining quality throughout the recovery period.

By supporting these efforts through in-home care delivery, connected technology, and data-driven coordination, DocGo can help hospitals meet TEAM’s requirements while advancing a broader goal: a healthcare system that rewards better outcomes for patients. quickly respond to the data is the first step to an era where heart failure management resembles proactive care rather than reactive crisis management.”