On August 1, 2024, Centers for Medicare & Medicaid Services (CMS) released its FY2025 Hospital Inpatient Prospective Payment System (IPPS) for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System final rule.
As part of this rule, CMS has finalized a new mandatory episode-based alternative payment model known as the Transforming Episode Accountability Model (TEAM). While this model shares similarities with other alternative payment models, such as the Comprehensive Care for Joint Replacement Model (CJR) or the Bundled Payments for Care Improvement-Advanced (BPCI-A), it also contains unique elements and a number of significant details.
Download our TEAM Complete Guide for Orthopedic Care here.
Perhaps most unique in this mandatory model is the direct tying of reimbursement to pay-for-performance quality measures, including patient-reported outcome measures (PROMs). This means hospitals will not only have to worry about managing episode-related costs, but also care quality outcomes as measured by both objective metrics and by patients themselves. This includes:
- Fee-for-service (FFS) expenditures relative to a “target price,” and
- Quality of care as measured by quality measures, including readmissions, patient safety, and the total hip/knee arthroplasty patient-reported outcome performance measure (THA/TKA PRO-PM).
TEAM is an immense and comprehensive payment model. Keeping track of the various components and requirements is no small feat, especially considering this model covers 5 different episode categories, from orthopedic to cardiac episodes. Find everything you need to know in our TEAM Complete Guide for Orthopedic Care.
Hospitals with previous experience in mandatory alternative payment models and those who have had many years of experience with effective quality reporting and PRO collection will likely find the shift to TEAM as a relatively small lift. In fact, many of these hospitals already collect and report the required data on all of their patients and seamlessly meet the most recent regulatory data collection and quality requirements. To see some examples of such organizations, access our latest case study here.
As TEAM is a two-sided risk model, being ahead of the curve could translate to many millions in financial incentives or penalties for hospitals at a time when cost containment and resource allocation challenges are top of mind for healthcare executives. As CMS regulations continue pushing all providers toward full accountability for both cost and quality of care, enhancing your PROs collection, digital patient management, and remote care capabilities can prepare you for the future of value-based orthopedic care.
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