What TEAM Actually Is (In Plain English)
Starting January 2026, Medicare is testing a new payment approach called TEAM (Transforming Episode Accountability Model) in about 741 hospitals across roughly 188 geographic areas. Let's take a look at the revised approach:
The Basics:
- Hospitals become financially responsible for their surgical patients' total care costs for 30 days after discharge
- Only covers 5 surgery types: joint replacements, hip fractures, spine fusions, heart bypass, and major bowel procedures
- Runs for 5 years (2026-2030) as a test program
- Only affects 25% of U.S. markets
The SNF Connection:
If hospitals are penalized for high costs (including readmissions), they'll pressure SNFs to keep patients healthier and out of the hospital. If they save money, they might share some savings with high-performing SNF partners.
Important: 3-Day Stay Waiver
Under TEAM, hospitals can discharge surgical patients directly to SNFs without the traditional 3-day inpatient hospital stay requirement. To qualify:
- Patient must meet TEAM eligibility criteria
- Must have a qualifying outpatient procedure OR hospital inpatient stay
- SNF admission must occur within 30 days of hospital discharge
- SNFs must submit claims with the required TEAM demonstration code A9 to receive payment
This waiver gives hospitals more flexibility in discharge planning and could increase referrals to SNFs for appropriate surgical patients.
The Real Numbers: How Big Is This Really?
Let's cut through the noise and look at what TEAM actually means for a typical SNF.
| If You're NOT in a TEAM Market (75% chance): | If You ARE in a TEAM Market: |
|---|---|
|
For a typical 100-bed SNF, TEAM affects:
|
That's it. Not hundreds of patients. Not millions of dollars. Just 30-40 patients who need excellent post-surgical care.
Your Three-Step Action Plan
Step 1: Find Out Your Status (Do This Week)
Call your referring hospitals and ask:
- "Are you required to participate in the Medicare TEAM model?"
- "Which surgical procedures do you perform that are included?"
- "When can we discuss partnership opportunities?"
Quick Check: If your hospitals don't know about TEAM or aren't participating, you can stop worrying and revisit this next year.
Step 2: Size Your Opportunity (Next Month)
If you're affected, pull these numbers:
- How many joint replacement patients did you admit last year?
- How many hip fracture patients?
- What about spine surgery patients?
- What's your readmission rate for these patients?
The Math: Add these up. If it's less than 20 patients annually, TEAM is a minor consideration. If it's 40+, it deserves focused attention.
Step 3: Take Proportional Action (Next 3 Months)
For Small Impact (Under 20 TEAM Patients/Year):
- Assign a point person to monitor TEAM
- Join one hospital partnership meeting
- Make minor tweaks to existing processes
- Investment needed: Under $25,000
For Moderate Impact (20-40 TEAM Patients/Year):
- Create a surgical recovery quality team
- Develop basic readmission prevention protocols
- Track outcomes for these specific patients
- Negotiate a simple gainsharing agreement
- Investment needed: $50,000-75,000
For Significant Impact (40+ TEAM Patients/Year):
- Hire a part-time care coordinator
- Implement predictive analytics for readmission risk
- Create specialized post-surgical programs
- Negotiate comprehensive partnership agreements
- Investment needed: $75,000-125,000
The Five Things That Actually Matter
1. Readmission Prevention: This is Job 1. Keep surgical patients from bouncing back to the hospital within 30 days. This means catching problems early and managing them in your facility.
2. Communication with Hospitals: Daily updates on high-risk patients. Quick calls when something seems wrong. Clear documentation of everything. Hospitals need to trust you're watching their patients closely.
3. Efficient but Safe Discharges: Pressure to reduce length of stay is real, but not dramatic. If average stay drops from 20 to 18 days, ensure patients are truly ready to go home.
4. Quality Metrics That Count: Focus on:
- Functional improvement (Can they walk? Climb stairs?)
- Infection prevention (especially surgical sites)
- Pain management
- Medication accuracy
5. Partnership Agreements: Get it in writing:
- What percentage of savings you'll receive (aim for 5-10%)
- Minimum referral commitments
- Support for new capabilities you need
- Quality benchmarks that trigger bonuses
Common TEAM Myths vs. Reality
| Myth | Reality |
|---|---|
| TEAM will devastate SNF revenues | It affects 2% of your business |
| We need to transform our entire operation | You need focused improvements for 30-40 patients |
| Hospitals will cut us out entirely | They need SNF partners who deliver quality outcomes |
| This requires massive technology investments | Basic tracking and communication tools are sufficient |
| TEAM is everywhere starting in 2026 | 75% of markets aren't included at all |
What Success Actually Looks Like
For SNFs in TEAM markets, winning means:
- Becoming the "preferred partner" for 1-2 local hospitals
- Reducing surgical patient readmissions by 20-30%
- Earning $20,000-50,000 in annual gainsharing
- Building capabilities that help with all patients, not just TEAM
This is achievable without:
- Massive organizational restructuring
- Million-dollar technology platforms
- Laying off staff or cutting services
- Panicking about survival
Red Flags: When to Worry More
You should pay extra attention if:
- Surgical referrals are 30%+ of your admissions
- Your main hospital is a major orthopedic center
- Your readmission rates exceed 20%
- You're already struggling with quality scores
- Multiple referring hospitals are in TEAM
Even then, this is about focused improvement, not an existential crisis.
The Bottom Line for SNF Leaders
TEAM is like getting a new, pickier customer who represents 2% of your business. You want to serve them well, but you don't redesign your entire operation for them.
If you're in a TEAM market:
- Size the real impact (probably 30-40 patients)
- Make proportional improvements (spend $2,000-3,000 per affected patient)
- Focus on readmission prevention
- Negotiate fair partnerships
- Use this as practice for future value-based care
If you're not in a TEAM market: Watch, learn, and gradually improve. You have plenty of time.
How can SHP help?
TEAM focuses exclusively on people with Traditional Medicare/Fee-for-Service undergoing surgical procedures. The model does NOT include:
- Medicare Advantage patients
- Commercial insurance patients
- Medicaid patients
- Dual eligible patients in managed care plans
You Already Have What TEAM Hospitals Need
SNFs preparing for TEAM partnerships don't need new systems—SHP's existing analytics directly address TEAM's core requirements. Here are three tools that give you immediate TEAM readiness.
Unplanned Re-hospitalization Trend Report - Short Stay – Your TEAM Scorecard
- What It Does: Tracks 30-day readmissions for Traditional Medicare patients—exactly what TEAM measures.
- TEAM Application: This IS your TEAM metric. When hospitals ask about readmission rates, pull this report. If you're below 18%, you're already outperforming.
- Quick Start: Check your current rate and 12-month trend. Print it. This is page one of your hospital presentation.
Length of Stay (LOS) Report – Find Your TEAM Patients
- What It Does: Lets you drill down to identify specific surgical populations and their outcomes.
- TEAM Application: Filter for the five TEAM surgeries (joint replacement, hip fracture, spine, cardiac, bowel) to see exactly how many TEAM patients you manage and their average stay length.
- Quick Start: Run report → Filter for surgical types → Count Medicare FFS patients. Now you know if you have 5 or 50 TEAM patients annually.
MDS Audit Data Points Report – Track Your Risk Indicators
- What It Does: Provides filterable access to MDS Section J data (J2000-J5000) by Assessment Reference Date (ARD).
- TEAM Application: Section J contains critical post-surgical monitoring elements like pain indicators (J0100-J0200), fall history (J1700-J1900), and other health conditions. Filter this data for your surgical patients to show hospitals how closely you monitor risk factors.
- Quick Start: Filter for surgical residents → Review Section J indicators → Flag any patients with multiple risk factors. This becomes your early warning system.
Final Thought: Keep Calm and Carry On
TEAM is neither a goldmine nor a disaster for SNFs. It's a modest change affecting a small slice of patients that requires proportional response. Don't ignore it, but don't lose sleep over it either.
For most SNFs, TEAM means getting a bit better at what you already do: taking care of surgical patients and keeping them healthy. The facilities that approach this calmly and strategically will find it's completely manageable.
Remember: We're talking about 30-40 patients out of 400-500. That's a focused quality improvement project, not a revolution.
Take a deep breath. You've got this.
The key to TEAM success? Right-size your response to match the actual impact. For most SNFs, that means targeted improvements for a small patient population, not wholesale transformation. Focus on what matters: preventing readmissions for 30-40 surgical patients a year.
Your 60-Day Quick Start Guide
| Days 1-20: Discovery | |
|---|---|
| ☐ | Confirm which hospitals are in TEAM |
| ☐ | Count your affected patients |
| ☐ | Calculate your current readmission rate |
| ☐ | Identify your biggest opportunities |
| Days 21-40: Planning | |
| ☐ | Set improvement targets |
| ☐ | Budget proportional investments |
| ☐ | Draft partnership proposals |
| ☐ | Assign team responsibilities |
| Days 41-60: Action | |
| ☐ | Launch pilot improvements |
| ☐ | Begin hospital negotiations |
| ☐ | Start tracking key metrics |
| ☐ | Train staff on changes |
Get TEAM-Ready Before Your Hospital Asks
When hospitals start TEAM partnerships in January 2026, they'll want data on your surgical readmission rates, patient volumes, and clinical outcomes. Can you answer those questions today?
SHP's Real-Time Analytics gives you immediate visibility into the metrics TEAM hospitals care about:
- PDPM LOS Report drills down to your specific TEAM surgery types—hip fractures, joint replacements, spine procedures, cardiac, and major bowel surgeries—so you know exactly how many TEAM patients you manage
- MDS Audit Data Points tracks Section J risk indicators (pain levels, fall history, health conditions) that help you identify which surgical patients are at risk for readmission
- Rehospitalization tracking for your Traditional Medicare population—the foundation of TEAM performance measurement
Request a demo to see how SNFs are using these reports to:
- Size their TEAM opportunity in minutes, not weeks
- Prepare data-driven presentations for hospital partnership meetings
- Identify their 30-40 TEAM patients and track the outcomes that matter
Get the analytics you need to be a preferred TEAM partner—before your competitors do.
Additional TEAM Resources:
- CMS TEAM Model Page: cms.gov/priorities/innovation/innovation-models/team-model
- TEAM Participant Hospital List: cms.gov/team-model-participant-list
- TEAM FAQs: cms.gov/team-frequently-asked-questions
- Email CMS TEAM Questions: CMMI_TEAM@cms.hhs.gov
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