Anesthesia Services and the Transforming Episode Accountability Model
How your anesthesia department can support the “TEAM” effort
The Centers for Medicare and Medicaid Services’ (CMS) new Transforming Episode Accountability Model (TEAM) is about to change the rules for perioperative care across five high-impact surgical episodes. Beginning in 2026, designated hospitals will carry more responsibility for quality, complications, and total episode spending. This means anesthesiology can no longer be viewed as a narrow, intraoperative service. Success will depend on anesthesiology stepping into a broader leadership role in perioperative optimization, partnering on data and quality reporting, and helping to design workflows that support safer care, fewer readmissions, and stronger financial performance.
What’s Happening
In August 2024, CMS finalized a new mandatory model – the “Transforming Episode Accountability Model,” more commonly known as “TEAM.” The model focuses on five surgical episodes of care:
- Coronary Artery Bypass Graft (CABG)
- Major Bowel Procedures
- Lower Extremity Joint Replacement (LEJR)
- Surgical Hip and Femur Fracture Treatment (SHFFT)
- Spinal Fusion
Beginning January 1, 2026, certain acute care hospitals (selected by CMS) will become mandatory participants in the model. The program will run for five years with various tracks for participation involving both upside and downside risk for most participants. Hospitals will be responsible for the total Medicare Fee for Service spending during the episode of care, with limited exceptions. One of the primary goals of the model is to ensure coordinated high-quality patient care during and after the designed surgical episodes of care.
How To Prepare
Your anesthesia team is likely already engaged in standard “best practices” when a patient is in the operating room. Common quality measures tied to anesthesia care typically include:
- Utilization of a multimodal pain management approach
- Maintenance of normothermia
- Prevention of post-operative nausea and vomiting
- Collection and action on patient feedback regarding their anesthetic experience
The expectations of this new model in terms of quality measure reporting may be new for some anesthesia teams, specifically:
- A focus on prevention of readmission
- Targeted feedback for total hip and/or total knee arthroplasty patients
- Reporting of specific safety and adverse events
- Prevention of falls with injury
- Reporting on postoperative respiratory failure
- Risk-standardized death rate among surgical inpatients with complications (failure to rescue)
The Next 5 Years
Year 1: Reporting will be required for three specific measures.
Year 2: The CMS Patient Safety and Adverse Events Composite Measure will be replaced by the three “hospital harm” measures:
- Falls with Injury
- Postoperative Respiratory Failure
- Thirty-day Risk Standardized Death Rate among Surgical Inpatients with Complications).
Year 3: The final measure relating to Information Transfer for LEJRs and Spinal Fusion (outpatient) will be added. These measures are sourced from the Inpatient Quality Reporting program and measure specifications can be located on the CMS website.
Year 4-5: The measures should remain stable for years 4-5 with minimal changes expected.
How Anesthesiology Can Lead
Perioperative patient optimization is an important component to help hospitals succeed in meeting these new measures, as well as reducing unanticipated expense during the episode of care. Your anesthesia team can add tremendous value by leading or guiding preoperative optimization efforts via a structured preoperative process.
Standard guidelines can identify and escalate higher-risk patients for more immediate evaluation by a member of the anesthesia team to prevent same-day cancellations or suboptimal surgical outcomes.
If your organization has the infrastructure to implement a perioperative surgical home (PSH) program with an integrated perioperative care clinic (PCC), the anesthesia team can act as leaders in the PCC along with a multidisciplinary cadre of consultative services, such as internists, cardiologists, pulmonologists, endocrinologists, geriatricians, pharmacists, nurse educators, nutritionists, physical therapists, and social workers.
Your anesthesia team is an invaluable knowledge resource and contributor for developing an accurate data collection and reporting infrastructure. Metrics should be clearly defined and tracked, with frequent and transparent information-sharing sessions for key stakeholders. While many EMRs will passively collect data relating to quality measures, your anesthesia team can also capture and analyze adverse events in a non-punitive environment using an adverse-event reporting platform.
It is advised that significant adverse events be fully reviewed by anesthesia leadership and learnings applied for future patient encounters. Considering the challenging state of anesthesia staffing, there is value in incorporating TEAM-related activities into existing workflows whenever possible; ideally utilizing additional administrative staff to support non-clinical activities.
TEAM implementation is coming. As your facility readies for this requirement, the anesthesia department has a strong role to play throughout the planning process and can be an integral part of ongoing discussions as data becomes available.
Leverage Experts
As TEAM goes live, hospitals that leverage their anesthesia team as leaders in perioperative optimization, quality reporting, and data driven improvement are better positioned to thrive under these new expectations. Your anesthesia partner is a powerful resource to ensure a solid optimization framework. They can provide review and implementation support tied to relevant quality measures and help establish the data collection and feedback structure needed for reliable reporting, as well as overall performance improvement.
If your anesthesia team would benefit from support in this area, our anesthesia consulting team can help. With clinical experts as part of a national award-winning quality program, we bring decades of insight in quality innovation, data collection and analysis, program development, and knowledge tied to CMS complexities. We can help you build a sustainable approach where TEAM becomes a true win/win, improving outcomes and care coordination while protecting performance.