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CMS TEAM Model: What 741 Hospitals Must Do Now — The Mandatory Bundled Payment That Changes Orthopedic Practice
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CMS TEAM Model: What 741 Hospitals Must Do Now — The Mandatory Bundled Payment That Changes Orthopedic Practice

January 2026: CMS launched TEAM — the first mandatory bundled payment model covering joint replacement, spinal fusion, and CABG at 741 hospitals. PROM collection is required, 30-day episodes are tracked, and there's zero infrastructure funding. Here's what orthopedic practices need to do now.

policypromirehabjoint-replacement

The Letter That Changed Everything

In late 2025, administrators at 741 hospitals across the United States received a notification from CMS: starting January 1, 2026, their facility would be participating in the Transforming Episode Accountability Model — TEAM. Not invited. Not offered. Participating.

For the first time in orthopedic bundled payment history, this is not voluntary. There is no opt-out. And the requirements include something most of these hospitals have never done systematically: collecting Patient-Reported Outcome Measures before and after surgery, at scale.

This article is not a policy summary. It's an operational guide for what these hospitals — and the surgeons who operate in them — need to do right now.

What Is TEAM?

TEAM is a mandatory, 5-year bundled payment model launched by the Centers for Medicare & Medicaid Services on January 1, 2026, running through December 31, 2030[1].

SpecificationValue
Participating hospitals741 IPPS hospitals in selected CBSAs
Participation typeMandatory (no opt-out)
Duration5 years (Jan 2026 – Dec 2030)
Covered proceduresLower extremity joint replacement (LEJR), hip/femur fracture treatment, spinal fusion, CABG, major bowel procedure
Episode windowSurgery + 30 days post-discharge
Target priceCovers Medicare Parts A + B (surgery, hospital stay, all post-discharge care within episode)
PROM requirementMandatory — ≥50% matched pre/post completion
PROM infrastructure fundingNone

The term "CBSA" — Core Based Statistical Area — refers to geographic regions that CMS selected for mandatory participation. If your hospital is in a selected CBSA, you are in TEAM. The selection criteria are based on regional market characteristics, not individual hospital performance[2].

Why TEAM Is Different from BPCI-A

Hospitals familiar with CMS's Bundled Payments for Care Improvement Advanced (BPCI-A) model may assume TEAM is more of the same. It is not.

FeatureBPCI-ATEAM
ParticipationVoluntaryMandatory
Episode window90 days30 days
PROM collectionNot requiredRequired (≥50% match rate)
Risk tracksSingle3 tracks (Glide Path → Standard → Advanced)
Scope29 clinical episodes5 surgical categories
Financial riskShared savings/lossesShared savings/losses with stop-loss at 20%
Health equity adjustmentNoYes — dual-eligible and LIS adjustments

The 30-day episode window is shorter than BPCI-A's 90 days, but the combination of mandatory participation, mandatory PROM collection, and escalating risk tracks makes TEAM the most consequential bundled payment model CMS has ever launched for surgical care[3].

The PROM Mandate — And the 25% Problem

TEAM requires hospitals to collect PROM data using KOOS, JR. (for total knee arthroplasty) and HOOS, JR. (for total hip arthroplasty), with a matched pre-operative and post-operative completion rate of at least 50%[4][5].

Here is the problem: most hospitals are nowhere near 50%.

According to the American Joint Replacement Registry (AJRR) 2024 Annual Report, only 44% of member institutions have submitted any PROM data at all, and the one-year post-operative response rate is just 25-32%[6].

A survey of 612 AAOS members reveals why[7]:

  • 72% cite staff burden as the primary barrier
  • 69% point to patient completion challenges
  • 47% cite cost

Paper questionnaires achieve a completion rate of 9.5%. Electronic collection improves this to 53.85% — but this barely clears the 50% threshold, and only for the initial collection point[8].

CMS provides no funding for PROM collection infrastructure. Hospitals must build or buy their own systems — and they needed them yesterday.

For a deep dive into PROM tools, collection barriers, and digital solutions, see Why Your Surgeon Should Be Tracking PROM.

The Negative-Profit Chain: Why This Is a Financial Crisis

This is the section that should keep hospital CFOs awake at night.

Under TEAM, hospitals own every dollar of Medicare Parts A and B spending during the 30-day episode window. If total episode costs exceed the target price, the hospital absorbs the difference — up to a 20% stop-loss cap.

Now consider the reality of modern orthopedic practice: 34% of total knee replacements in the US are already same-day discharge, and that number is projected to reach 51-60% by 2026[6][9]. Mean length of stay for TKA has dropped to 0.89 days — down from 3.5 days in 2010.

Here is the negative-profit chain:

  1. Patient goes home on Day 0 or Day 1 — hospital has no direct monitoring capability
  2. Day 8: wound complication develops — patient doesn't know if it's normal or dangerous
  3. Day 10: patient visits ED — ED evaluation, possible readmission
  4. CMS counts the ED visit and readmission in the episode cost — this is not a separate billing event
  5. Episode cost exceeds target price — hospital pays the difference
  6. That TKA's margin goes to zero — or negative

A single unplanned readmission can add tens of thousands of dollars to the episode cost. For a TKA where the target price is already tight, one readmission within the 30-day window can erase the entire surgical margin.

Remote patient monitoring breaks this chain. Evidence suggests RPM can reduce post-surgical readmissions significantly[9]. In the TEAM context, RPM is not a clinical nicety — it is margin insurance.

For more on the same-day discharge trend and why it makes remote monitoring essential, see Same-Day Joint Replacement Is Here.

What 741 Hospitals Need to Do Now

If your hospital is in a TEAM-selected CBSA, here is the operational checklist for 2026:

1. Stand up a PROM collection system — immediately

  • Choose electronic collection (paper achieves 9.5% — mathematically impossible to hit 50%)
  • Deploy KOOS, JR. (TKA) and HOOS, JR. (THA) as CMS-designated instruments
  • Consider adding PROMIS CAT for more frequent monitoring — 4 questions, 45 seconds, zero ceiling/floor effects[10]
  • Use text/SMS reminders — proven to significantly boost completion rates[8]
  • Collect baseline PROMs pre-operatively (required for matched pair)

2. Build a post-discharge monitoring workflow

  • Implement remote monitoring for the 30-day episode window at minimum
  • Focus on wound complications — they account for a majority of 90-day readmissions after outpatient TKA[6]
  • Enable patient-initiated alerts (pain spikes, wound concerns) that trigger clinical review
  • Establish escalation protocols: which alerts go to the nurse coordinator, which go to the surgeon

3. Use baseline PROMs for risk stratification

  • Machine learning models using biopsychosocial data can predict recovery trajectories with AUC of 0.888[11]
  • Key predictors: preoperative functional scores, age, comorbidity count, and preoperative mental health status
  • High-risk patients identified pre-operatively can receive intensified monitoring — before the episode clock starts

4. Establish care coordination across the episode

  • The 30-day window includes skilled nursing facilities, home health, physical therapy, and ED visits
  • Coordinate with post-acute care providers — their costs count against your target price
  • Track episode costs in near-real-time, not retrospectively

How iRehab Addresses the TEAM Challenge

iRehab is De Novo Orthopedics' platform for post-surgical remote monitoring and rehabilitation. In the TEAM context, it addresses the two core requirements simultaneously:

PROM collection:

  • Built-in PROMIS Global-10 — sent via QR code, link, or email; patients complete on their phone
  • Automatic T-score calculation — physical and mental health computed separately, benchmarked against US population norms
  • Time-series tracking — surgeons see a trend line, not isolated numbers
  • Designed to support KOOS, JR. and HOOS, JR. at CMS-mandated milestones (preop, 6 weeks, 3 months, 1 year)

Post-discharge monitoring:

  • Daily exercise completion tracking within the 30-day episode window
  • Pain score monitoring with alert thresholds
  • Wound photo submission for remote assessment
  • PROM scores, rehab data, and clinical alerts on a single timeline

The goal is not to replace clinical judgment. It is to ensure that the 30-day post-discharge window — the window that now determines surgical profitability — is not a blind spot.

In the future, when Discovery R's implantable sensors generate real-time biomechanical data, the picture will be even more complete: objective tissue forces cross-referenced with patient-reported experience. But that is tomorrow's story. The TEAM mandate is today's problem.

The Global Signal

CMS does not operate in a vacuum. When the world's largest single-payer ties bundled payments and PROM collection to reimbursement, other health systems take notice.

The pattern is consistent: CMS leads, and within 3-5 years, major health systems in Europe, Australia, and Asia follow with analogous quality measurement requirements. The UK's NHS already ties PROMs to hospital performance metrics. Australia's ACORN registry is expanding PROM integration.

For orthopedic practices outside the United States — including in Taiwan, where NHI policy increasingly references CMS quality frameworks — TEAM is a directional signal. The question is not whether PROM-linked reimbursement is coming. The question is whether your infrastructure will be ready when it arrives.

This Is Not Optional

TEAM represents a fundamental shift in how orthopedic surgical quality is measured and paid for. For the first time:

  • Participation is mandatory — 741 hospitals, no opt-out
  • PROM collection is required — not aspirational, not voluntary
  • Post-discharge costs are the hospital's problem — every readmission counts
  • Infrastructure funding is zero — CMS requires it but does not pay for it

The hospitals that will thrive under TEAM are those that treat post-surgical monitoring as core infrastructure — not an afterthought, not a compliance checkbox, but the system that protects surgical margins in a bundled payment world.

The 30-day episode window started on January 1, 2026. The clock is already running.

References

  1. CMS TEAM Model official page. Centers for Medicare & Medicaid Services. Link

  2. TEAM Frequently Asked Questions. CMS. Link

  3. New TEAM Payment Model Brings Opportunities, Challenges for Surgeons and Hospitals. ACS Bulletin. Jan 2025. Link

  4. New CMS policy mandating PROM collection for THA/TKA. 2024. PubMed

  5. AAOS resources support PROM adoption amid new CMS requirements. AAOS Now. Jan 2026. Link

  6. 2024 AJRR Annual Report Highlights. PMC

  7. Patient-Reported Outcome Measure Collection and Use Among AAOS Members. JAAOS. 2024. Link

  8. Text messaging improves PROM completion rates. 2024. PubMed

  9. The Case for Same-Day Discharge in Outpatient Knee Replacement. OrthoNet AI. Mar 2026. Link

  10. Psychometric Properties and Feasibility of PROMIS CATs. JBJS. Nov 2025. Link

  11. Biopsychosocial ML models predict improvement after TKA. Scientific Reports. 2025. Link