Because the Facilities for Medicare & Medicaid Providers strikes ahead with the Transforming Episode Accountability Model (TEAM), hospitals are taking up monetary accountability for Medicare’s most advanced and dear surgical episodes. Hospitals that don’t take motion to realize higher affected person outcomes might discover themselves owing Medicare cash.
Whereas TEAM shifts significant threat to hospitals, it additionally creates a chance usually lacking in value-based care: true collaboration with specialists. TEAM design permits hospitals to align incentives with physicians by means of Collaboration Agreements, both passing on damaging or constructive funds primarily based on the goal surgical episode price. Whether or not TEAM succeeds—or breaks down below strain—will rely upon how specialists, hospitals and first care physicians work collectively.
Too usually, Worth-Based mostly Care efforts depend on doctor scoring as a lever for lowering variation in prices by supplier. Comparative price or high quality rankings could also be framed as suggestions, however they not often really feel collaborative. As an alternative, they sign fault and create resistance—an strategy borrowed from payer reporting fairly than partnership. Underneath TEAM, this mindset dangers undermining participation earlier than it begins.
If specialists view Collaboration Agreements as punitive or one-sided, they could decide out completely, leaving hospitals to soak up monetary threat or lose surgical quantity. That final result serves nobody. Surgical episode prices are pushed by components throughout the continuum—from affected person readiness and hospital processes to post-acute providers—lots of which sit outdoors any single doctor’s management.
A simpler path ahead is shared inquiry. By utilizing trusted, built-in knowledge to grasp the place variation happens and why, hospitals and physicians can deal with enhancing processes, stopping issues, and coordinating care—notably earlier than surgical procedure. When Collaboration Agreements are constructed round transparency, studying, and shared accountability, TEAM can operate because it was supposed: a framework for collaboration, not management.
Six Suggestions for Win-Win TEAM Collaboration Agreements with Specialists
The hospital, surgical staff, the affected person, and the affected person’s main care doctor are the central actors in TEAM. Research present that price variation throughout TEAM procedures is basically pushed by issues that result in prolonged hospital stays, readmissions, or greater ranges of service. Some sufferers enter surgical procedure with medical circumstances that improve the danger of issues, making sturdy main care–medical staff communication important to TEAM success. The next greatest practices in hospital–specialty doctor collaboration must be mirrored in Collaboration Agreements.
1. Be sure that your Collaboration Agreements embody the total complement of the medical staff, together with surgeons, anesthesiologists, and consulting medical specialists. You need to be physician-group-focused and embody apply directors as a part of the implementation to assist physicians.
2. Plan for full aggregation and integration of EHR (each doctor and hospital) knowledge and CMS claims knowledge for viewing full surgical episodes of care. Your data-sharing functionality is an important software you will have for price management, and data-sharing must be a part of each Collaboration Settlement with specialists. Why is the EHR knowledge important? Can’t you simply use CMS claims knowledge? No, and right here’s why: the claims knowledge will lack affected person threat and different medical necessities to your inquiry into prices.
3. As allowed by CMS, contemplate financing the aggregation of specialty knowledge to your collaborating practices. Most personal practices is not going to be keen to do that on their very own, and the inclusion and analysis of the specialists’ personal knowledge might be important to their belief of the analytics of the surgical episode. There might be boundaries to barter.
4. Don’t “rating” physicians by price or create analytics that appear to do that. Analytics that target specialists fairly than the episode itself and its explicit price drivers will really feel punitive. As an alternative, use your price variation curve to ask suggestions on improved processes and different options.
5. Facilitate prevention of affected person issues previous to surgical procedure by means of advance referrals to main care physicians (and pre-treatment, when potential). That is your largest probability to make sure that the affected person is ready for surgical procedure medically. The potential delay in surgical procedure might be effectively definitely worth the effort.
6. Use Collaboration Agreements to beat limitations to adopting ERAS rules.
Incorporating Enhanced Restoration After Surgical procedure (ERAS) expectations into Collaboration Agreements may also help tackle long-standing operational and cultural challenges which have restricted the implementation of those evidence-based requirements. Evaluating efficiency on the episode stage permits hospitals and specialists to raised perceive how standardized care pathways affect each price and high quality outcomes.
TEAM doesn’t require hospitals to “handle” specialists—it requires them to associate with them. Collaboration Agreements that emphasize transparency, shared studying, and joint problem-solving create the circumstances for sustained price management and higher outcomes, with out eroding doctor belief. When hospitals focus much less on attribution and scoring and extra on understanding the total episode of care, TEAM turns into what it was supposed to be: a framework for collective accountability and coordinated enchancment. The hospitals that strategy TEAM as a relationship mannequin—not only a reimbursement mannequin—might be greatest positioned to succeed.
About Theresa Hush
Theresa Hush is a healthcare strategist and alter skilled with expertise throughout the healthcare spectrum. Terry’s broad vary of well being care expertise contains govt positions in public, non-profit and personal sectors, from each payer and supplier sides of the enterprise, peppered with well being care public coverage and regulation expertise. She is co-founder and CEO of Roji Health Intelligence, fashioned in 2002 to assist suppliers implement Worth-Based mostly Care with expertise and data-guided providers.
