Transforming Episode Accountability Model (TEAM): Performance in Skilled Nursing FacilitIES within new CMS Alternative Payment Model
On July 31, 2025, CMS published the FY 2026 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule, which included final updates to TEAM policies.
In the Transforming Episode Accountability Model (TEAM), selected acute care hospitals coordinate care from surgery through 30 days post-hospitalization for people with Original Medicare undergoing one of five surgical procedures: lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedures. TEAM is a mandatory model and will run for five performance years from January 1, 2026, to December 31, 2030, in selected Core-Based Statistical Areas nationwide.
According to CMS, "...The model is designed to complement longitudinal care management through policies that align with Accountable Care Organizations (ACOs) and promote primary care referrals. Under TEAM, a person receiving care from (aligned to) providers in an ACO will be in an episode if they receive one of the surgeries included in TEAM at a hospital that is participating in TEAM. Allowing a person with Original Medicare to be included in both TEAM and ACO initiatives will encourage provider collaboration. Also, TEAM will require hospitals to refer patients to primary care services to support continuity of care, preventive care, and positive long-term health outcomes..." https://www.cms.gov/priorities/innovation/innovation-models/team-model
As hospitals enter and more prepare for the CMS TEAM model, many are discovering a familiar challenge: strategy is clear at the executive level, but execution—particularly in post-acute care—can be particularly challenging. In value-based models, performance is no longer defined at discharge. It extends into the skilled nursing facility (SNF), home health, and the broader post-acute portion of the ecosystem. Under TEAM, gaps in SNF performance - variation in length of stay, inconsistent clinical management, and gaps in network alignment - can undermine otherwise strong hospital performance. The issue is not awareness. Most health systems understand the importance of post-acute care: it has been established that SNF represents the single largest Post-Acute Care expense for Medicare PAC (Ackerley DC, Grabowski DC. N Engl J Med 2014; 370:689-691). The issue is operational integration and collaborative management. High-performing post-acute networks do not happen organically—they are designed, structured, and actively managed.
A critical but often overlooked component is the clinical care model inside the SNF. Success depends on intentional coordination between nursing and PT/OT teams, with a shared focus on measurable functional improvement and safe discharge home. Functional improvement must be owned by the care team at-large to positively impact the patient's experience and their outcomes, including reduced readmissions and an appropriate length of stay.
At Vantage Clinical Partners, we focus specifically on closing that gap between strategy and execution using our direct experience in:
Designing and implementing high-performing Post-Acute Networks
Structuring SNF network agreements tied to measurable quality and outcomes
Deploying clinical care models directly within SNFs
Engaging Directors of Nursing and Administrators to drive meaningful behavior change
Leading and operating within Accountable Care Organization (ACO) environments
Success under TEAM will depend on more than preferred provider networks. It will require aligned care models, coordinated therapy models, and durable partnerships with SNF operators with aligned incentives. The opportunity is clear - post-acute care must be seen as a strategic extension of a hospital delivery system. Although the TEAM impacts only five surgical procedure areas and is mandatory in approximately 700 US hospitals, the writing is on the wall unmistakenly pointing to further expansion of this model to more diagnoses and more hospitals.
Beth Papetti, MBA FHM
Prinicpal & Chief Operating Officer