Anesthesiologists have previously pioneered forward-thinking initiatives such as the perioperative surgical home, but these models were not always embraced by hospitals. The new CMS (Centers for Medicare & Medicaid Services) Transforming Episode Accountability Model (TEAM) model has the potential to reverse this trend. Faced with financial pressures, hospitals will now rely on anesthesiologists’ expertise in perioperative care. Covering 25% of all U.S. hospitals and three major surgical specialties, the TEAM model marks a pivotal shift in healthcare innovation.

What Is the CMS TEAM Model?

The TEAM model is a mandatory, episode-based payment model for Medicare fee-for-service cases that will run from Jan. 1, 2026 to Dec. 31, 2030. It will be implemented at 740 hospitals, representing about 25% of all U.S. hospitals. The model covers the following surgical procedures:

• orthopedic, lower extremity joint replacement surgery (LEJR);
• orthopedic, surgical hip/femur fracture treatment;
• orthopedic, spinal fusion;
• cardiac, coronary artery bypass graft (CABG); and
• colorectal, major bowel procedures

The bundled payment episode starts on the day of admission for inpatient cases or the date of surgery for outpatient cases, and continues through 30 days post-discharge. This is the largest mandatory bundled payment model to date, impacting millions of Medicare patients.

Key Components of the TEAM Model

Anesthesiologists are well positioned to educate patients on the benefits of nonopioid therapies and set realistic expectations for postsurgical pain. Effective patient education is essential for encouraging acceptance of alternatives to opioids, and collaboration with surgeons and nursing staff is key to building pain management protocols.

1. Bundled payments: CMS will provide a single, lump-sum payment for each episode of care, covering everything from preoperative consultations to surgery, inpatient care and post-discharge services, including skilled nursing and follow-up appointments.
2. Episode-based accountability: The TEAM model requires all providers involved in a care episode—surgeons, anesthesiologists, nursing staff, rehab specialists and others—to share accountability for quality and cost outcomes.

3. Performance-based adjustments: Providers can earn higher reimbursements by excelling in metrics like readmission rates, patient satisfaction, pain management and complication avoidance. In contrast, poor outcomes may result in financial penalties.
4. Emphasis on patient-centered care: The model prioritizes coordinated, efficient care that enhances patient satisfaction and reduces costs. Metrics like patient satisfaction and reduced opioid use are central to its evaluation.
5. Billing process: While providers will continue to bill Medicare on a fee-for-service basis, hospitals will receive a target price for each episode of care. This price reflects the costs for the surgical procedure and related services, based on regional performance, not historical spending patterns.

Implications of TEAM for Anesthesiologists

The TEAM model creates both opportunities and challenges for anesthesiologists. Although payment structures will remain unchanged for individual services, hospitals will face penalties if the total cost of care (Medicare Parts A and B) exceed the set benchmarks. Anesthesiologists, as hospital-based providers, will likely be called upon to help control costs and improve quality.

Because the model ties payment to collective outcomes, anesthesiologists will be evaluated alongside other care team members. Optimizing patient care at every stage can directly affect key metrics, such as reducing readmissions, minimizing complications and improving patient satisfaction.

Perioperative Optimization

One of the anesthesiologist’s primary contributions to the TEAM model lies in preoperative optimization. Thorough risk assessment before surgery is crucial for identifying potential complications, particularly in patients with comorbidities. By conducting detailed preoperative evaluations, anesthesiologists can categorize patients by risk level, address specific needs and manage chronic conditions to optimize them for surgery.

In the TEAM model, perioperative optimization influences more than immediate outcomes—it directly impacts cost savings and quality metrics. Patients who are better prepared for surgery generally experience fewer complications, shorter hospital stays and reduced readmission rates—all of which align with TEAM’s payment methodology.

Financial Implications and Shared Accountability

Anesthesiologists will have a significant impact on the financial success of the TEAM model. Because bundled payments are tied to both quality and cost, every provider’s actions directly affect the bottom line. By reducing complications, shortening hospital stays and implementing multimodal pain management strategies, anesthesiologists can help lower episode costs and support the model’s goals.

Preventing complications that lead to extended hospital stays or readmissions further supports TEAM’s financial objectives. Additionally, CMS TEAM explicitly defines opportunities for gain-sharing between hospitals and providers, including surgeons and anesthesiologists.

Conclusion

The CMS TEAM model offers anesthesiologists a unique opportunity to proactively engage with hospitals and become integral to the initiative. Their involvement can enhance hospital financial performance while enabling anesthesiologists to benefit from gain-sharing arrangements. However, there is a risk that hospitals may bypass anesthesiologists and work exclusively with surgeons, potentially causing anesthesiologists to miss a critical chance to redefine their role in perioperative medicine and achieve greater financial rewards.

Kain is a member of the Anesthesiology News editorial board.