Because the Facilities for Medicare & Medicaid Providers strikes ahead with the Transforming Episode Accountability Model (TEAM), hospitals are taking over monetary accountability for Medicare’s most advanced and expensive surgical episodes. Hospitals that don’t take motion to realize higher affected person outcomes may 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 via Collaboration Agreements, both passing on damaging or optimistic funds primarily based on the goal surgical episode value. Whether or not TEAM succeeds—or breaks down beneath 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 value 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 method borrowed from payer reporting reasonably than partnership. Underneath TEAM, this mindset dangers undermining participation earlier than it begins.
If specialists view Collaboration Agreements as punitive or one-sided, they might choose out solely, 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 companies—lots of which sit outdoors any single doctor’s management.
A more practical path ahead is shared inquiry. By utilizing trusted, built-in information to know the place variation happens and why, hospitals and physicians can give attention to bettering processes, stopping problems, and coordinating care—significantly earlier than surgical procedure. When Collaboration Agreements are constructed round transparency, studying, and shared accountability, TEAM can operate because it was meant: a framework for collaboration, not management.
Six Suggestions for Win-Win TEAM Collaboration Agreements with Specialists
The hospital, surgical crew, the affected person, and the affected person’s main care doctor are the central actors in TEAM. Research present that value variation throughout TEAM procedures is basically pushed by problems that result in prolonged hospital stays, readmissions, or larger ranges of service. Some sufferers enter surgical procedure with medical circumstances that enhance the chance of problems, making sturdy main care–medical crew communication important to TEAM success. The next greatest practices in hospital–specialty doctor collaboration must be mirrored in Collaboration Agreements.
1. Be certain that your Collaboration Agreements embrace the complete complement of the medical crew, together with surgeons, anesthesiologists, and consulting medical specialists. You need to be physician-group-focused and embrace apply directors as a part of the implementation to assist physicians.
2. Plan for full aggregation and integration of EHR (each doctor and hospital) information and CMS claims information for viewing full surgical episodes of care. Your data-sharing functionality is crucial device you’ve gotten for value management, and data-sharing must be a part of each Collaboration Settlement with specialists. Why is the EHR information important? Can’t you simply use CMS claims information? No, and right here’s why: the claims information will lack affected person threat and different medical necessities on your inquiry into prices.
3. As allowed by CMS, take into account financing the aggregation of specialty information on your collaborating practices. Most non-public practices won’t be prepared to do that on their very own, and the inclusion and analysis of the specialists’ personal information will likely be important to their belief of the analytics of the surgical episode. There will likely be boundaries to barter.
4. Don’t “rating” physicians by value or create analytics that appear to do that. Analytics that concentrate on specialists reasonably than the episode itself and its explicit value drivers will really feel punitive. As an alternative, use your value variation curve to ask suggestions on improved processes and different options.
5. Facilitate prevention of affected person problems previous to surgical procedure via advance referrals to main care physicians (and pre-treatment, when doable). That is your largest probability to make sure that the affected person is ready for surgical procedure medically. The potential delay in surgical procedure will likely be effectively definitely worth the effort.
6. Use Collaboration Agreements to beat obstacles to adopting ERAS rules.
Incorporating Enhanced Restoration After Surgical procedure (ERAS) expectations into Collaboration Agreements might 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 value 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 value management and higher outcomes, with out eroding doctor belief. When hospitals focus much less on attribution and scoring and extra on understanding the complete episode of care, TEAM turns into what it was meant to be: a framework for collective accountability and coordinated enchancment. The hospitals that method TEAM as a relationship mannequin—not only a reimbursement mannequin—will likely be greatest positioned to succeed.
About Theresa Hush
Theresa Hush is a healthcare strategist and alter knowledgeable with expertise throughout the healthcare spectrum. Terry’s broad vary of well being care expertise consists of 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, shaped in 2002 to assist suppliers implement Worth-Based mostly Care with know-how and data-guided companies.
