Episode 4: Surgery, Recovery and Responsibility: Understanding Medicare’s TEAM Model
Medicare’s new TEAM Model is designed to change how hospitals think about surgery and recovery. It bundles the procedure and thirty days of follow up into one episode, which means hospitals are now responsible for everything that happens after a patient leaves the OR. On paper it looks like policy. In real life it affects families.
In this episode, I talk about the model through the lens of my own experience helping my mom after her spinal fusion. She was in Texas and I was in Georgia, and like so many families, we were balancing distance, multiple providers, and the emotional weight of trying to keep her safe. TEAM tries to create the coordination that caregivers often build on their own. It can improve recovery, but it also adds real pressure on hospitals that are already stretched.
If you want a clear, human explanation of how TEAM works, why CMS chose these five surgeries, and what it means for patients and health systems across the South, this episode walks you through it in a practical and approachable way.
Transcript
Surgery may start in the hospital, but under Medicare’s new team model, accountability doesn’t end there. It follows patients all the way home.
Hi there, and welcome to Health Law with Tara Ravi, your friendly guide to the world of healthcare law. Here we make healthcare law human, approachable, and a little more exciting than you might expect. We’ll break down regulations, policy, and operational decisions that shape the care people actually receive and uncover insights you can really use. Quick heads up, although I’m a healthcare partner at Bradley, the views expressed here are my own and not the firm’s or any of its clients, and they’re not intended as legal advice. But I promise to make this fun, insightful, and practical. Whether you’re a healthcare executive, attorney, clinician, or just someone who wants to understand the system better, you’re in the right place. This is Health Law with Tara Ravi.
Hi there, and welcome back to Health Law with Tara Ravi, where we turn complex healthcare topics into casual conversations that actually make sense. And today, we’ve got a complex topic for you. We’re talking about Medicare’s new team model, the Transforming Episode Accountability Model, and why it matters for hospitals, clinicians, and the patients they serve.
Starting January 1st, 2026, coming up soon, Medicare will change how it pays for major inpatient surgeries. Instead of reimbursing each service separately, it will pay hospitals 1 bundled amount for the entire episode, surgery plus 30 days of recovery. That means hospitals will now be financially responsible not for just what happens in the OR, but for everything that comes after, rehab, home health, readmissions, and coordination across multiple providers.
So what does team cover? The model includes 5 surgeries. Hip and knee replacements, hip and femur fracture repairs, spine fusions, heart bypasses, major bowel procedures. These are all pretty intensive, expensive procedures that have been tracked to have a fair amount of readmissions. They’re complex, high-volume, high-cost surgeries where outcomes after discharge drive much of the total expense. CMS’s logic is that, by tying payment to the whole episode, hospitals will have an incentive to manage recovery more tightly.
In theory, that means fewer readmissions and better continuity of care. In practice, it means new administrative layers, data demands, and reimbursement risk. I want to add just a personal note here. My mom, she had a spinal fusion several years ago, and similar to these statistics, she had a couple readmissions after that. And the reason I bring this up is she was in Texas, I was in Georgia, and it was very difficult to manage her healthcare while she was there all alone from three states away. And in that example, she really doesn’t have someone to interact with her or for her between the hospital and for her care. This is important because hospitals now, they have to take ownership of what happens to that, silver tsunami patient, especially in examples where their family members are pretty far away or there’s no caregiver to directly assist.
It’s not just the administrative layer data demands and reimbursement risks for the hospitals, but it’s also the hospital having the ability to step in and actually act as a family member for those patients. So, I just think these team models are important to coordinate care, but we do need to recognize the additional burden that we have. Especially here where our parents decide to retire in another warm state, but you may be living far away.
So what does it mean for patients? From a patient perspective, team could feel positive, more check-ins, smoother handoffs, fewer lost instructions, but that coordination has to come from somewhere. Hospitals will need to formalize processes that used to happen informally. Someone has to track that patient through every setting. Someone has to document the handoffs, verify discharge plans, and make sure post-acute partners are meeting the standards. And in some examples, like I said, where you’re living very far away from a parent, the hospital has to hold that parent’s hand while navigating family members from far away. If that doesn’t happen seamlessly, the risk of denied claims or missed savings is real. So, while patients may benefit from better follow-up, providers will carry a much heavier operational lift to make it possible.
What does it mean for hospitals? For hospitals, team is both an opportunity and an obligation. It offers shared savings for organizations that perform well, but it also introduces downside risk for those that don’t. Costs that were once someone else’s problem now stay on your balance sheet for 30 days. It also tightens the link between quality and payment in a way that can feel unforgiving. A single readmission or poor transition of care can erase the margin for an entire episode. Add that to the analytics requirement. New governance structures and coordination with post-acute care partners, this becomes a heavy administrative lift, and especially for mid-sized regional systems.
So how does that translate to what’s happening in the South? Here in the South, some health systems are already building towards this model. Hospitals in Georgia, Florida, and Alabama are creating navigator programs and preferred post-acute care networks to smooth recovery and track performance. They’re finding that the work is resource-intensive, but it also exposes gaps that were easy to overlook, like inconsistent documentation between acute and post-acute settings, or misaligned incentives among surgeons and care managers. In other words, team doesn’t create those challenges, it shines a light on them.
So my final thoughts, team, it’s not a silver bullet. It’s another step in Medicare’s long march towards value-based care. And that path has always come with friction. It asks hospitals to take on more accountability and risk, often without matching resources. But it also rewards those who plan, plan, plan ahead, that build data transparency and align their teams around recovery outcomes. At its best, team can help hospitals prove the value they already deliver. At its worst, it can create new administrative hurdles for organizations that are already stretched. As always, the real story will depend on execution.
Thanks so much for listening to Health Law with Tara Ravi. I hope you’ll find new ideas, helpful insights, or even a little inspiration along the way. If you like this episode, hit subscribe so you never miss a conversation. And share it with colleagues, friends, or anyone passionate about their health care. Everything we’ve talked about, episodes, insights, and conversations, is waiting for you at teraravi.com. Don’t forget to check out the resources tab on the website, where you can access laws, guidance, or materials referenced in today’s episode. See you next time when we continue exploring health law with some heart.