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The Transforming Episode Accountability Model (TEAM) went into effect on Jan. 1, 2026, and while full industry-wide data likely will not be available until mid-2027, the model will increasingly lead hospitals to emphasize outpatient services and tighten coordination between hospitals, home health agencies and other post-acute partners, experts told Home Health Care News.
“[TEAM] changes the importance and the opportunity for home health to better serve patients coming out of the outpatient setting, which we expect will be a higher volume of patients, but also very potentially very different patient types,” said Brian Fuller, managing director of Washington, DC-based healthcare research and advisory services company ATI Advisory.
TEAM holds participating acute-care hospitals financially accountable for the cost and quality of care during five specified episodes. The model is designed to support care coordination and transitions between providers. TEAM participants must refer patients to primary care services that bolster care continuity and long-term health outcomes, according to the Centers for Medicare & Medicaid Services (CMS).
The model bundles payments for lower-extremity joint replacement, surgical hip and femur fracture treatment, spinal fusion, coronary artery bypass graft and major bowel procedure.
“[TEAM] is an excellent source for Medicare referrals,” Dr. Taimur Mirza, chief medical officer at ArchCare and medical director for Mary Manning Walsh, told HHCN. “For post [acute] providers, we really prize Medicare over any other payer source.”
New York City-based ArchCare provides home care, memory care, nursing homes and other services for older adults across New York City and surrounding counties. One of the facilities ArchCare operates is Mary Manning Walsh, a nursing home located in Manhattan’s Upper East Side neighborhood of Yorkville.
A similar model reduces readmissions
For nearly five years, the nursing home Mary Manning Walsh has operated a dedicated floor for patients referred from the Hospital for Special Surgery, a medical center focused on musculoskeletal health based in in New York City. The floor mostly admits orthopedic patients under conditions similar to those now covered by TEAM, said Mirza.
Over that time, Mary Manning Walsh has maintained an average length of stay of six to eight days, a 4% hospital readmission rate and a patient satisfaction score above 90% — metrics that are ideal for hospital partners that lower patient costs, Mirza said.
Collaboration with home-based care has been a crucial driver of Mary Manning Walsh’s lower readmission rates and shorter length of stays, Mirza notes. Upon discharge to ArchCare’s certified home health agency, clinicians monitor the patient for health declines. If a patient shows signs of illness, the home health clinicians prefer to send the patient to a nursing home for evaluation rather than a hospital.
“The hospitals really like that,” Mirza added.
However, these statistics vary across locations. While Mary Manning Walsh has a readmission rate of around 4%, its Staten Island facility, about 21 miles away, has a readmission rate closer to 14%, Mirza said.
“We really have to work on… standardizing the way we do things across all of our nursing homes,” Mirza said.
For TEAM, data available in 2027 and 2028 will help determine with more certainty how the model is trending, Fuller said.
What’s next
While TEAM has upsides, one thing that surprised Fuller was how little attention and focus many hospitals have placed on it.
“We’re still seeing a lot of hospitals take a bit of a wait-and-see approach,” Fuller said. “They’re kind of doing the minimally necessary.”
One reason for that is that, in 2026, TEAM was upside-only. Financial downside risk will begin in 2027, Fuller said, and he anticipates seeing an increase in activity and focus TEAM hospitals, which will involve post-acute care providers such as skilled nursing facilities and home health partners.
However, the comprehensive care for joint replacement expanded (CJR-X) model could enhance hospitals’ focus on models including TEAM, Fuller notes. Finalized on July 31, 2026, the CJR-X model aims to increase collaboration among health care entities including home health providers for joint replacement patients.
Though only a few weeks past CJR-X’s finalization, Fuller said he anticipates the model will build focus on bundled payment models.
“The more we see this bundled payment momentum, particularly in a mandatory format, [the more] it will add to the level of importance and the level of attention that hospitals and post-acute care providers start to devote to these models,” Fuller said.
CJR-X is scheduled to take effect on Jan. 1, 2028. As hospitals prepare to take on downside financial risk in TEAM’s second year, Mirza said that post-acute providers entering exclusive, geography-based partnerships and assume risk alongside hospital partners should discuss opportunities to share financial gains generated by strong performance.
“If we provide good results, and they get rewarded for that, there should be a conversation where we can share some of those profits too if we assume some of the risk,” Mirza said. TEAM’s shift in focus from inpatient to outpatient changes referral volume for home health providers, Fuller said. It will also potentially increasereferral partners’ expectations regarding specialized clinical programs, front-loaded home health episodes and post-ambulatory surgery center discharge. In addition, more cardiovascular procedures, oncology and orthopedics are likely to be performed in outpatient care settings.
Separate policy changes — including the scheduled elimination of Medicare’s inpatient-only list — could accelerate the shift to outpatient care and raise the stakes for home health providers, Fuller said.
“The elimination of the inpatient-only list for hospitals [is] scheduled to end by Jan. 1, 2028,” Fuller said. “If you’re not treated in an inpatient setting, and if you don’t have a qualifying hospitalization to be eligible for skilled nursing, then your default discharge location almost has to be home — either with or without home health.”
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