May 2026

ORTHOPAEDICS

UNDERSTANDING THE MEDICARE TEAM MODEL IN ORTHOPAEDIC CARE

The Medicare Transforming Episode Accountability Model (TEAM) is a mandatory, five‑year bundled payment program launched on January 1, 2026, involving 735 hospitals nationwide. Orthopaedic surgeons are primary drivers of TEAM performance as they are episode initiators for three of five included procedures: lower‑extremity joint replacement, hip and femoral fracture surgery, and spinal fusion.

A peer-reviewed analysis of TEAM — led by Northwestern Medicine Orthopaedics faculty and published in The Journal of Bone and Joint Surgery — examines the model’s structure, financial risk, and practical implications for surgeons practicing under episode‑based reimbursement.

TEAM compresses financial and quality accountability into a 30‑day episode, shifting greater emphasis to early perioperative decisions, post‑acute utilization and care coordination.

Key Implications
Although hospitals hold financial risk, orthopaedic surgeons play a central role in determining TEAM outcomes through decisions affecting perioperative care, post‑acute utilization and complication prevention. TEAM allows gainsharing and co‑management arrangements, supported by CMS regulatory waivers, enabling closer alignment between surgeons and hospitals.

The inclusion of high‑variability procedures — particularly hip fracture surgery and spinal fusion — heightens financial risk, especially since the model does not normalize for hospital‑level episode mix. Many hospitals also face readiness challenges due to limited prior experience with bundled payments and insufficient data infrastructure.
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Key Actions for Orthopaedic Surgeons
To position for success under TEAM, surgeons should focus on:
  • Establishing co‑management frameworks with hospital leadership for each TEAM procedure category
  • Standardizing care pathways where evidence supports consistency, while allowing flexibility for complex patients
  • Optimizing pre-operative risk stratification and early perioperative decision‑making
  • Managing post‑acute utilization, including discharge planning and skilled nursing facility use
  • Leveraging data and analytics to track episode‑level costs, complications and patient‑reported outcomes
  • Structuring compliant gainsharing arrangements tied to quality and reduction of unnecessary utilization

In summary, TEAM poses meaningful risk, but it also offers orthopaedic surgeons a clear opportunity to lead care standardization, align incentives, and shape the future of value‑based surgical care. Surgeons who engage early and help shape infrastructure, pathways and governance will be best positioned under the model.
Although Northwestern Medicine is not mandated to participate in TEAM, the strategies included in the publication could apply to current reforms that Northwestern Medicine participates in, such as the Patient-Reported Outcomes (PRO) mandate, or future reforms that Northwestern Medicine will be required to participate in, like the CJR-X (Comprehensive Care for Joint Replacement Expanded) Model.

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