As part of the FY 2025 Hospital Inpatient Prospective Payment System (IPPS) final rule, CMS finalized a new, mandatory alternative payment model (APM) that would apply to certain hospitals when episodes are triggered by the performance of one of the following procedures at that hospital:
- Spinal Fusion;
- Coronary Artery Bypass Grafting;
- Lower Extremity Joint Replacement;
- Surgical Hip and Femur Fracture Treatment; and
- Major Bowel Procedure.
As part of the Transforming Episode Accountability Model (TEAM), hospitals in select geographic areas will be required to participate. The model has a finalized initial performance year of 2026 and will run for five years, although stakeholder concern about its mandatory nature may result in advocacy efforts to convert it to a “voluntary” or “opt-out” model or delay the start date.
The Agency has provided more details on the TEAM web page.
As a reminder, in June, the AANS and the CNS submitted comprehensive concerns to CMS about the implementation of this model. The AANS and the CNS will continue to engage in advocacy and member education in response to CMS’s decision to move forward with the model.
