As the Centers for Medicare & Medicaid Services moves forward with the Transforming Episode Accountability Model (TEAM), hospitals are taking on financial accountability for Medicare’s most complex and costly surgical episodes. Hospitals that don’t take action to achieve better patient outcomes could find themselves owing Medicare money.
While TEAM shifts meaningful risk to hospitals, it also creates an opportunity often missing in value-based care: true collaboration with specialists. TEAM design allows hospitals to align incentives with physicians through Collaboration Agreements, either passing on negative or positive payments based on the target surgical episode cost. Whether TEAM succeeds—or breaks down under pressure—will depend on how specialists, hospitals and primary care physicians work together.
Too often, Value-Based Care efforts rely on physician scoring as a lever for reducing variation in costs by provider. Comparative cost or quality rankings may be framed as feedback, but they rarely feel collaborative. Instead, they signal fault and create resistance—an approach borrowed from payer reporting rather than partnership. Under TEAM, this mindset risks undermining participation before it begins.
If specialists view Collaboration Agreements as punitive or one-sided, they may opt out entirely, leaving hospitals to absorb financial risk or lose surgical volume. That outcome serves no one. Surgical episode costs are driven by factors across the continuum—from patient readiness and hospital processes to post-acute services—many of which sit outside any single physician’s control.
A more effective path forward is shared inquiry. By using trusted, integrated data to understand where variation occurs and why, hospitals and physicians can focus on improving processes, preventing complications, and coordinating care—particularly before surgery. When Collaboration Agreements are built around transparency, learning, and shared accountability, TEAM can function as it was intended: a framework for collaboration, not control.
Six Tips for Win-Win TEAM Collaboration Agreements with Specialists
The hospital, surgical team, the patient, and the patient’s primary care physician are the central actors in TEAM. Studies show that cost variation across TEAM procedures is largely driven by complications that lead to extended hospital stays, readmissions, or higher levels of service. Some patients enter surgery with medical conditions that increase the risk of complications, making strong primary care–clinical team communication essential to TEAM success. The following best practices in hospital–specialty physician collaboration should be reflected in Collaboration Agreements.
1. Ensure that your Collaboration Agreements include the full complement of the clinical team, including surgeons, anesthesiologists, and consulting medical specialists. You should be physician-group-focused and include practice administrators as part of the implementation to help physicians.
2. Plan for full aggregation and integration of EHR (both physician and hospital) data and CMS claims data for viewing complete surgical episodes of care. Your data-sharing capability is the most important tool you have for cost control, and data-sharing should be part of every Collaboration Agreement with specialists. Why is the EHR data essential? Can’t you just use CMS claims data? No, and here’s why: the claims data will lack patient risk and other clinical essentials for your inquiry into costs.
3. As allowed by CMS, consider financing the aggregation of specialty data for your collaborating practices. Most private practices will not be willing to do this on their own, and the inclusion and evaluation of the specialists’ own data will be essential to their trust of the analytics of the surgical episode. There will be boundaries to negotiate.
4. Don’t “score” physicians by cost or create analytics that seem to do this. Analytics that focus on specialists rather than the episode itself and its particular cost drivers will feel punitive. Instead, use your cost variation curve to invite feedback on improved processes and other solutions.
5. Facilitate prevention of patient complications prior to surgery through advance referrals to primary care physicians (and pre-treatment, when possible). This is your biggest chance to ensure that the patient is prepared for surgery medically. The potential delay in surgery will be well worth the effort.
6. Use Collaboration Agreements to overcome barriers to adopting ERAS principles.
Incorporating Enhanced Recovery After Surgery (ERAS) expectations into Collaboration Agreements can help address long-standing operational and cultural challenges that have limited the implementation of these evidence-based standards. Evaluating performance at the episode level allows hospitals and specialists to better understand how standardized care pathways influence both cost and quality outcomes.
TEAM does not require hospitals to “manage” specialists—it requires them to partner with them. Collaboration Agreements that emphasize transparency, shared learning, and joint problem-solving create the conditions for sustained cost control and better outcomes, without eroding physician trust. When hospitals focus less on attribution and scoring and more on understanding the full episode of care, TEAM becomes what it was intended to be: a framework for collective accountability and coordinated improvement. The hospitals that approach TEAM as a relationship model—not just a reimbursement model—will be best positioned to succeed.
About Theresa Hush
Theresa Hush is a healthcare strategist and change expert with experience across the healthcare spectrum. Terry’s broad range of health care experience includes executive positions in public, non-profit and private sectors, from both payer and provider sides of the business, peppered with health care public policy and regulation experience. She is co-founder and CEO of Roji Health Intelligence, formed in 2002 to help providers implement Value-Based Care with technology and data-guided services.
