Up to two-thirds of participating hospitals may lose revenue under TEAM, with 714 hospitals mandated to participate. For hospitals managing ~1,000 annual TEAM-eligible episodes, improvements in follow-up completion and care routing can translate into $7.5-20M+ in protected revenue annually.
For many Medicare patients, having surgery, whether in the hospital or an outpatient setting, can feel like navigating a maze of disconnected appointments and providers. Poor care coordination, scheduling delays, missed follow-ups, and gaps in communication often lead to fragmented care that can slow recovery, increase complications, and drive-up costs through emergency room utilization.
These challenges are rooted in the traditional fee-for-service (FFS) payment model, which often leads to duplicated use of resources, and nominal health outcomes. In an effort to change the trajectory of post-operative care fragmentation, The Centers for Medicare & Medicaid Services (CMS) Transforming Episode Accountability Model (TEAM) policy will reshape how care is delivered and coordinated to support Medicare patients throughout their surgical journey. TEAM is a mandatory model that will run for five performance years from January 1, 2026, to December 31, 2030, in selected Core-Based Statistical Areas nationwide, requiring 714 hospitals to participate.
Bottom line: success in TEAM depends on how well a hospital ensures patients get the care they need.
The policy requires selected acute care hospitals to coordinate care from surgery through 30 days post-hospitalization for people with, as CMS designates, Original Medicare undergoing one of five surgical procedures:
- Lower extremity joint replacement
- Surgical hip femur fracture treatment
- Spinal fusion
- Coronary artery bypass graft
- Major bowel procedures
CMS outlined that their goals for TEAM is to improve health outcomes for these Original Medicare patients by “improving care transitions, encouraging provider investment in healthcare infrastructure and redesigned care processes, and incentivizing higher value care across the inpatient and post-acute care settings for the episode.”
How Hospitals Must Evolve with the Policy
Hospital executives, care transition teams, and provider network leaders must align quickly to meet CMS expectations for the start of 2026. This means investing in systems that reduce friction between discharge and follow-up care, giving staff visibility into referral completion, and maintaining documentation that satisfies continuity of care requirements.
Financial Stakes of TEAM
Up to two-thirds of participating hospitals may lose revenue under TEAM, with 714 hospitals mandated to participate and a build-in 2% discount favor lowering target prices from day one, according to a Brandeis University analysis. Because a single readmission can push an episode over the target, preventing complications and ensuring timely follow-up become core revenue-protection strategies, not optional improvements.
Convert Referrals to Appointments
Only half of Medicare beneficiaries readmitted within 30 days had a follow-up visit, and nearly two-thirds of adverse post-discharge events were preventable or mitigable with timely care. TEAM directly ties financial performance to fixing this gap.
ReferWell delivers meaningful lift where it counts:
- 80-85% referral-to-appointment completion (vs. 50% baseline)
- 85% loop closure, more than double the national average
- 30-35% more patients receiving post-surgical care to avoid complications.
The Financial Upside
For surgical episodes that cost $30,000-50,000, preventing one readmission saves approximately $15,000, while avoiding complications or keeping patients in-network can protect an additional $8,000-25,000 per case. For hospitals managing ~1,000 annual TEAM-eligible episodes, improvements in follow-up completion and routing can translate into $7.5-20M+ in protected revenue annually.
Why ReferWell Matters for TEAM Compliance
ReferWell was built for this moment. Our software-as-a-service scheduling platform and care navigators help health systems schedule post-discharge appointments in real time, ensuring every patient, including Medicare beneficiaries, leaves the hospital with follow-up care already in place. Here’s how:
- To retain more referrals, smart provider matching keeps patients in-network: Advanced matching based on specialty, location, insurance, and real-time availability shows the RIGHT provider, not just any provider. Built-in tools allow for direct scheduling when real-time booking is available, and appointment requests when it’s not.
- Booking appointments is faster and critical for the TEAM 30-day window: To reduce scheduling from 20 minutes to 45 seconds, ReferWell delivers one unified workflow for all referrals, resulting in fewer clicks and less confusion. The intuitive platform integrates seamlessly with existing electronic health record service providers (athenahealth, Epic, etc.) real-time schedule aggregation eliminates document worksheets, and new providers appear immediately—no manual updates needed.
- Simplified scheduling at point of care is specifically designed for front-desk and care coordination teams: ReferWell’s smart work-listing tracks referral status and shares workload for full visibility into patient transitions and appointment completion. It also offers secure, compliant data sharing between referring and receiving providers.
With January 1 quickly approaching, ReferWell’s end-to-end platform can be implemented and operational before the TEAM rule goes live, meaning compliance and improved performance outcomes from day one.
ReferWell is the platform of choice for providers and is well positioned to support both the scheduling and documentation aspects of the TEAM mandate, offering a direct path to meeting CMS expectations and protecting hospital revenue under the new model.
More information about the final rule, which included final updates to TEAM policies, can be found here: FY 2026 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS).
Reach out to learn how ReferWell can help hospitals streamline post-discharge scheduling and continuity of care documentation.
