Feds Seeking to Save Medicare Money on High-Volume, High-Cost Procedures

Feds Seeking to Save Medicare Money on High-Volume, High-Cost Procedures

Federal officials are taking a TEAM approach to saving federal dollars on certain high-volume, high-cost surgical procedures with a new program embedded in the recent Proposed Rule for inpatient and long-term care hospitals (LTCHs) for the 2025 fiscal year.

All-caps fully intended: that’s the Transforming Episode Accountability Model (TEAM), which is slated to begin on a mandatory five-year trial basis, starting in January 2026.

Specifically, officials said, they want to see if the new model could reduce Medicare expenditures for the designated procedures while preserving or enhancing the quality of care, hoping it will “incentivize coordination between care providers during a surgery, as well as the services provided during the 30 days that follow, and require referral to primary care services to support continuity of care and drive positive long-term health outcomes.”

Officials said the model would complement other Centers for Medicare & Medicaid Services (CMS) value-based care initiatives by promoting collaboration with accountable care organizations (ACOs).

“Before and after surgery, people on Medicare often experience fragmented care, especially following hospital discharge. This can lead to complications, prolonged recovery, unnecessary care, and even readmissions,” Liz Fowler, CMS Deputy Administrator and Director of the CMS Innovation Center, said in a statement. “By bundling all the costs of care for an episode, this proposed rule can incentivize care coordination, improve patient care transitions, and decrease the risk of an avoidable readmission.”

The designated procedures include lower extremity joint replacement, surgical hip fracture treatment, spinal fusion, coronary artery bypass grafts, and major bowel procedures – several are estimated to be performed hundreds of thousands of times annually in the U.S.

In a news release about the broader Proposed Rule, officials noted that the TEAM model would also speak to the American health system’s climate resilience and sustainability; individuals would be able to collect and voluntarily share greenhouse gas emissions data with CMS, and CMS would provide technical assistance to them to enhance organizational sustainability.

For a fact sheet on TEAM, visit: https://www.cms.gov/files/document/team-model-fs.pdf

For frequently asked questions (FAQs) on TEAM, visit: https://www.cms.gov/team-model-frequently-asked-questions 

Mark Spivey is a national correspondent for RACmonitor and ICD10monitor who has been writing and editing material about the federal oversight of American healthcare for more than 15 years. He can be reached at mcspivey33@gmail.com.  

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Navigating AI in Healthcare Revenue Cycle: Maximizing Efficiency, Minimizing Risks

Navigating AI in Healthcare Revenue Cycle: Maximizing Efficiency, Minimizing Risks

Michelle Wieczorek explores challenges, strategies, and best practices to AI implementation and ongoing monitoring in the middle revenue cycle through real-world use cases. She addresses critical issues such as the validation of AI algorithms, the importance of human validation in machine learning, and the delineation of responsibilities between buyers and vendors.

May 21, 2024
Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
2025 IPPS Masterclass Day 3: MS-DRG Shifts and NTAPs

2025 IPPS Masterclass Day 3: MS-DRG Shifts and NTAPs

This third session in the ICD10monitor 2025 IPPS Masterclass will feature a review of FY25 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by senior healthcare consultant Laurie Johnson, with bonus insights and analysis from CDI expert Dr. Erica Remer.

August 15, 2024
2025 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

2025 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

This second session in the ICD10monitor 2025 IPPS Masterclass will feature a review of the FY25 changes to ICD-10-PCS codes, presented by senior healthcare consultant Laurie Johnson, with bonus insights and analysis from CDI expert Dr. Erica Remer.

August 14, 2024
2025 IPPS Masterclass Day 1: Master ICD-10-CM Changes

2025 IPPS Masterclass Day 1: Master ICD-10-CM Changes

This first session in the ICD10monitor 2025 IPPS Masterclass will feature a review of FY25 changes to ICD-10-CM codes and guidelines, SDoH, CCs/MCCs and revisions to the MCE, presented by senior healthcare consultant Laurie Johnson, with bonus insights and analysis from Dr. Erica Remer.

August 13, 2024
2025 IPPS Masterclass: Final Rule Update with Expert Insights and Analysis

2025 IPPS Masterclass: Final Rule Update with Expert Insights and Analysis

Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY25 Inpatient Prospective Payment System (IPPS) Final Rule, including new ICD-10-CM/PCS codes, plus insights, analysis and answers to questions from the country’s most respected subject matter experts.

August 13, 2024

Trending News

Happy World Health Day! Our exclusive webcast, ‘2024 SDoH Update: Navigating Coding and Screening Assessment,’  is just $99 for a limited time! Use code WorldHealth24 at checkout.

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →