Building TEAM-Ready Orthopedic Episodes: How Orthopedic Hospitals and ASCs Can Win in the New Value-Based Care Era
- SolvEdge
- Dec 17, 2025
- 4 mins read
The CMS TEAM 2026 preparation clock is ticking. Starting January 2026, the Transforming Episode Accountability Model (TEAM) will mandate episode-based payments for lower extremity joint replacement (LEJR) and spinal fusion in selected markets—expanding risk to orthopedic hospitals and ambulatory surgery centers (ASCs) alike. This shift accelerates orthopedic value based care, tying reconciliation payments to total episode cost, quality scores, and patient-reported outcomes.
For ortho-focused providers, TEAM isn’t just another bundle—it’s an existential pivot. Success in joint replacement bundles and spine surgery bundled payments demands precision across OR efficiency, short-stay pathways, orthopedic episode cost reduction, and PROMs in joint and spine surgery. The winners will be those who build coordinated, data-driven episodes today. Here’s the playbook ortho leaders are using to thrive under TEAM model orthopedics.
The TEAM Imperative for Orthopedic Providers
TEAM holds participants accountable for 30-day episodes, with target prices based on historical spend and regional benchmarks. Quality adjustments—driven by readmissions, complications, HCAHPS, and PROMs—can swing shared savings or trigger repayments.
Key pressures for ortho hospitals and ASCs:
Migration to outpatient: CMS pushes eligible LEJR to ASC settings, intensifying competition on cost and outcomes.
PROM weighting: Patient-reported functional scores directly impact composite quality.
Post-acute exposure: SNF, HHA, and readmission costs fall squarely on the episode owner.
One early adopter modeling TEAM projects $800K–$1.5M annual exposure per 400 LEJR episodes—flipped to potential gain with disciplined execution.
Core Strategies for TEAM-Ready Orthopedic Episodes
1. Optimize OR Efficiency and Short-Stay Pathways
Maximize same-day or 23-hour discharge while protecting margins.
Predictive block scheduling aligned to surgeon outcomes and implant costs.
Standardized preference cards and automated case prep to minimize turnover.
Risk-stratified pathways shifting low-acuity cases to ASCs.
Facilities excelling here achieve 78–85% OR utilization and 45%+ outpatient migration for knees and hips.
2. Drive Orthopedic Episode Cost Reduction Without Cutting Corners
Focus on controllable spend:
Implant standardization with surgeon buy-in via outcome transparency.
Goal-directed fluids, multimodal pain protocols, and early ambulation to shorten LOS.
Pre-op optimization (anemia, nutrition, SDOH screening) to prevent complications.
Leading ortho programs reduce cost-per-episode 12–18% while maintaining or improving functional scores.
3. Elevate PROMs Collection and Clinical Integration
PROMs in joint and spine surgery are no longer optional—they’re a quality multiplier.
Baseline collection pre-op, automated follow-ups at 14, 30, and 90 days.
Closed-loop feedback: Sub-threshold scores trigger navigator outreach.
Surgeon-level dashboards linking PROM trends to technique and implant choices.
High performers hit 90%+ response rates, adding critical points to TEAM quality scores.
4. Build an Orthopedic Hospital Value Based Strategy with Unified Analytics
Siloed data kills bundle performance.
A centralized episode analytics layer—integrating EHR, claims, PROMs, and OR data—enables:
Real-time cost forecasting and variation alerts.
Risk-adjusted benchmarking against TEAM targets.
Scenario modeling for reconciliation planning.
Target-State Metrics for TEAM Winners
| Area | Current Average | TEAM Winner Target | Impact |
|---|---|---|---|
| Outpatient LEJR Migration | 25–35% | 50–70% | Lower post-acute spend |
| Episode Cost Reduction | Baseline | 12–18% | Shared savings potential |
| PROM Response Rate | 55–70% | 90%+ | Higher quality adjustment |
| 30-Day Readmissions | 4–6% | <3% | Penalty avoidance + bonus |
Launch Your TEAM-Ready Orthopedic Program
Orthopedic hospitals and ASCs don’t need to overhaul infrastructure to win under TEAM—they need coordinated intelligence.
Baseline your episodes: Map current cost, PROMs, and migration rates for LEJR and spine.
Prioritize quick wins: Standardize one pathway (e.g., TKA) and automate PROMs.
Layer in analytics: Connect data sources for real-time episode visibility.
Ready to turn TEAM model orthopedics pressure into performance?
Discover how unified episode analytics are powering orthopedic value based care success