January 1, 2026 quietly marked the beginning of a five-year experiment that could reshape how hospitals think about some of the most expensive operations in American medicine.

The Transforming Episode Accountability Model, or TEAM, is mandatory for selected acute-care hospitals in designated geographic areas and runs through December 31, 2030. It covers five major surgical categories: lower-extremity joint replacement, surgical hip/femur fracture treatment, spinal fusion, coronary artery bypass grafting and major bowel procedures. The financial episode extends from the surgery through 30 days after the hospitalization.

Think about that list for a moment. Orthopedics. Spine. Cardiac surgery. Major general surgery. These are not fringe procedures. They represent exactly the high-acuity cases around which hospitals and increasingly advanced outpatient programs build service lines.

TEAM changes the conversation because the hospital can no longer view the surgical encounter as an isolated revenue event. A preventable emergency visit, readmission or inefficient post-acute pathway can become part of the economic story. CMS also requires participating hospitals to facilitate referral to primary care, reinforcing the idea that the episode does not end when the patient leaves the recovery room.

For ASCs, TEAM creates an interesting competitive paradox. The ASC is not simply competing against the hospital for today’s case. It can become part of the solution to tomorrow’s episode economics. Surgeons who can demonstrate low complication rates, predictable discharge, standardized multimodal pain protocols and disciplined post-operative pathways become increasingly valuable.

And now CMS has finalized CJR-X, a nationwide 90-day joint replacement model beginning in 2028. TEAM lasts 30 days. CJR-X lasts 90. CMS will eventually possess an extraordinary amount of data showing what happens when hospitals remain economically connected to patients long after surgery.

The future surgeon may therefore be judged on two scoreboards: how well the operation went and how expensive the patient’s recovery became.
That is a very different business model from fee-for-service surgery.