The Transforming Episode Accountability Model from CMS is set to go into effect Jan. 1, 2026, and ties payments to the hospital to the total cost of care as well as quality of care delivered across an entire surgical episode.
ASCs will be important to hospitals being able to succeed under the new model due to the quality of care reporting, care coordination and post-op transition requirements.
Eddie Qureshi, CEO of Rainfall Health, recently connected with Becker’s to share the potential impact of the new model on hospitals and how ASCs will step more into the forefront.
Rainfall Health is an AI-powered healthcare software company that has been working with hospitals to help get them into compliance with the TEAM model before it goes live in a few months.
Note: Responses were lightly edited for clarity and length.
Question: What is different about the new TEAM model compared to how hospitals and facilities currently operate?
Eddie Qureshi: Not to be too dramatic, but I think it is leagues different from everything that’s come before. This one is really moving and trying to create a blueprint for the next generation of outcome-based care. CMMI is saying that we’re going to tie in everybody from an ASC to a hospital to primary care to hospice, everything together into one episode. It’s going to actually put ASCs more front and center wherever possible, because there’s a huge financial component to this model as well. Care coordination is at the center of it. Quality is going to be part of the reimbursement model.
Q: Do you anticipate that hospitals will turn to ASCs and outpatient facilities to make sure they are compliant with the new model?
EQ: I think that’s where the strategy on the winners and the losers of this model are going to be determined on how they decide to take a step back and strategically look at the landscape. There is a look back period that is mandated by CMS. It’s not just about the reconciliation payments that are going to be calculated in that look back period. It’s also your quality. And you’re also looking at how you perform under these other models to say, where can we improve and how can we reduce cost where possible? That’s going to mean ASCs have to come into the picture, otherwise you are dealing with those higher costs of care, which are now your responsibility as a facility, which is everybody should be more terrified, I think, in my opinion, than they are. ASCs are not listed specifically, but they’re going to need to play a role, especially wherever possible where you can see that there’s going to be a less complex procedure.
The way that facilities, who are going to be winners are going to look at this and say, Where are the ways that we can reduce costs for less complex pieces of the procedures and not treat every single patient kind of in the same fashion? Where are places for improvement for us as a facility and that strategy? Where can we reduce costs and where do our costs land us? That’s kind of what we do as Rainfall Health is to synthesize that information, use AI to extract the workflows, financials and provide that post acute support as well. It’s an all-inclusive piece, and then facilities see the real hard dollars and cents that are either going to come to our bank account or going to be paid from our bank account. That puts that money on the table for a system to decide how they want to invest in making the infrastructure better for this model.
Q: What do ASCs need to do to be prepared for these changes?
EQ: They need to take some of their destiny into their own hands. These other facilities that are not mandated, but are going to be part of the strategy, can opt in and say, we’re already doing best practices. We are going to start adhering to the data sharing and coordination components that are required of this model. Instead of us putting everything on the hospital, then have that dictated to us and then follow whatever the one facility says on this side of the equation and another facility says on the other side of the equation, we’re actually going to create a standard that can sit above all that to respond to all the requirements, so that we become part of the strategy more easily.
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