Addressing CMS’ Transforming Episode Accountability Model (TEAM) Challenges: The Case for Enhanced Recovery Protocols
As hospitals navigate CMS’s Transforming Episode Accountability Model (TEAM), many are searching for evidence-based approaches that align with the model’s focus on quality, satisfaction, outcomes, and costs. Enhanced Recovery protocols represent one promising avenue, though implementation has proven challenging across the healthcare system.
The Implementation Gap
Despite 25 years of research supporting Enhanced Recovery protocols, adoption remains inconsistent. The reality is that no single department typically owns responsibility for implementing these protocols. Is it Anesthesia? Surgery? Nursing? Administration? This diffusion of responsibility contributes to slow uptake, even when the clinical team is familiar with the evidence.
Healthcare innovation at-large faces a well-documented challenge: studies suggest it can take up to 17 years for evidence-based practices to achieve widespread adoption.
This implementation gap doesn’t just exist between hospitals – it exists within them. Even when Enhanced Recovery is in place, participation varies widely. Some specialties and individual surgeons champion these pathways, while others opt out entirely or apply them inconsistently. The result is a patchwork of care where outcomes depend as much on who performs the surgery as on the protocol itself – a reflection of the broader challenge of translating evidence into everyday practice.
What Enhanced Recovery Protocols Offer
The core principles of enhanced recovery focus on reducing surgical stress through proactive interventions. Multimodal pain management, for instance, promotes non-opioid modalities (both pharmacological and non-pharmacological) before surgery and after surgery. The result is a more proactive strategy with better outcomes, happier patients, and less unnecessary exposure to opioids.
Other elements include updating outdated practices. While many patients still receive instructions advocating “nothing after midnight,” the American Society of Anesthesiologists changed its guidance in 1999. Guidelines now recommend clear carbohydrate drinks up to two hours before surgery. The updated protocol improves hydration, pain management, and healing capacity.
The TEAM Connection
Recent JAMA research indicates that readmission rates for TEAM procedures nationally exceed 11%. This presents both a clinical quality concern and a financial challenge for facilities operating under the bundled payment structure. At Goldfinch, we have demonstrated a 2.5% 30-day readmission rate for TEAM qualifying patients (77% lower than the national benchmark).
The opioid reduction aspect of these protocols carries additional benefits beyond addiction prevention. Research has identified links between opioid use and increased infection rates, blood clot risk, fall risk in older populations, and other complications that can drive 30-days readmissions, complications, and expense.
Founded for value-based care, Goldfinch Health has built an innovative surgery continuity of care platform. The approach features Enhanced Recovery implementation and execution support, tech-enabled nurse navigation, and expertly curated patient resources to optimize the surgical journey. Goldfinch’s recent RAIN Compliant designation with best-in-class certification reflects a broader industry movement toward transparency in value-based care partnerships.
The Transparency Question
As TEAM requirements push 740+ hospitals nationally toward greater accountability, the question of vendor vetting becomes relevant. Third-party auditing of operations, data infrastructure, and clinical evidence may become increasingly important as hospitals evaluate which partnerships can withstand the scrutiny of outcome-based payment models.
Looking Forward
TEAM may provide the external catalyst that finally drives wider Enhanced Recovery adoption. For the mandated facilities, the model’s financial structure creates urgency around reducing complications and readmissions post-surgery. The implementation of evidence-based protocols is becoming less optional and more essential to financial sustainability under value-based care.
To learn more, visit https://goldfinchhealth.com/.