CMS proposes changes to inpatient quality reporting requirements, including the removal of quality measures focused on health equity and social drivers of health from the Hospital Inpatient Quality Reporting (IQR) Program, as well as the removal of the health equity adjustment from the Hospital Value-Based Purchasing (HVBP) Program’s scoring methodology. The new Administration did not back off of or delay the start date of the new mandatory Transforming Episode Accountability Model (TEAM), despite a recent decision to terminate four other Medicare value-based payment models ahead of schedule. TEAM, which was finalized last year under the Biden Administration, is a mandatory episode-based payment model that will run from January 1, 2026, through December 31, 2030. Selected acute care hospitals will take responsibility for the cost and quality of care of five procedural episodes— spinal fusion, CABG, joint replacement, femur fracture, and major bowel procedures—through the first 30 days after a Medicare patient’s surgery. The model is projected to save Medicare $481 million over five years. In the FY 2026 proposed rule, CMS proposes to:
- Establish a methodology to update the pricing and payment methodology when there are coding changes.
- Add an Information Transfer Patient Reported Outcome-based Performance Measure (Information Transfer PRO-PM).
- Apply a neutral quality measure score for TEAM participants with insufficient quality data.
- Update the risk adjustment methodology, including extending the lookback period to 180 days.
- Expand the Skilled Nursing Facility (SNF) 3-Day Rule Waiver to include swing beds.
- Remove policies related to health equity.
CMS also seeks comment on several topics it hopes to address in the future, including policies related to low-volume hospitals, standardized prices, reconciliation amounts, and primary care service referral requirements. More information about previous comments submitted by the AANS and the CNS on TEAM can be found here. Organized neurosurgery will continue to work with other specialties impacted by the model to respond to these latest proposals, advocate for sensible value-focused policies, and keep its membership informed of updates related to the model’s implementation.
