Upcoming CMS surgery bundle targets 5 procedures

Will roll out at Lutheran, Platte Valley and Saint Joseph on Jan. 1, 2026

Starting on Jan. 1, 2026, three of our Front Range hospitals will adopt the new CMS TEAM Model, which separately bundles five different high-volume, high-cost surgeries, in an effort to standardize the safest, highest-quality care while keeping costs low.

Hospitals: Lutheran Hospital, Platte Valley Hospital and Saint Joseph Hospital

Procedures: coronary artery bypass graft, major bowel, lower extremity joint replacement, surgical hip and femur fracture treatment, and spinal fusion

The program bundles the costs for all care, including the procedure, follow-up care and rehabilitation, into one episode that extends for 30 days after discharge.

Click here to review the list of inclusions.
Click here to review the list of exclusions.
Click here to review the patient eligibility criteria.

Patients who meet the criteria for inclusion will be enrolled automatically, and physicians will be notified of their status in Epic. The quality measures we will report to CMS as part of the program, which we already track, will be embedded in the documentation.

One notable change is that physicians will be responsible for referring patients to their primary care provider for follow-up, post-surgery care – or providing them with resources if they don't already have a PCP – rather than relying on patients to manage that vital step in recovery on their own.

At the end of the first year of the program, CMS will compare the hospitals' actual expense per episode and compare it to the pre-set target price of the bundle. If all quality measures are met, we can expect full reimbursement plus a reconciliation payment of up to 10%.

The risk of negative reconciliation does not activate until the second year in the program. This risk can be avoided by providing efficient, high-quality care within the program's parameters.

Appropriate medical directors are aware of the program and can answer any questions physicians might have about specifics.

Thank you for your partnership in providing our patients with expert care and a seamless experience from surgery through recovery.