The Rainfall Health Podcast

The CMS TEAM model is now mandatory for 721 IPPS hospitals — covering 5 surgical episodes and a 30-day post-discharge window. For hospital CEOs and CFOs, that means up to 20% Medicare reimbursement impact and real penalties for non-compliance.

Rainfall Health CEO Eddie Qureshi sits down with Dr. Hemant Keny, Regional Clinical Leader for Surgical Quality and Safety at Kaiser Permanente Northern California, where he co-leads the KP NorCal Senior Surgical Care Program across 21 medical centers — one of the most scaled geriatric surgery programs in the country. Dr. Keny sits on the American College of Surgeons' Geriatric Surgery Verification leadership committee, serves on Rainfall's R.A.I.N. Advisory clinical subcommittee, and has been featured on the Becker's Healthcare Podcast (May 2025) and in General Surgery News (January 2026).

In this episode:
- What the CMS TEAM mandate requires and who is affected
- How surgical quality reduces hospital readmissions and length of stay
- Why value-based care ties Medicare reimbursement to patient outcomes
- How Kaiser verified 14 of 21 hospitals at the highest ACS geriatric surgery level
- What role AI plays in post-surgical episode of care management
- Why improving quality is the fastest path to lower cost
- How to drive CMS TEAM implementation when change management is the hardest part

Read the full CMS TEAM Guide: https://www.rainfallhealth.com/cms-team/
Composite Quality Score & quality measures explained: https://www.rainfallhealth.com/cms-team/what-is-team/
Hospital Leader's Guide: https://www.rainfallhealth.com/post/navigating-the-cms-team-mandate-ebook/
Learn more: https://www.rainfallhealth.com

CMS TEAM model, Medicare reimbursement, and value-based care — what 721 mandated hospitals need to know before the CMS TEAM mandate reshapes surgical reimbursement.

The CMS TEAM mandate launched January 1, 2026, requiring 721 hospitals across 188 markets to participate in mandatory episode-based bundled payments — with no opt-out. Jessica Ohlssen (SVP of Revenue) and Robby Wallace, MSN, RN (VP of Clinical Implementation) from Rainfall Health are joined by Dr. Bradley Heiges, MD, orthopedic surgeon at Optim Orthopedics, to break down what CMS TEAM means for hospitals, physicians, and patients.

What's covered:
- The 5 surgical episode types and 3 payment tracks explained
- Pre-TEAM vs. post-TEAM: same patient, same surgery — $42K–$55K episode vs. $22K–$28K
- Physician blind spots, data, and the shift to collaborative care
- Real financial impact: one CA health system's $16.3M upside or $8.2M penalty annually

Read the full CMS TEAM Guide: https://www.rainfallhealth.com/cms-team/
Hospital Leader's Guide (features this same Randy case study): https://www.rainfallhealth.com/post/navigating-the-cms-team-mandate-ebook/
More CMS TEAM articles & press: https://www.rainfallhealth.com/about/blogs-press-cms-team

Get your free TEAM financial analysis: [email protected]
Learn more: rainfallhealth.com