In 4 of 1,539 TEAM hospital and surgery pairs, the hospital stay alone costs more than the 2026 target price, according to Kent Applied's analysis of CMS files.
4 of 1,539
hospital and surgery pairs where the stay alone exceeds the target
In 4 of 1,539 TEAM hospital and surgery pairs, the hospital stay alone costs more than the 2026 target price, according to Kent Applied's analysis of CMS files.
Each pair is one hospital's 2024 Medicare stays in one surgery, counted the way TEAM counts them and divided by CMS's 2026 target for its region and mix of cases. The other 1,535 leave part of the target for doctors and the 30 days after discharge.
Sources: TEAM position report: where each hospital stands in CMS's TEAM model (opens in a new tab), Fig. 1 table, Over 100% column; CMS, TEAM model page (opens in a new tab), Model overview: what target prices cover and when an episode ends. Verified October 2026.
Related charts
- From research
In 4 of 1,539 TEAM hospital and surgery pairs, the stay alone costs more than the target
Kent Applied, TEAM position report and method; CMS, TEAM PY1 preliminary target prices; CMS, Medicare Inpatient Hospitals by Provider and Service, 2024; CMS, TEAM episode construction specifications; CMS, payment standardization method - From the blog
At the median TEAM hospital, the hospital stay uses 38% to 70% of the target, by surgery
Kent Applied, TEAM position report and method; CMS, TEAM PY1 preliminary target prices; CMS, Medicare Inpatient Hospitals by Provider and Service, 2024; CMS, TEAM episode construction specifications; CMS, payment standardization method; CMS, TEAM model page - From the blog
A TEAM hospital in Track 3 can owe CMS up to 20% of its total target price in a year
CMS, TEAM Model Overview slides (updated September 2026); 42 CFR 512.550, TEAM reconciliation (eCFR) - From the blog
Payers initially denied nearly 12% of hospital and physician claims in 2024
Kodiak Solutions, press release on 2024 initial denial rates (May 21, 2025)
Sources for the figures above: 42 CFR 512.550, Reconciliation process and determination of the reconciliation payment or repayment amount (opens in a new tab); Rate of initial denials of medical insurance claims continued to rise in 2024, Kodiak Solutions proprietary data show (opens in a new tab).
Related facts
38%
of the 2026 target used by the stay
At the median TEAM hospital, the hip or femur fracture stay uses 38% of the 2026 target price, according to Kent Applied's analysis of CMS files.
Source: TEAM position report: where each hospital stands in CMS's TEAM model.
KentApplied20%
of its total target price, the most a Track 3 hospital repays
Under TEAM, a Track 3 hospital's repayment to CMS for a year is capped at 20% of its total target price, per 42 CFR 512.550.
Source: 42 CFR 512.550, Reconciliation process and determination of the reconciliation payment or repayment amount.
KentApplied31
baseline episodes: TEAM's low-volume threshold
CMS holds a TEAM hospital to account for spending over target in a surgery only if it had at least 31 episodes in the three-year baseline.
Source: TEAM Model Overview slides (updated September 2026).
KentApplied
Sources for the figures above: 42 CFR 512.550, Reconciliation process and determination of the reconciliation payment or repayment amount (opens in a new tab); CMS, TEAM Model Overview slides (updated September 2026) (opens in a new tab).
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