CMS’ TEAM Initiative: How Data Improves Ostomy Management

With over 100,000 ostomy surgeries performed each year in the U.S., the real challenge isn’t the procedure — it’s ensuring patients succeed once they leave the hospital.

In 2026, the Centers for Medicare & Medicaid Services (CMS) will launch the Transforming Episode Accountability Model (TEAM), a new payment model that will reshape how hospitals deliver and manage care. Under TEAM, hospitals will be responsible for both the quality and cost of care during hospitalization and for 30 days following certain surgical procedures, including ostomy surgeries.

With the upcoming implementation of TEAM, healthcare systems are rethinking how they monitor and manage surgical outcomes. For clinicians managing patients with new ostomies, this presents an opportunity to improve care, reduce complications, and prevent costly readmissions.

In this value-based model, hospitals and clinicians must carefully track outcomes — not just for compliance but also for quality. Monitoring clinical and patient-centered data allows for proactive intervention, personalized education, and better long-term results. Ultimately, it means transforming data into a tool for smarter, safer care.

Why monitoring outcomes matters in ostomy management

Ostomy patients, particularly older adults or those managing comorbidities like diabetes, face a higher risk of readmissions due to issues like skin irritation, dehydration, or pouching challenges.

According to CMS data, unplanned readmissions can cost the healthcare system billions — an estimated $15 to $20 billion annually. Under TEAM, hospitals could bear the financial consequences of inadequate discharge planning and poor follow-up care.

By adopting a culture of outcome-based care, clinicians can:

• Identify early warning signs of complications.
• Tailor patient education based on trends in self-care challenges.
• Demonstrate value-based performance to leadership and CMS.
• Foster accountability across multidisciplinary teams.

5 metrics to monitor in ostomy management

To align with TEAM expectations, care teams must start capturing and analyzing specific, relevant data. The most effective programs prioritize the following metrics:

1. 30-day readmission rates

Readmission rates are the most obvious and impactful metric under TEAM. Track both all-cause and ostomy-related readmissions, such as those for wound infections, pouching problems, or stoma complications.

2. Complication rates

Monitoring clinical complications helps assess the success of inpatient care and post-discharge support. And research shows some common issues include:

• Peristomal skin breakdown
• Pouch leakage
• Retraction
• Stomal stenosis
• High- or low-output stomas
• Hernias or prolapse
• Stoma necrosis

Tracking these conditions allows early intervention and flags incidences of protocol failure.

3. Patient-reported outcome measures

Patient-reported outcome measures (PROMs) provide insights into patients’ perspectives on their health, recovery, and quality of life. One study highlighted the need for more validity in PROMs, as they continue to be an important factor influencing care outcomes.

Tools like the Ostomy Adjustment Scale and the Stoma Quality of Life Questionnaire assess factors such as:

• Body image and psychosocial impact
• Satisfaction with stoma care
• Self-efficacy in managing the ostomy
• Sleep and daily function disruption

These surveys help tailor support and demonstrate compliance with CMS patient-centered care models.

4. Supply usage and access

How do supplies correlate with outcomes? Track how many patients receive ostomy management supplies before discharge and whether any gaps in delivery or insurance approval caused delays. Delays often correlate with complications and higher emergency department visits.

5. Follow-up compliance and engagement

Did your patient attend their one-week follow-up? Were they able to connect with an ostomy nurse within 72 hours of discharge? Monitoring adherence to follow-up recommendations is a necessary step.

Digital dashboards or remote patient monitoring tools can help flag patients who are at risk of missing early check-in appointments.

Building a culture focused on outcomes

Successful monitoring requires infrastructure, training, and a culture of collaboration.  Here are some ways to integrate outcome tracking into workflows.

Leverage your EHR

Use electronic health records (EHR) to document complications, PROM scores, and readmission triggers. Create structured templates and checklists that prompt staff to complete key metrics during every patient encounter.

Develop standardized tracking tools

Create forms or dashboards for tracking ostomy-specific data points, including PROMs, supply delivery, and follow-up compliance. Make sure the tool is accessible to all team members.

Use technology for follow-up

Implement remote monitoring or virtual check-ins for high-risk patients. These platforms allow patients to report symptoms, send photos, and receive real-time support.

Close the loop

Have a system in place for reviewing and acting on outcome data. Monthly reviews or case conferences can help identify recurring issues and drive quality improvement efforts.

Better wound and ostomy care through outcome tracking

The Relias webinar, The Importance of Wound Healing in Improving Quality Measures, underscores how effective wound management elevates care outcomes. The session will highlight how consistent wound care, including peristomal skin and ostomy management, not only reduces hospital readmissions and prevents complications but also significantly boosts satisfaction among patients.

Both the clinical and operational aspects of patient care are equally important to healing. When addressing these components, clinicians are better equipped to deliver care that aligns with value-based care expectations like those outlined in TEAM. This feedback loop reinforces the importance of embedding wound care into broader quality improvement efforts.

Clinicians looking to lead in outcome-based wound and ostomy care can strengthen their expertise through WCEI’s comprehensive education programs, designed to prepare them for specialized certifications like the Ostomy Management Specialist (OMS) and Wound Care Certified (WCC).

Is TEAM a call-to-action?

TEAM reflects a broader transformation in healthcare — one that rewards outcomes, not just actions. For clinicians, this is a chance to prove the value of comprehensive, compassionate, and data-driven support for patients during a vulnerable time, while delivering measurable, meaningful results that improve both lives and systems.