Participants in Medicare's New Mandatory Bundled Payment Program.

To date, most bundled payment programs have been voluntary in design. However, such programs are limited by provider and patient selection, the potential exacerbation of health disparities, and results with limited generalizability. In 2026, Medicare will address these concerns through the Transforming Episode Accountability Model (TEAM), the first mandatory program to require nationwide participation across multiple surgical procedures. To anticipate whether the TEAM model can provide generalizable evidence for scaling bundled payments nationwide, the authors used Medicare data to conduct a cross-sectional analysis comparing the characteristics of markets and hospitals selected to participate in TEAM with those that were not. The current study found that, although the 186 TEAM markets were larger than the 618 markets that will not participate, they were similar with regard to structural characteristics (e.g., Medicare advantage penetration, exposure to prior bundled payment programs) and population characteristics (e.g., education, income). The 727 TEAM hospitals differed from the 2155 others with regard to key characteristics, including teaching and safety-net status, profit margin, and patient volume. Overall, these findings suggest that TEAM may generate findings that can be generalized to all US markets while expanding the types of hospitals that have participated in bundled payment programs.