The mandatory TEAM model has made one thing unavoidable: what happens after a patient goes home is now a hospital's financial problem. Here's how leading health systems are solving it.
For decades, a joint replacement surgery ended, financially and clinically, when the patient walked out the door. Under the Transforming Episode Accountability Model (TEAM), that era is over.
Starting in 2026, 741 hospitals are mandated to accept financial accountability for the full cost of care from surgery through 30 days post-discharge. With 2/3 of TEAM hospitals projected to lose under current spending patterns, an average of $1,350 per episode, the pressure to act is rising.
In 2027, 20% of target reimbursement goes fully at risk. The infrastructure to manage that exposure takes at least a year to build.
Most hospitals are treating 2026 as a free pass. The ones that will succeed in 2027 aren't watching. They're building; not just to protect margins, but to ensure every patient who goes home actually recovers the way they should.
The site-of-care decision, in-patient rehab facility (IRF) versus home, is where most TEAM episode cost variance lives. Historically it has been made subjectively: a clinician's read of the patient, a family's input, an instinct about risk. Under TEAM, that process carries a hard dollar consequence. An unnecessary IRF admission adds $8–12K above home-based alternatives.
OneStep is closing this gap with continuous gait analysis, capturing how a patient walks during everyday movement using the smartphone they already carry. Unlike a physical therapy evaluation (effort-dependent, controlled environment) or patient self-report (notoriously unreliable near discharge), gait data reflects real-world functional capacity. Patients who show normalized cadence and gait speed go home safely. Those with persistent asymmetry, shortened stride, or declining velocity get triaged to appropriate care before a complication forces the issue.
The result is a discharge pathway grounded in objective data making it defensible, documented, and aligned with episode savings.
Reducing LOS cannot come at the expense of readmission risk. Without objective data, most care teams won't discharge a patient a day earlier than they have to. The problem isn't caution, it's the absence of the signal that would make earlier discharge feel safe.
Three strategies are working:
Pre-operative benchmarking. Capturing gait data before surgery establishes a personalized recovery baseline, what recovery looks like for this patient, not a population average. High-risk patients can be identified before the procedure and resourced accordingly.
Objective discharge criteria. When a care team can point to a patient's Walk Score, a daily mobility signal captured from their smartphone, the discharge decision becomes data-supported, not instinct-driven. A patient on a strong recovery trajectory goes home with confidence. One who isn't gets the attention they need before a complication occurs. Every third of a day reduction in LOS saves approximately $3,000 per episode. Across a high-volume orthopedic program, that adds up quickly.
Continuous post-discharge monitoring. The counterintuitive key to discharging earlier is monitoring more closely after discharge. When the care team receives a daily objective signal on every patient, surgeons feel confident sending patients home because the safety net exists to catch a decline. Without it, the instinct is always to keep patients longer.
This is the question TEAM makes unavoidable and the one most hospitals currently can't answer.
The standard model, a care manager phone call, a 6-week follow-up, was never built to catch the functional decline that turns into a readmission penalty over a 30-day window. Claims data arrives 60–90 days late. Patient self-report is subjective. And manually following up on every discharged patient is operationally unsustainable.
Leading systems are closing this gap with continuous mobility monitoring.
Using the patient's own smartphone, gait data is captured passively during daily life and generates a daily Walk Score that care coordinators act on. A drop of just 0.1 m/s in gait speed correlates to a 10% higher readmission risk and a 7% higher fall risk. OneStep detects that signal 10-14 days before a clinical event, providing enough time to reassess therapy, adjust the care plan, or make a proactive call before a complication escalates.
Instead of calling every patient and getting told they're fine, coordinators act on the ones who actually need attention.
OneStep is trusted by orthopedic programs across 250,000+ patients. No hardware. No IT project. Operational in weeks.
For health systems preparing for 2027's full financial exposure, the question isn't whether to build post-discharge monitoring capability. It's whether to start while 2026 still offers a margin for learning.