Supporting Clinicians in Delivering Coordinated, High-Quality Ostomy Care Under the TEAM Model

Kelly Seeger, MPH

Senior Manager, Payor Relations and an employee of Coloplast

Caring for patients after ostomy surgery requires coordination and management of care to address an array of medical and psychosocial needs. In the immediate post-operative period, focus is placed on surgical recovery, ostomy product selection to ensure the best fit aiding in the protection of skin integrity, and patient education to
build patients’ confidence in self-care. Because the early post-discharge period is a high-risk time for ostomy related complications,¹ well-coordinated transitions and timely follow-up are critical.²  Studies show that patients undergoing ostomy surgery experience high early readmission rates,³ and that structured post-discharge support can reduce preventable healthcare utilization, including readmissions and emergency department visits.⁴  

Coloplast can help clinicians by offering evidence-based product options, structured education, and patient support resources that reinforce best practices in ostomy management. These tools are designed to complement clinical workflows and promote continuity as patients transition from inpatient care to home.

This approach aligns closely with the goals of the Centers for Medicare & Medicaid Services (CMS) Transforming Episode Accountability Model (TEAM), which holds acute care hospitals accountable for quality and total cost of care during inpatient surgical episodes— including ostomy-related procedures under MS-DRG 329, 330, and 331—and for 30 days post-discharges.⁵

TEAM aims to:

• Strengthen transitions of care
• Reduce preventable complications, ED visits, and readmissions
• Improve patient experience and preparedness for recovery at home
• Encourage collaboration with outpatient clinicians, primary care, and ACOs⁵

For clinicians, TEAM reinforces the importance of reliable discharge planning,³ clear patient instruction,⁶ and timely access to appropriate supplies^7,8—key factors in early postoperative stabilization for ostomy patients.

Coloplast’s ostomy product portfolio and clinical support services reflect these priorities. Evidence-based product election guidance, sizing and fit resources, educational materials, and post-discharge support can help patients adhere to care plans, manage their ostomy confidently, and recognize issues early.^7,9 These resources can complement provider efforts to reduce the likelihood of leakage-related skin complications, unplanned encounters, and other events that TEAM seeks to minimize.⁵

The TEAM model begins its five-year performance period in 2026, with participation requirements based on hospital location.⁵ As hospitals prepare, clinicians may find value in tools and resources like Coloplast Care that support consistent patient education, care coordination, and effective patient self-management—core components of achieving TEAM’s quality and cost objectives in ostomy care.

To learn more about how Coloplast can help you navigate the ostomy patient pathway in your facility, click here.
 Coloplast OneSolution

Bibliography:
1. Fish DR, Mancuso CA, Garcia-Aguilar J, Lee SW. Readmission After Ileostomy Creation: A Retrospective Review of a Common and Significant Event. Dis Colon Rectum. 2017;60(12):1282-1287.doi:10.1097/DCR.0000000000000920.

2. Cox J, Isip R, Reid M, Hulme D, Marra A. Predictors of Hospital Readmission in Patients Undergoing Creation of an Intestinal Ostomy. J Wound Ostomy Continence Nurs. 2023;50(3):215-221.

3. Schott LL, et al. Characteristics, Hospital Length of Stay, and Readmissions Among Individuals Undergoing Abdominal Ostomy Surgery: Review of a Large US Healthcare Database. J Wound Ostomy Continence Nurs. 2022.

4. Rojanasarot S. The Impact of Early Involvement in a Postdischarge Support Program for Ostomy Surgery Patients on Preventable Healthcare Utilization. J Wound Ostomy Continence Nurs. 2017;44(6):552-557. doi:10.1097/WON.0000000000000376.

5. Centers for Medicare & Medicaid Services. Transforming Episode Accountability Model (TEAM) Overview. Baltimore, MD: CMS; 2025. Accessed November 2025.

6. Johnston D, Miller D, Frecea M, McKenzie ME, Pearsall E, Johnston D, et al. Enhanced Recovery After Surgery: Best Practice Guideline for the Care of Patients With a Fecal Diversion. J Wound Ostomy Continence Nurs. 2016;43(5):498–507.

7. Taneja C, Netsch D, Rolstad BS, Inglese G, Eaves D, Oster G. Risk and economic burden of peristomal skin complications following ostomy surgery. J Wound Ostomy Continence Nurs. 2019;46(2):143–149.

8. United Ostomy Associations of America; WOCN Society. Ostomy and Continent Diversion Patient Bill of Rights. 2022.

9. Colwell JC, McNichol L; WOCN Society Practice Issue Panel. North America WOC and Enterostomal Therapy Nurses Current Ostomy Care Practice Related to Peristomal Skin Issues. J Wound Ostomy Continence Nurs. 2014;41(5):429–436.