Interview with Secretary David Shulkin (U.S. Department of Veterans Affairs): Beyond the OR: Mandatory Bundles Under CMS TEAM

What happens when bundled payments stop being optional? In this episode of The Surgical Journey, host Lisa Miller sits down with Dr. David Shulkin, the 9th Secretary of the U.S. Department of Veterans Affairs and former health system CEO, to examine the implications of CMS's new mandatory bundled payment program: TEAM (Transforming Episode Accountability Model). Beginning in 2026, 780 hospitals will be required to participate in TEAM, a Medicare value-based care model that ties hospital reimbursement to outcomes across the full surgical episode — including the 30 days after discharge. Dr. Shulkin explains why this shift from voluntary to mandatory bundled payments could fundamentally change how hospitals manage surgical care, why many health systems are unprepared for episode-based accountability, and where the greatest clinical and financial risk actually occurs after surgery. The conversation explores the future of value-based reimbursement, surgical episode management, Medicare payment reform, and the operational challenges hospitals face when managing outcomes beyond their walls. If you work in hospital leadership, surgical care, bundled payments, value-based care strategy, or healthcare policy, this episode provides a clear view into how mandatory episode accountability may reshape the economics of surgery in the United States.   EPISODE CONTENTS  00:00 — Introduction to The Surgical Journey Overview of the podcast and its focus on improving surgical outcomes through better coordination, communication, and data. 00:51 — Introducing Dr. David Shulkin Background on the former VA Secretary and his leadership experience across health systems and federal healthcare policy. 04:30 — Shulkin's Path from Physician to Health System Leader How clinical training led to executive roles in major health systems and eventually national healthcare leadership. 08:45 — The Evolution of Value-Based Care in the U.S. Why payment reform has progressed slowly and what structural barriers health systems face. 13:50 — Why Bundled Payments Emerged in Surgical Care The rationale behind episode-based payment models and their role in aligning incentives across the surgical journey. 18:35 — CMS TEAM and the Shift to Mandatory Participation 780 hospitals received notice that they will participate beginning in 2026, marking a departure from voluntary bundle programs. 19:30 — Why TEAM Matters Financially Procedures included in TEAM can represent 15–20% of hospital revenue, making performance under the program financially significant. 19:42 — Are Hospitals Ready? Shulkin argues that many hospitals are not operationally prepared to manage surgical episodes under mandatory accountability. 23:10 — Managing Outcomes Beyond the Hospital Walls Why the post-discharge recovery period represents the highest risk for complications, readmissions, and episode costs. 26:00 — What Hospitals Must Do Differently How health systems will need to rethink care coordination and episode management to succeed under TEAM.