An evolving payment landscape, regulatory changes and patient expectations are reshaping orthopedics. Leaders from across the field shared what they believe will have the greatest impact on practices in the year ahead.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: From prior authorizations to implant costs and private equity, what economic or policy trends do you expect will have the biggest impact on orthopedics in the year ahead?
Brian Blackwood, MD. Orthopedic surgeon at Boulder(Colo.)Centre for Orthopedics & Spine: Being a surgeon is the only deflationary profession in the world these days. Continued cuts to reimbursement will have the greatest impact on orthopedics, driving practices to sell or merge into larger entities. Surgeons without ASC ownership may be forced into employment models to survive.
Ben Holt, MD. Retired orthopedic surgeon at Columbia (Mo.) Orthopaedic Group and CEO of RTR Practice Advisors: The provisions of the One Big Beautiful Bill allowing full first-year depreciation of capital expenses will significantly affect orthopedic practices. It should make it easier for groups to invest in new imaging and ASC equipment, as well as office renovations and expansions.
David Kalainov, MD. Medical Director of Orthopedics at Northwestern Memorial Hospital (Chicago): Prior authorization will remain a major hurdle to timely care for Medicare Advantage and some commercial plan patients. The “WISer” AI-based preauthorization model for traditional Medicare, launching in 2026, may or may not work in beneficiaries’ favor.
Philip Louie, MD. Spine surgeon and Medical Director of Research and Academics at Virginia Mason Franciscan Health (Seattle): Three “C”s define the landscape ahead: cost, consolidation and consumerism. Prior authorization reform and digital APIs will boost efficiency only for practices that have standardized workflows. Expanding bundled and episode-based payments will pressure hospitals and surgeons to understand true costs before payers define value. Site-neutral payments will accelerate migration of spine and joint procedures to ASCs, rewarding well-integrated systems. Implant price transparency will rise, driving vendor accountability. As private equity and corporate consolidation continue, surgeons must prove value through outcomes, education and stewardship. Patients, meanwhile, expect transparency, convenience and digital navigation to care.
John Uribe, MD. Chief Medical Executive of Orthopedic Surgery at Baptist Health Orthopedic Care (Miami): As more surgeons are employed by large systems, AI will increasingly determine the value of procedures and hardware. Surgeons will be required to justify any deviations from AI-driven recommendations.
James Wylie, MD. Orthopedic surgeon and Medical Director for Hip and Knee Preservation and Director of Orthopedic Research at Intermountain Healthcare (Salt Lake City): Rising healthcare costs and economic uncertainty could reduce demand for elective orthopedic procedures. Layoffs and shrinking employer-sponsored coverage, along with potential Medicaid cuts and higher premiums, may lead some patients to defer elective surgeries. Demand may decline most in sports medicine and small joint procedures but remain stable for joint arthroplasty due to the aging population.
