Orthopedics is heading into a turbulent year as payment models shift, technology accelerates and care migrates outpatient.
Five disruptions in particular are poised to reshape care delivery within the specialty in 2026:
1. Outpatient migration accelerates as regulations, technology and patient demand converge: CMS’ proposal to remove additional musculoskeletal procedures from the inpatient-only list, payer pressure to shift to lower-cost sites and rising patient preference for ASCs are all propelling the migration. By late 2023, outpatient orthopedic volume was 33 times higher than that of inpatient, and minimally invasive techniques, improved anesthesia and emerging site-neutral policies are expected to push even more joints, sports and select spine cases to ASCs in 2026.
2. AI, robotics and smart implants deliver faster planning, greater precision and new postoperative insight: AI is showing practical value in orthopedics, with surgeons reporting major gains in speed and accuracy. James Germano, MD, who performed the first U.S. AI-assisted hip replacement, told Becker’s that AI now produces surgical plans in minutes rather than weeks, making recommendations for precise implant size and positioning that surgeons refine and execute with robotics or navigation.
Across practices, surgeons echo that automated planning, ambient AI documentation and smart implants that track gait, range of motion and walking speed are improving personalization and reducing administrative burden.
3. Site-of-service shifts intensify ASC-hospital competition: Single-specialty orthopedic ASCs are multiplying, driven by high-efficiency joint and spine workflows and strong patient preference for same-day recovery.
However, persistent staffing and anesthesia shortages are forcing ASCs to recalibrate growth plans, while hospitals reassess which orthopedic volumes they can realistically retain.
4. Workforce strain and consolidation threaten independent practice: Surgeons predict a continued decline in private practice, fewer independent physicians and a widening gap in complex joint replacement capacity as revision volumes climb.
Chairs and service line leaders add that reimbursement cuts, limited staffing, anesthesia shortages and the rising cost of compliance are driving consolidation and complicating recruitment. Declining physician pay, expanding regulatory demands and corporatized care models are pushing many surgeons away from private practice and risking long-term access issues for patients.
5. Value-based and risk-based models redefine medical necessity: Orthopedics is being pushed deeper into bundled and episode-based models by reimbursement cuts, implant cost scrutiny, expanding prior authorization requirements and site-neutral payment proposals. These pressures will require tighter outcomes tracking, clearer appropriateness criteria and a stronger grasp of true procedural costs.
Medicare’s upcoming AI-driven “WISer” authorization system may also influence which procedures are approved and under what conditions.Surgeons expect AI-driven decision support, predictive analytics and population health models to play a growing role in determining surgical necessity. They anticipate accountable care frameworks that tie quality to cost and increased emphasis on longitudinal MSK management rather than episodic care. Together, these shifts will raise the bar for data infrastructure, standardized workflows and defining when surgery delivers meaningful value.
