Last year was a crucial year of learning for spine and orthopedic leaders, with artificial intelligence understanding and implementation being a top priority for many.
Other changes surgeons are making include a focus on patient education and growth strategies.
The 19 leaders featured in this article are speaking at Becker’s 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, set for June 11-13, 2026, at the Swissotel Chicago.
If you would like to join the event as a speaker, please contact Carly Behm at cbehm@beckershealthcare.com.
As part of an ongoing series, Becker’s is connecting with healthcare leaders who will speak at the event to get their insight on thought-provoking questions within the industry. The following are answers from event speakers, lightly edited for clarity.
Question: What’s one lesson your practice learned in 2025 that will impact operations going forward?
Jared Ament, MD. Neurosurgery & Spine Group (Santa Monica, Calif.): Our practice learned that patients truly appreciate educational platforms and feedback from other patients. So, having testimonials and contact options (when possible) was critical.
Wael Barsoum, MD. President and Chief Transformation Officer at Healthcare Outcomes Performance Co. (Phoenix): One lesson that we are actively learning is how to appropriately and safely introduce artificial intelligence into our practices. Many people see artificial intelligence as a panacea that will quickly revolutionize healthcare. I think we are seeing it more as a tool to help us operationally manage our practices, more efficiently and more effectively. A good example would be using call center trees and genetic agents to ensure that the right patient is being seen by the right provider. Other areas are in revenue cycle enhancements. The use of artificial intelligence and actually delivering healthcare is not in our short-term plan.
Tan Chen, MD. Inova Health System (Fairfax, Va.): In 2025, the biggest lesson our practice learned was that great spine surgery isn’t just about what happens in the operating room, it’s about the entire patient journey. We took a hard look at how patients move through evaluation, preparation, surgery, and recovery, and made meaningful improvements to reduce delays, streamline communication, and enhance recovery. By focusing on preparation and teamwork, we created a smoother, less stressful experience for our patients, with safer surgeries, shorter hospital stays, and more predictable outcomes. Moving forward, our commitment is simple: deliver exceptional surgical care within a system designed entirely around the patient.
Travis Doering, MD. Bone Drs. Orthopedic Care (Austin, Texas): We learned to be very careful in evaluating new AI centric products! My group switched EHR vendors from a legacy option to one with AI-driven charting/orders/billing/coding/RCM… and it has been a bit of a nightmare. The focus on the right buzzwords made us overlook deficiencies in basic practice workflows, and both efficiency and quality of care have taken a nosedive.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: The most important lesson is educating patients about the finances of their healthcare. Some patients don’t understand how their health insurance, whether an HMO, PPO, Medicare or Medicare Advantage works, and I think there’s been an active disinformation campaign on the part of carriers on what patients rights and responsibilities are for their insurance. So, one lesson we’ve learned is that we have to continue to educate them on what their benefits are and what their benefits are not. We’ve really doubled down on teaching patients as soon as they call so they really understand how, for instance, if they’re out of network, that they know what that means. They understand what their responsibilities are. It’s very transparent.
If they have surgery they know upfront what that cost is going to be, and about how they can maximize their out-of-network benefits, and we get them more comfortable with the idea of being more versed in their coverage. What I’ve seen, time and time again, is that patients don’t understand things like out of pocket maxes, they don’t understand coinsurance and they don’t understand sometimes even what a deductible is.
I think there’s been a lot of misinformation, particularly on the part of some of the media outlets that try to paint doctors as bad actors and bad guys, and there are obviously bad guys and bad actors, but for the most part, doctors fees and when patients see doctors make up only about 6% of healthcare spend. And a lot of patients, if they knew more, may be willing to confront their insurance companies or even see out-of-network physicians to get the care they want. And many times insurance companies will continue to play with the physicians outside of the patient’s knowledge. A good example is a clawback where the insurance company has paid for a claim and anywhere from six months to three years after the fact they try to take back money for some usually concocted reason.
Insurance companies, by and large, don’t tell patients what they are entitled to, because if the patients realize that, then they become empowered, and therefore a threat to the company’s bottom line. I think if those clawbacks happen, we should inform our patients, and we’re doing that now.
Alejandro Fernandez. CEO at Synergy Orthopedic Specialists (San Diego): In 2025, Synergy Orthopedic Specialists learned that owning and tightly integrating conservative care and rehab is a strategic requirement, not a “nice to have,” and that lesson will drive how new sites and service lines are built.
Building on that, Synergy will increasingly integrate AI-driven patient documentation tools to streamline visits, reduce provider burnout, and improve accuracy in coding and compliance. MRI imaging workflows will be optimized using AI to standardize protocols, flag incomplete or low-yield studies, and surface key findings faster for surgeons and referring providers.
On the access side, an AI-powered phone auto attendant will route calls more intelligently, answer common questions, and reduce front-desk bottlenecks while still escalating complex or high-touch issues to staff. Together, integrated rehab, AI documentation, AI-optimized imaging, and AI call handling will form a single, data-driven operational model that supports value-based care, better patient experience, and more efficient growth.
Megan Friedman, DO. Chair and medical director at Pacific Coast Anesthesia Consultants (Los Angeles): In 2025, we learned that predictability is the foundation of both clinical performance and financial stability in anesthesia. Volume variability is inevitable, but unmanaged variability is expensive, driving inefficiency, subsidy pressure, and operational disruption. We redesigned our model around defined shifts, active anesthesia leadership oversight of scheduling and case allocation, data-driven concurrency targets, and structured redeployment within and across sites to align staffing with where cases are actually running. That disciplined operational model has stabilized costs, preserved throughput, and created dependable work structures that support long-term physician retention.
Tracy Hoeft-Hoffman. Administrator at Heartland Surgery Center (Kearney, Neb.): One of the biggest lessons we learned in 2025 is that patient experience is shaped long before and long after the surgery itself. In orthopedics especially, anxiety decreases and outcomes improve when patients feel fully prepared — so we redesigned our pre-operative education, set clearer expectations for pain control and recovery milestones, and increased proactive follow-up after discharge by a text messaging system and a phone call when needed. Moving forward, we will continue to prioritize communication, education, and continuity, because an exceptional surgical result means little if the patient doesn’t feel supported throughout the entire journey.
Steve Holtzclaw, MD. CEO at USOP: One lesson we were reminded of in 2025 is that you can’t keep trimming the roots and expect the tree to keep growing. We faced real economic headwinds — largely outside our control — but in healthcare the “roots” are your people, access, and patient experience. If you continually tighten staffing or delay investment in the name of efficiency, it will eventually show up in volume.
What made the difference for us was alignment. Our physicians and administrators stood together as one MSO, trusted the processes we’d built, and stayed disciplined. There’s a difference between removing waste and weakening infrastructure. Because we protected the fundamentals, we’re entering 2026 positioned for sustainable growth.
Vamsi Kancherla, MD. Specialty Orthopaedics (Gainesville, Ga.): In 2025, our practice learned the critical value of integrating AI-driven predictive analytics into our preoperative planning and patient risk stratification processes, which not only reduced surgical complications by identifying high-risk cases earlier, but also streamlined scheduling and resource allocation, leading to a 15% improvement in operational efficiency.
While overhead costs continued to pose a significant challenge, we focused on optimizing our payer contracts and reducing collection expenses through partnerships with resources like CAAP, a Clinically Integrated Network in Watkinsville, Ga., which helped us negotiate better reimbursements and minimize administrative burdens. Additionally, we enhanced MRI throughput by implementing add-on software such as Philips’ Compressed SENSE, accelerating scan times without compromising image quality, and brought services like EMG/NCS studies in-house to cut external referral costs and improve patient convenience. Moving forward, these strategies will drive sustained cost reductions and operational agility, allowing us to adapt more effectively to the evolving healthcare landscape.
Ira Kornbluth, MD. President of Clearway Pain Solutions (Annapolis, Md.): Unexpected issues frequently arise in developmental projects. We need to be nimble, adaptive and self-reflective so we can replicate our successes and avoid making similar mistakes. We learned to build more contingency time and resources into our plans from the start.
Paul Lynch, MD. CEO and founder at US Pain Care (Phoenix): One of the biggest lessons our practice learned in 2025 is that real estate is strategy.
For many physician groups, rent has historically been viewed as a fixed expense. What we learned is that lack of control over your space creates real operational risk. If you can be displaced, non-renewed, or priced out, the disruption can be devastating — especially for an ambulatory surgery center where long-term stability, accreditation, and capital investment depend on continuity of location.
When we structure ownership or long-term control around our buildings — particularly in ambulatory surgery centers and high-acuity pain practices — we create operational leverage. It stabilizes occupancy costs, strengthens EBITDA, and builds enterprise value beyond clinical revenue alone.
In 2025, we began treating real estate as an asset to manage — like any other asset — not simply an expense to pay.
Melissa Rice. Administrator at Loyola Ambulatory Surgery Center, part of Trinity Health (Oakbrook Terrace, Ill.): One of the biggest lessons we learned in 2025 was the importance of building operational flexibility into every process. From staffing to scheduling to supply chain, having contingency plans and clear communication pathways allowed us to respond quickly to unexpected challenges. We also reinforced the value of real‑time data — using metrics to guide decisions helped us prevent small issues from becoming larger disruptions. Going forward, these practices will be embedded into our daily operations to support consistency, safety, and a better patient experience.
Ken Rich, MD. President of Raleigh (N.C.) Neurosurgical Clinic: I think last year it became very evident that artificial intelligence is going to be part of our world going forward. Insurance companies are already using it heavily to deny pre-authorization and claims. If we don’t get on that bandwagon the unfair practices insurance companies engage in will only get worse.
Jacob Rodman. CEO at Raleigh Neurosurgical Clinic: One of the most important lessons our practice learned in 2025 is that operational alignment must precede growth.
As we continued expanding — clinically, geographically, and organizationally — it became clear that adding services, locations, or partnerships without first hardwiring standardized processes creates friction that ultimately limits scalability. Growth amplifies both strengths and weaknesses. If scheduling workflows, revenue cycle processes, clinical documentation standards, payer strategies, and leadership accountability structures are not tightly aligned, expansion exposes those gaps quickly.
In 2025, we learned that:
- Standardization is leverage. Clear SOPs across front office, pre-certification, ASC coordination, and postoperative follow-up improved throughput and reduced rework.
- Data transparency drives performance. Weekly KPI visibility (access lag, denial rates, implant margin performance, block utilization, cost-per-minute metrics) shifted conversations from anecdotal to objective.
- Payer strategy cannot be reactive. In a tightening reimbursement environment, proactive contracting and cost discipline became essential to protect margins.
David Russo, DO. Columbia Pain Management (Hood River, Ore.): In 2025, we learned that margin discipline is a strategy, not merely an accounting exercise. Amid reimbursement compression, prior authorization friction, and labor inflation, it became clear that independent practices can’t operate reactively. We tightened revenue cycle analytics, standardized clinical workflows, and aligned compensation with collections and site-level performance. We also invested in ancillaries and data transparency to protect autonomy in a consolidating market. Going forward, operational clarity, knowing exactly where value is created and where it leaks, will determine which practices remain independent and which are absorbed.
Erica Taylor, MD. Duke University School of Medicine (Durham, N.C.): One of the most important lessons we learned in 2025 is that growth and value are not the same thing. Demand for orthopaedic services continues to increase, but simply seeing more patients or adding more cases does not automatically translate into stronger performance.
We had to become much more intentional about aligning volume with comprehensive care, particularly as value-based contracts increasingly require documentation, coordination, and attention to social and clinical drivers that influence outcomes. Operational efficiency can’t come at the expense of understanding the full context a patient brings.
Going forward, our focus is on building workflows that support both access to care and the depth of care. Sustainable growth will depend on systems that enable clinicians to deliver high-quality, coordinated care without burnout, rather than simply increasing throughput.
Michael Verdon, DO. President at Dayton (Ohio) Neurological Associates: Establishing a process and following it for data collection and patient reporting outcomes PROMs/ VAS/ODI. This is no longer optional and will be required going forward for payers (see Ambulatory Specialty model Medicare 2026). Having a platform to quantify symptom resolution, return to work and quality of life improvement are essential to “validate ” delivered value of diagnostic and surgical services provided to patients.
Sylvester Youlo, MD. Phelps Health (Rolla, Mo.): In 2025, we recognized that clinical documentation is a financial strategy. As margins tightened and CMS reimbursement changes worsened the pressure, we reviewed charts. Many encounters used significant resources, yet reimbursement was delayed or denied. Our case mix index did not reflect patient severity.
The care was appropriate. The record did not capture complexity.
Physicians often document for communication and medicolegal protection, but modern payment depends on specificity and risk adjustment. We implemented focused clinician education to document the patient, not just the visit.
Within months our case mix index rose. Days in accounts receivable fell. Reimbursement improved materially. The lesson is simple: documentation competency drives operational performance, and organizations that train clinicians will outperform those focused only on productivity.
