Orthopedics is entering 2026 with strong demand and expanding outpatient opportunity, but under intensifying financial and operational pressure. Reimbursement erosion, administrative burden and consolidation are reshaping how groups structure their practices, align with payers and invest in technology.
For orthopedic leaders, the path forward is less about volume growth alone and more about sustainability, securing predictable payment, redesigning care models and proving value in an increasingly cost-conscious environment.
Here are five forces shaping orthopedics in 2026:
1) Payer partnerships are becoming central to orthopedic ASC value: As reimbursement tightens and operating costs rise, orthopedic ASCs are redefining value around payer alignment. Leaders say strategic partnerships with insurers are increasingly shaping how outpatient orthopedic care is financed and delivered, with the goal of lowering total costs while supporting sustainable reimbursement for surgeons and anesthesia providers.
These arrangements are viewed as a path to stronger, more predictable payment in the ambulatory setting. However, Medicare remains a wild card, with procedure-level variability creating uncertainty in how aggressively ASCs can incorporate Medicare volume into their outpatient growth strategies.
2) Physician-led platforms are offering a “third path” amid consolidation: As consolidation accelerates, more orthopedic surgeons are turning to physician-led practice models that blend autonomy with scale. Leaders say these platforms integrate clinic operations, ASCs, imaging and administrative support, giving surgeons ownership-driven environments without full hospital employment.
These emerging structures are positioned as a middle ground between hospital employment and fully independent private practice, allowing surgeons to maintain clinical control, reduce administrative burden and operate more efficiently in 2026.
3) Fee schedule pressure and AI discipline are reshaping orthopedic operations: Orthopedic leaders say continued erosion of the physician fee schedule, combined with rising expenses, prior authorization hurdles, denials and downcoding, is straining practice economics in 2026. The growing administrative load is increasing staff burden, delaying care and accelerating consolidation across health systems, private equity and large physician-led groups.
At the same time, AI is expected to shift from hype to disciplined deployment. Rather than “bolt-on” tools, practices are focusing on workflow-integrated AI in revenue cycle, preauthorization and productivity, with measurable ROI, quality improvement and operational efficiency as the goal.
4) Outpatient growth is accelerating, but economics are tightening: Orthopedic volume continues shifting to ASCs as CMS expands the outpatient list and payers favor lower-cost sites of care. By late 2023, outpatient orthopedic volume was 33 times higher than inpatient, with projected growth of about 6% annually through 2030.
However, Medicare pays ASCs roughly 50% of HOPD rates, while implant costs and prior authorization requirements are rising, narrowing margins as more complex cases move to outpatient settings.
5) Workforce redesign and value-based care are moving into operational reality: Orthopedic leaders say 2026 will require structural redesign as musculoskeletal demand rises alongside clinician burnout and administrative burden. Practices are expanding advanced practice clinicians roles, adopting team-based models and leveraging digital tools to streamline workflows and protect access.
At the same time, value-based care is shifting from concept to implementation. As bundled payments and outcomes-based arrangements mature, organizations are investing in standardized pathways, longitudinal care models and stronger patient-reported outcomes infrastructure to align reimbursement with functional recovery and long-term musculoskeletal health.
