Orthopedic leaders say reimbursement changes could rapidly reshape care delivery, accelerating the shift toward value-based care, outpatient surgery and more coordinated, patient-centered treatment models. But many also cautioned that changes to payment structures could fundamentally alter physician employment, surgical decision-making and patient access across the specialty.
The 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 Sophie Eydis at seydis@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: If reimbursement models changed tomorrow, how would orthopedic care delivery change overnight?
Wael Barsoum, MD. President and Chief Transformation Officer, Healthcare Outcomes Performance Company; Orthopedic Surgeon at Cleveland Clinic Florida (Weston): I think the biggest change would be around hospital employment for orthopedic surgeons. We are already seeing significant challenges with hospitals, finding that they are having a hard time justifying the employment of orthopedic surgeons, giving the shift from inpatient to hospital outpatient status for most procedures.
That is bound to increase, especially as we come up on site neutrality payments. It simply doesn’t make sense for hospitals to continue to employ orthopedic surgeons and try to keep the volume in the hospital. Appropriate cases should shift to ASCs where patients generally have higher patient experience scores and significantly lower costs. Of course, hospitals we still play a very important role in the care of orthopedic patients, but it will most certainly be more difficult to justify the employment of orthopedic surgeons as their reimbursement continues to drop.
Ravi Bashyal, MD. Director of Outpatient Hip and Knee Replacement Surgery at Endeavor Health (Evanston, Ill.): If reimbursement models changed tomorrow, orthopedic care delivery would likely move even faster toward value-based models, with greater emphasis on outpatient care, standardization, patient education, care coordination and measurable outcomes.
That shift has tremendous potential to improve access, affordability and patient experience, but it is important that reimbursement models also account for patient complexity, social factors and the resources required to safely care for higher-risk patients. The goal should be to reward high-quality, efficient care without unintentionally discouraging care for the patients who may need us most.
Kevin Bozic, MD. Professor and Chair, Department of Surgery & Perioperative Care, Dell Medical School at the University of Texas (Austin): If reimbursement models changed tomorrow to reward outcomes that matter to patients per dollar spent to achieve those outcomes, musculoskeletal care delivery would become more coordinated, data-driven and patient-centered. We would see accelerated adoption of care delivery and payment models focused on appropriateness, longitudinal outcomes, patient-reported outcomes measures and team-based care designed to improve health rather than simply increase procedural volume.
Brian Curtin, MD. Orthopedic Surgeon at OrthoCarolina Hip and Knee Center (Charlotte, N.C.): If reimbursement suddenly shifted to site-neutral payments, private practices would immediately redirect as many appropriate cases as possible from hospitals to their own ASCs, since the financial disadvantage of performing cases outside the hospital would disappear overnight. Schedulers would begin rerouting upcoming elective cases and surgeons would reinforce this shift by prioritizing ASC block time and expanding capacity.
Hospitals losing their pricing advantage would give private practices a stronger competitive position. Much lower out-of-pocket costs for patients would make ASC-based care more attractive, fueling higher demand from patients and payouts alike. Practices may invest rapidly in additional staff, equipment and room capacity to accommodate the new volume increase. Site-neutral payments would catalyze an immediate migration of cases to private ASCs, fundamentally altering market dynamics.
Travis Doering, MD. Orthopedic Hand, Upper Extremity and Peripheral Nerve Surgeon at Upper Extremity ATX (Austin, Texas): If reimbursement models shifted to truly reward outcomes, function and longitudinal patient health, orthopedic care delivery would evolve almost overnight toward more coordinated, prevention-focused care.
Patients would ideally arrive at their orthopedic consultation having already completed appropriate imaging and physical therapy, with a stronger understanding of their condition and the spectrum of nonoperative treatment options available to them. We would also likely see significantly improved access to ancillary services that are critical to recovery, mobility, and, in many cases, avoiding unnecessary surgery altogether.
Clay Dorenkamp, DO. Orthopedic Surgeon at Michigan Orthopedic Center (Lansing): If reimbursement models truly aligned around outcomes and long-term value instead of procedural volume, orthopedic care would shift almost overnight toward optimization, prevention and coordination. Surgeons and care teams would finally have the time and infrastructure to invest in perioperative conditioning, patient education and longitudinal follow-up instead of being pushed toward high-throughput episodic care just to keep the lights on.
Nyleen Flores. Administrator and COO of Lake Oconee Orthopedics (Greensboro, Ga.): If reimbursement rates improved appropriately, hospitals could redirect resources away from routine outpatient orthopedic procedures and focus more heavily on acute care, complex surgical cases and long-term patient management where hospital-level infrastructure is truly needed.
Increased reimbursement could also improve physician practice sustainability, allowing orthopedic surgeons to expand access, invest in staffing and care coordination and care for patients more efficiently rather than being constrained by razor-thin margins and administrative burden.
Tyler Goldberg, MD. CEO at North American Orthopedic Concierge Association (Austin, Texas): If reimbursement models changed tomorrow, orthopedic care delivery would shift rapidly toward alternative pathways outside the traditional insurance system. More surgeons would move toward concierge, direct-pay, bundled care or limited-network models in order to preserve sustainability, autonomy and the ability to deliver high-quality patient care.
The reality is that reimbursement compression has been occurring slowly for years while complexity, overhead, and administrative burden continue to rise. There is ultimately a threshold where surgeons decide the traditional model is no longer viable, and that shift would significantly impact patient access to experienced orthopedic specialists.
Vamsi Kancherla, MD. Spine Surgeon at Specialty Orthopedics (Gainesville, Ga.): If reimbursement models flipped tomorrow to reward true value and outcomes over volume, orthopedic spine care would transform almost overnight. The old hospital-centric, high-volume playbook would give way to a surge in same-day endoscopic and minimally invasive
procedures in ASCs, powered by precision patient selection and rapid-recovery pathways that actually restore function faster.
Here at Specialty Orthopaedics, this shift would be rocket fuel for the philosophy we’ve always practiced: leveraging our dual orthopedic-neurosurgical training and cutting-edge endoscopic expertise to deliver superior long-term results, fewer complications and real life-changing care, finally aligning incentives with what patients deserve.
William Levine, MD. Frank Stinchfield Chair of Orthopedic Surgery at Columbia University (New York City) and Orthopedic Surgeon-in-Chief at NewYork-Presbyterian/Columbia: If reimbursement models changed tomorrow, orthopedic care delivery would change almost overnight because incentives drive behavior. In a fee-for-service environment tied to productivity metrics like wRVUs, surgeons face pressure to operate, contributing to more “fringe surgery” procedures that may technically be indicated but are not necessarily in the patient’s best interest.
I see this regularly, from frozen shoulder patients being scheduled for surgery before exhausting conservative treatments to a 75-year-old with end-stage arthritis whom I advised against shoulder replacement because he had very little pain. The patient was ultimately relieved surgery was unnecessary, something I believe reflects the expectations created by the current system.
If reimbursement shifted toward value-based and outcome-driven models, I think we would see greater emphasis on appropriate indications, shared decision-making, prevention and long-term musculoskeletal health. Orthopedic surgery can be transformative when appropriately indicated, but reimbursement structures should reward judgment, restraint, and outcomes as much as procedural volume. The best surgeons are not the ones who operate the most. They are the ones who know when not to operate.
Chad Mather III, MD. Associate Professor of Orthopedic Surgery at Duke University School of Medicine (Durham. N.C.): The most noticeable overnight change would be an abrupt shift away from low-value care delivery enabled by the fee-for-service structure. We accept low-value, low-skill work because we are paid to deliver it, while many high-value activities without direct payment mechanisms, care coordination, whole-person care, intentional shared decision-making, and outcomes measurement, for example, remain underutilized.
We likely would not see an immediate surge in these high-value services, but many low-value encounters would rapidly disappear. Instead, you would see expanded telehealth adoption, clinic sessions populated with more appropriate patients, and greater use of digital health tools for postoperative management. In many ways, this aligns with Peter Drucker’s observation: “If you want to start doing something new, you have to stop doing something old.”
Michael Rivlin, MD. Hand and Wrist Surgeon at Rothman Orthopaedics (Philadelphia): Reimbursement has been shifting from fee-for-service toward value-based models, especially bundled payments in orthopedics. The driver has been the cost of the total episode of care: surgical cost, complications, readmissions, rehab and functional recovery. This has pushed orthopedic care toward outpatient surgery, standardized pathways, cost awareness and closer coordination across the care continuum.
However, to truly benefit patients, reimbursement should reward the right care, rather than simply more care. Shared decision making, appropriate workup, risk stratification, safe surgery, complication prevention and meaningful outcomes like pain relief and return to function should be the drivers. It also needs fair risk adjustment, so surgeons are not discouraged from treating complex or higher-risk patients.
Marceline Rogers. COO and Senior Vice President, Orthopedics of Parkview Health (Fort Wayne, Ind.): This is a topic that’s especially relevant given the economic pressures we’re facing in healthcare, and it seems we are already experiencing a rapid evolution in how we approach care delivery.
Our team continues to critically evaluate the technologies and biologics we use, particularly those that may not offer clear value for patients. We recognize these can often drive up costs without meaningful benefits, so our focus is on making thoughtful choices that support both fiscal responsibility and patient outcomes. Alongside this, we’re embracing innovation and technology to streamline processes, lessen administrative burdens and develop creative new strategies for delivering care.
Operational efficiency is a top priority for us. We are dedicated to empowering our teams so they can devote more energy to patient care, consistently achieve high-quality results, and minimize time spent on tasks that don’t add value. At the heart of our efforts is our care team model, which encourages seamless workflows, open communication, and a collective understanding of how best to support clinicians as they care for patients.
Richard White, MD. Orthopedic Surgeon at Fitzgibbons Hospital (Marshall, Mo.): Orthopedic care would most likely have to adapt to the new model. This has always been the case. It would most likely need to become more efficient, and each practice will need to consider prioritizing the new benefits that the new model is creating. Goals of care should still strive for excellence, regardless.
Graham Young. Co-Chief Executive Officer, Strategy and Growth at U.S. Orthopaedic Partners (Alpharetta, Ga.): If reimbursement models changed tomorrow, orthopedic care delivery would move almost immediately. We’ve already seen it in joint arthroplasty: when CMS removed total knees from the inpatient-only list and expanded outpatient eligibility, the market moved fast toward ASCs, sharper pre-op optimization and more disciplined patient selection.
Bundled payments created the same urgency, forcing practices to standardize protocols, reduce unnecessary post-acute utilization and manage the full episode of care with much greater precision. That’s why independent orthopedic platforms like ours have to stay nimble, because in orthopedics, policy can change the economics overnight, and the best operators adapt quickly.
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
