This is a column by Les Jebson, administrator of the Orthopedics and Sports Medicine Network at Prisma Health.
Thirty years ago, Car and Track Magazine produced a calendar with luxury and bespoke car manufacturers’ greatest inventions. They would become known as “super” cars. The Lamborghini Countach, The Ferrari F40, Porsche 959, Mclaren F1 and others would battle for horsepower and performance supremacy. In the early 2000s, the dawn of the ‘hyper’ car label with the 250 mile an hour Bugatti Veyron, Ferrari LaFerrari, Porsch 918 and Mclaren P1 began. This next iteration in the exotic car automotive industry echoed with tones of even bigger, faster and grander scale. One could argue that similarly in the US healthcare delivery systems that in roughly the same period orthopedic practices began consolidation and like the exotic cars, “super” groups would begin to form throughout the country. These practices consist of dozens and even hundreds of physicians and advanced practice providers across metropolitan areas and even states. Orthopedic group consolidation has shown no signs of easing, as a slew of additional mergers has been announced in the last 24 months. The reasons for the formation of these organizations are multifaceted, but include rising payer complexity, flat reimbursements, increasing payer consolidation, technological investment requirements and the need for greater negotiating leverage.
This begs the question, is the next iteration of integration the emergence of orthopedic “hyper” groups? A behemoth of multiple orthopedic groups that span statewide with the high hundreds if not thousands of orthopedic specialists and advanced practice providers. Unlike traditional practice management companies or private equity platforms, hyper groups would function as unified clinical enterprises that combine economies of scale with standardized care pathways, centralized technology, sophisticated data analytics and coordinated population health strategies. While a definitive structure remains uncertain, I would submit that economic and healthcare trends suggest that hyper groups could become a defining feature of musculoskeletal care during the next decade.
If we look at the rapidly evolving forces that support the advent of hyper groups, healthcare economics is increasingly favoring scale. Administrative costs continue to rise due to increasingly complex payer billing rules, quality reporting requirements, human resources management, compliance oversight, and EHR maintenance. These fixed costs are easier to absorb across larger organizations than smaller independent practices. At the same time, commercial insurers have consolidated into fewer, larger organizations. Negotiating favorable contracts has become progressively more difficult for groups that lack significant market presence. Hospitals and health systems have also continued market consolidation into regional and multistate health systems. In the past 2 years alone, Hospital and health system mergers totaled 86 announced transactions according to data from Kaufman Hall. This includes 46 mergers recorded in 2025 and 40 mergers during just the first half of 2026.
The reason for the formation of hyper groups is compelling, but governance and orchestrated focus over geographic distance with differing market forces could present significant challenges. If we are to look at supergroups and explore how they might reach a hypergroup designation – hypergroups by nature would represent a fundamentally different organizational model. Rather than serving one geographic market, these organizations would operate across multiple states under unified governance. Individual local practices could retain their regional identities while sharing centralized business functions, technology platforms, clinical protocols, and strategic planning. I would submit, scaling the supergroup models around the country, to even larger footprints. A mature hypergroup might consist of at least 500 to 2000 clinicians and have continued integration with outpatient physical therapy and imaging facilities. Sports performance and some niche cash-based service offerings would also be part of the overall brand and suite of services. The hypergroups would operate a network of orthopedic centric urgent care centers or have joint ventures with conventional urgent care or free-standing emergency room operators. The sheer scale and geographic footprint could lend itself to the provision of multiple clinical research studies. The hypergroup because of its scale might also own and operate hotel type facility offerings as a patient experience enhancer and additional revenue capture opportunity.
A central informatics program not constrained by geography could serve centralized revenue cycle operations and a robust artificial intelligence and business analytics offering. Such organizations would resemble national professional service firms more than traditional medical practices. The centralized information programs would serve as a great integrator. The technological infrastructure required to support hyper groups is becoming increasingly feasible. Cloud-based EHRs enable standardized documentation across multiple states. The artificial intelligence and business analytics offerings could drive measurable improvements in surgical scheduling, coding optimization, predictive outcome and post-operative monitoring. Remote monitoring technologies can allow patients recovering from surgery to transmit mobility data directly to clinicians. Virtual visits increasingly permit follow-up care without requiring patients to travel long distances. These technologies reduce the importance of geographic proximity while increasing the feasibility of managing large, distributed clinical enterprises.
With supergroups, hypergroups have the potential to enhance standardization of musculoskeletal care.
Hyper groups would likely invest heavily in evidence-based clinical pathways for common orthopedic conditions. Improved patient outcomes while reducing costs through consistent implant selection, rehabilitation pathways, infection prevention measures, and hospital and ASC perioperative optimization. Importantly, standardization would not eliminate physician judgment but instead provide evidence-informed defaults while allowing individualized decision-making when clinically appropriate. Value base care initiatives continue to slowly shift conventional fee-for service payment models. Bundled payments for joint replacement have already demonstrated that surgeons who coordinate care effectively can improve financial performance while maintaining quality.
Hyper groups may be uniquely positioned to manage bundled payment models, shared savings and rebate agreements and direct-to-employer contracts. Because orthopedic care represents a substantial portion of healthcare spending, employers increasingly seek partners capable of managing musculoskeletal conditions efficiently across broad geographic regions.
National employer relationships exist in a very limited fashion. Large employers increasingly seek healthcare partners capable of delivering consistent care regardless of employee location. Hyper groups could negotiate national contracts with state government agencies, school systems and fortune 500 companies. Rather than negotiating separately with dozens of regional orthopedic practices, employers may prefer a single organization capable of coordinating musculoskeletal care across multiple states.
As has been the case with the formation of orthopedic super groups, there are significant challenges to hyper group formation. Despite compelling economic drivers, significant obstacles remain. State-specific regulations governing medical practice vary considerably; even in neighboring states. Licensure requirements, corporate practice of medicine laws, insurance contracting rules, and certificate-of-need regulations complicate multi-state integration. This is further complicated by cultural differences between practices. Each orthopedic group develops unique approaches to governance, compensation, scheduling, and decision-making. Successfully integrating these cultures requires thoughtful leadership and transparent communication. Maintaining physician and advanced practice engagement within very large organizations may also become increasingly difficult. With broad geographic footprints, clinicians may perceive greater administrative distance from leadership. Hyper groups must therefore balance centralized efficiency with local autonomy.
State and federal regulatory considerations will also influence the formation of hypergroups. Federal regulators continue monitoring healthcare consolidation for potential effects on competition. Future hyper groups may therefore expand by entering new geographic regions rather than dominating individual local markets. Maintaining competitive pricing and demonstrating improvements in quality will likely remain important for regulatory approval.
By the mid-2030s, the orthopedic landscape will look substantially different from today. At present, over 50% of orthopedic specialists practice in independent or private settings. Southern states have seen the fastest rate of consolidation, seeing a 140% increase in health system ownership over recent multi-year tracking. In the Northeast, corporate owned practices have expanded by over 150% as smaller orthopedic groups seek refuge in larger networks and the ability to handle regulatory burden. In the Midwest, corporate ownership has been the slowest. Instead of thousands of independent practices, the United States could include several dozen physician-led hyper groups operating across multiple states. These organizations would compete based on measurable quality, patient outcomes, technological sophistication, and operational efficiency rather than simply geographic presence.
Patients may experience more standardized care, expanded access to subspecialty expertise, improved care coordination, and greater use of digital health technologies. Clinicians may benefit from reduced administrative burdens, enhanced collaboration, and broader career opportunities, while also facing new challenges related to governance, organizational complexity, and preserving professional autonomy. Whether hyper groups ultimately dominate the market will depend on reimbursement trends, regulatory oversight, physician preferences, and the ability of large organizations to maintain both clinical excellence and local responsiveness. Even so, the forces that fueled the rise of orthopedic super groups—economic pressure, technological advancement, and the pursuit of scale—remain active. If those trends continue, multi-state orthopedic hyper groups represent a plausible next phase in the evolution of musculoskeletal care delivery.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
