Orthopedic care entered a period of rapid transformation in 2025 as reimbursement cuts tightened margins, outpatient migration accelerated and new technologies reshaped surgical practice.
From payment pressure to robotics and prevention-focused care models, five forces in particular have defined how musculoskeletal care evolved this year.
1. Medicare’s 2025 fee schedule cut is directly contributing to a 3% drop in orthopedic surgeon pay: Orthopedic surgeons remained among the highest-earning physicians in 2025 at an average annual salary of $543,000, but compensation fell 3% year over year as Medicare reduced its conversion factor by 2.83%.
Leaders have warned the cuts are unsustainable amid rising labor and supply costs, which climbed 82% per full-time equivalent from 2013 to 2022 in physician-owned multispecialty practices.
“We’re just having to fight more every day for the same dollar,” Andrew Lovewell, CEO of Columbia (Mo.) Orthopaedic Group, told Becker’s.
2. Orthopedic and spine procedures are rapidly shifting to ASCs as CMS removes more surgeries from the inpatient-only list: ASCs are seeing rising volumes across specialties, and that includes orthopedics and spine procedures.
Outpatient hip, knee and shoulder replacements have steadily grown since 2020, and nearly all hand, foot and ankle and sports medicine arthroscopy now occurs in the ASC setting.
Alex Meininger, MD, orthopedic surgeon and sports medicine specialist at Steamboat Springs, Colo.-based Steamboat Orthopaedic and Spine Institute, told Becker’s that ASCs offer greater efficiency, consistent OR teams, improved implant decision-making and higher patient satisfaction.
Spine procedures, including multilevel disc replacements and lumbar surgeries, are also expanding rapidly into outpatient settings.
3. Robotics, AI and motion-preserving techniques are gaining ground: Orthopedic and spine surgeons say technology adoption is accelerating, with robotics expanding rapidly and expected to integrate more deeply with AI to improve surgical precision and alignment.
Surgeons also anticipate major growth in AI-enabled postoperative monitoring, generating large datasets to better evaluate functional outcomes and close the final performance gap in joint replacement results.
Leaders additionally have pointed to rising interest in computer navigation, motion-preserving disc arthroplasty, outpatient spine expansion, site-neutral payment shifts and consolidation pressures that continue to reshape practice economics and surgeon autonomy.
4. Orthopedics is shifting from repair to prevention as leaders reimagine musculoskeletal care models: Orthopedic departments are increasingly being pushed to move beyond treating injuries and toward preventing them altogether.
Leaders across major academic and health system programs told Becker’s prevention requires new care models, aligned incentives and deeper collaboration between clinicians, researchers and payers.
Efforts include embedding athletic trainers in tactical units to reduce injury risk, expanding bone health clinics to identify osteoporosis early, adopting neuromuscular training programs shown to cut ACL injuries by up to 70% and using predictive analytics, wearables and AI to detect musculoskeletal problems before they develop.
Many emphasize prevention will take hold only when reimbursement, training and cultural expectations shift to reward proactive musculoskeletal health.
5. Consolidation and private equity are reshaping orthopedic practice structures: Consolidation is accelerating across orthopedics as financial pressures mount.
Some leaders have warned that large system mergers and corporate employment models can erode surgeon autonomy, increase administrative layers and limit influence over staffing and vendor decisions. Others view consolidation as a path to preserving independence, providing scale, capital and operational support that smaller groups cannot achieve alone.
Successful PE partnerships often depend on clear alignment: surgeons retaining clinical control while MSOs manage nonclinical functions. Many leaders expect continued aggregation as practices reorganize to manage musculoskeletal care more efficiently across patient populations.
