Orthopedics is entering 2026 amid political, financial and operational challenges. For Kevin Bozic, MD, chair of surgery and perioperative care at Dell Medical School at the University of Texas at Austin, those headwinds are shaping budgets, staffing models, care delivery structures and the future role orthopedic surgeons will play in the nation’s health system.
Across his leadership roles, Dr. Bozic is doubling down on something he believes the field has not yet fully embraced: coordinated, longitudinal, value-based care centered on musculoskeletal conditions.
For him, the year ahead will be about building the systems, measurements and teams required to support that shift, and ensuring orthopedics has a seat at the table as national models evolve.
The instability reshaping orthopedic decision-making
The modern orthopedic landscape is being defined not only by clinical complexity but also by volatile funding and policy shifts. That instability, Dr. Bozic said, now affects nearly every planning decision.
“We’re navigating very uncertain times in terms of government funding, from Medicare and Medicaid to NIH research support,” he said. “That uncertainty makes budgeting and planning very difficult.”
He added that the future of Affordable Care Act exchange subsidies remains unsettled, with their continuation or conversion depending on which party sets federal policy — a change that could directly influence patient access and surgical volumes.
But he also views the turbulence as an opportunity.
For years, Dr. Bozic has pushed to replace fragmented fee-for-service care with integrated, team-based models that reward outcomes rather than volume. He hopes today’s pressures will accelerate that shift.
Even as CMS introduces new models aimed at chronic condition management, Dr. Bozic said many remain “built on a fee-for-service chassis.”
What he wants instead is “a different way of paying for things that incentivizes teams to come together around the management of chronic conditions like musculoskeletal conditions,” with payment tied to optimizing care over time.
Such a model, he said, would “lead to better value for patients as measured by patient-reported outcomes,” while encouraging “more integrated, coordinated care.”
CMS’ TEAM — and the infrastructure it demands
Dr. Bozic’s department is preparing for CMS’ new Transforming Episode Accountability Model, a mandatory episode-based payment program that holds selected hospitals accountable for the cost and quality of care from surgery through 30 days after discharge.
TEAM relies heavily on capturing patient-reported outcome measures, but its focus on procedural episodes does not fully reflect how Dr. Bozic believes PROMs should function.
“We like to use it at point of care with the clinician, the clinical team and the patient,” he said. Even so, he views the requirement as a step toward normalizing outcomes measurement from the patient’s perspective.
The model also demands integrated care coordination across sites and disciplines, a capability that has expanded and contracted as earlier programs such as BPCI and CJR have come and gone.
For Dr. Bozic, the goal is consistency: systems that allow orthopedic teams to manage musculoskeletal conditions cohesively, regardless of the payment environment.
Scaling multidisciplinary care beyond academic walls
Since its inception, Dell Medical School has championed person-centered, multidisciplinary orthopedic care. But Dr. Bozic’s focus for 2026 is not proving the model works; it’s proving it scales.
He said many in the field assume Dell’s approach is only possible in a well-resourced academic environment. He is working to dismantle that perception.
“Our big focus this year is scalability and generalizability to different practice settings,” he said.
For him, scalability begins with integrating PROMs into everyday decision-making, rather than collecting them solely for compliance. He wants clinicians and patients to see that data as essential to triage, treatment planning and progress tracking.
He is also urging orthopedic practices to rethink the skill sets required for longitudinal musculoskeletal management. Roles such as social workers, physical therapists, dietitians and health coaches, often missing in orthopedic settings, will become increasingly important as payment shifts toward condition management.
Another priority is redistributing clinical responsibilities. Too often, surgeons serve as the first point of contact for minor musculoskeletal complaints. Instead, he believes practices should “downstream” care so that APPs, physical therapists and chiropractors manage front-line needs, with surgeons stepping in for more complex or operative cases.
AI’s promise — and its emerging pitfalls
Wielded responsibly, AI can reduce burden on clinicians and patients. But in its current state, it may be having the opposite effect, Dr. Bozic said, .describing what he called a growing arms race between payers and clinicians.
“The payers are using AI to deny claims [and] require more preauthorization.”Clinicians, meanwhile, are using AI to ensure their documentation satisfies increasingly complex requirements.
Instead of reducing administrative load, both sides are escalating it. Dr. Bozic wants to identify uses of AI that simplify care, improve decision-making and reduce burnout, not add new layers of digital bureaucracy.
The measurement shift that will define orthopedic value
Despite the uncertainty, he is convinced the next major shift in orthopedic performance will center on patient-reported outcomes.
It is not enough to track whether processes were completed efficiently. The real question is whether patients feel and function better.
“Are the things that we’re doing moving the needle… in terms of patient-reported outcome measures?” he asked. If not, he believes teams must revisit their approach or reconsider whether they are offering the right interventions.
He is adamant that PROMs should evolve from passive data collection to active clinical tools.
“I hate the phrasing of collecting patient-reported outcomes,” he said. “We don’t collect lab values and imaging. We use them.”
Reimagining the role of orthopedic surgeons
Looking back at 2025, Dr. Bozic said his biggest shift was recognizing how urgently orthopedic surgeons must expand beyond short, episodic involvement.
“If we silo ourselves into proceduralists… we’re going to make ourselves less relevant,” he said. Instead, he believes surgeons must lead integrated teams that manage musculoskeletal conditions throughout the entire patient journey.
Without that evolution, he warns, orthopedic surgeons risk losing influence over emerging care models.
Digital health companies are already positioning themselves as primary managers of musculoskeletal conditions, threatening to reshape the specialty’s traditional role.
“There are a lot of others now vying for primacy in that space,” he said.
To remain the trusted leaders in musculoskeletal health, the core mission of the American Academy of Orthopaedic Surgeons, where he holds multiple leadership roles, orthopedic surgeons must actively shape how digital tools and virtual platforms are incorporated into care.
What comes next
For Dr. Bozic, the future of orthopedic care will not hinge on a single technology, program or policy. It will be defined by how well teams integrate care, use outcomes meaningfully, adopt AI responsibly and guide patients across their full musculoskeletal journey.
His commitment is clear: fewer silos, fewer administrative burdens, more coordinated care and a specialty prepared to lead rather than follow.
As the field enters a turbulent but transformative period, he believes orthopedics has a rare chance not just to adapt to a changing system, but to help redesign it.
