Two forces are reshaping orthopedic care faster than almost any others: the steady absorption of independent practices into hospital systems and private equity platforms, and a debate over what value-based care actually delivers for patients.
Increasingly, orthopedic leaders see the two as intertwined, and not always in patients’ favor. As facility fees climb, reimbursements decline and independent practice grows harder to sustain, many surgeons worry that value-based care — a framework meant to align payment with outcomes — is being co-opted as cover for cost-cutting rather than a genuine push for better care.
Consolidation is changing where and how care is delivered
The shift away from independent practice has accelerated in recent years, with hospital systems and private equity-backed groups absorbing orthopedic practices at a rapid pace. Surgeons said the financial implications for patients are significant.
“The accelerating consolidation of orthopedic practices into hospital systems and private equity platforms is the biggest concern,” Kasra Ahmadinia, MD, a spine surgeon at Advanced Orthopedics of Oklahoma in Tulsa, told Becker’s. “It shifts care from lower-cost ambulatory and office settings into hospital outpatient departments, where facility fees can double or triple the cost of an identical procedure.”
Beyond cost, surgeons warn that consolidation narrows referral patterns and erodes clinical autonomy. Dr. Ahmadinia said vertical integration often nudges clinical decisions “toward higher-margin interventions rather than what’s genuinely best for the patient.”
Travis Doering, MD, a hand and upper extremity surgeon in Austin, Texas, echoed that concern, saying volume metrics and contract economics are increasingly driving clinical decisions inside large systems and private equity-backed groups.
“When surgeons lose the autonomy to practice at the top of their training, to offer the right procedure at the right time in the right setting, patients are the ones who pay the price,” Dr. Doering said. “Independent practice is harder than ever to sustain, but I believe it’s one of the last environments where truly individualized, surgeon-led care can still thrive.”
For Earl Kilbride, MD, an orthopedic surgeon at Austin Orthopedic Institute in Austin, Texas, the consequences for patients are already visible.
“The independent physician is shrinking. When that happens, patients suffer,” Dr. Kilbride said. “Costs rise, especially in hospital employment, surgeries get pushed to the higher revenue inpatient facilities, and access becomes communistic as healthcare systems spread patients to all providers regardless of patient requests.”
Dr. Kilbride pointed to a recent uptick in surgeons returning to private practice as a hopeful sign, but cautioned that health systems and private equity firms may ultimately outbid independent groups for future talent.
The value-based care question
As consolidation reshapes the field, value-based care has emerged as the industry’s preferred path forward, at least rhetorically. But several orthopedic leaders said the term has grown slippery, and its execution often falls short of its promise.
“The biggest worry is that value-based care becomes a label for cost reduction rather than an actual method for delivering better outcomes per dollar,” Philip Louie, MD, a spine surgeon and medical director of research and academics at Virginia Mason Franciscan Health in Tacoma, Wash., told Becker’s. “The two are not the same, despite how people use those terms. Cutting implants and narrowing networks can lower spend without improving what actually matters to patients.”
True value-based care, Dr. Louie said, requires measurement on both ends: patient-reported outcomes that reflect function and recovery, paired with transparent episode-level cost data and frameworks that flag unnecessary variability.
Without that, he warned that the model risks becoming a branding exercise.
“The next decade will reward groups that measure what patients actually experience and care about and price what care actually costs,” Dr. Louie said. “Everything else will hopefully be chalked up to ‘rebranding.'”
Other surgeons argue the shift toward outcomes-based reimbursement is overdue.
“The field of orthopedic surgery must continue to move toward value-based care and reimbursements tied to outcomes,” Amit Momaya, MD, chief of sports medicine at the University of Alabama at Birmingham, told Becker’s. “It is concerning that the same patient with the same pathology can get such different treatment based on which orthopedic surgery office they show up to.”
Dr. Momaya said he regularly sees patients who received non-evidence-based surgical care, or who could have benefited from a different approach or no surgery at all.
Where the two trends collide
The intersection of consolidation and value-based care is where many surgeons see the greatest risk. Andrew Kersten, MD, an orthopedic and sports medicine surgeon at Raleigh, N.C.-based EmergeOrtho, said hospital-employed models often introduce bureaucratic layers that work against the efficiency value-based care is supposed to reward.
“This trend risks compromising access, efficiency and innovation,” Dr. Kersten said. “It also contributes to higher overall healthcare spending, as care delivered in hospital settings is often significantly more expensive than equivalent procedures performed in outpatient ASCs.”
The next several years will test whether the industry can deliver on value-based care’s original promise or whether the term becomes another casualty of a consolidating market.
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