For Nader Nassif, MD, the evolution of orthopedics isn’t defined by technology alone — it’s defined by balance.
An orthopedic surgeon and division chief of joint replacement at Hoag Orthopedic Institute in Irvine, Calif., Dr. Nassif has helped lead a shift in joint replacement care toward efficiency, intentionality and patient-centered progress. His philosophy is simple: innovation only matters when it improves outcomes and access.
“The transition to outpatient surgery is probably one of the biggest things that has happened,” Dr. Nassif said. “More so than robotics.”
That shift, he explained, took years of planning. Moving hip and knee replacements safely into outpatient settings required rethinking every part of the process — anesthesia, pain control, physical therapy and patient education.
“It’s been a very intentional focus on patient quality to make sure pain is well controlled and all the protocols are dialed in,” he said.
Hoag was ahead of that curve.
“We were probably one of the early adopters of outpatient surgery about 10 years ago,” Dr. Nassif said. “COVID accelerated it, but it’s been part of our process for a long time.”
He believes the most meaningful advances in orthopedics are often those that happen quietly — refining protocols, reducing complications and personalizing recovery.
“There are new pharmaceutical offerings that will help with pain management and be less reliant on opioids,” he said. “That’s good for everybody.”
As the field faces rising demand from an aging population, Dr. Nassif said sustaining quality care requires a sharper focus on efficiency. For him, that does not mean doing more cases — it means aligning systems so surgeons can focus on the right ones.
“It’s really about optimizing efficiency,” he said. “Seeing the right patients, operating safely and efficiently — whether in an ASC or hospital.”
That kind of planning also applies to people. Hoag has made workforce development and succession planning part of its long-term strategy.
“We’re very attuned to generational legacy planning,” Dr. Nassif said. “We don’t want to be reactionary. We hire a bit ahead so we can grow new surgeons appropriately.”
Even as orthopedic programs grow more sophisticated, the administrative barriers to care have only multiplied. For Dr. Nassif, one challenge stands above the rest.
“Preauthorization is probably the bane of our existence,” he said. “It requires a lot of work and hours from our staff — work that’s not compensated by the insurance companies.”
He said the trend toward consolidation — both among health systems and insurers — has intensified those pressures, especially for private practice physicians.
“It becomes harder to compete or have leverage to sustain your practice,” he said. “We need to ensure we can practice appropriately and not be guided by whatever the insurance company thinks is right. They’re mostly focused on profit rather than the care of patients.”
Financial headwinds are another concern.
“The Medicare fee schedule hasn’t kept up with inflation,” Dr. Nassif said. “That devalues the medical services provided by physicians.”
If those pressures continue unchecked, he fears patient access could erode.
“At some point surgeons will say, ‘Enough is enough,’” he said. “There has to be change from both government and private payers if they truly value the care provided by doctors.”
Despite the challenges, Dr. Nassif remains optimistic about the role of AI in making orthopedics more sustainable. While AI has added new complexities — especially as insurers use it to review claims — he sees its potential to reduce documentation burdens and enhance surgical precision.
“AI is everywhere,” he said. “Insurance companies are using it to read over notes and deny things, but it can also decrease the burden of documentation. That’s where it can really help.”
He also expects it to become a valuable support tool in surgery.
“Once we have enough data, especially with robotic surgery, we’ll be able to have AI recommendations for things like knee replacement alignment,” he said. “It’ll never replace surgeons, but it’ll be a good additive option.”
For Dr. Nassif, progress isn’t about keeping pace with technology — it’s about keeping technology in service of patients.
“Every year it gets harder,” he said. “Administrative costs rise, reimbursement goes down and it becomes harder to provide care. But our responsibility is to keep finding ways to deliver it — safely, efficiently and with the patient at the center.”
