Whether to keep seeing Medicare patients, which technologies are worth the investment and how much complex care to move into ASCs are among the hardest calls spine, orthopedic and pain care leaders expect to make in 2027.
The leaders featured in this article are speaking at Becker’s 2027 Spine, Orthopedic & Pain Management-Driven ASC + The Future of Spine Conference, June 17-19 at Swissotel Chicago.
For speaker inquiries, contact Scott King at sking@beckershealthcare.com.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What is the hardest decision spine, orthopedic and pain care leaders will have to make in 2027?
Muhammad Abd-El-Barr, MD, PhD. Chief of Endoscopic Spine Surgery and Co-Director of the Spine Fellowship at Duke University Medical Center (Durham, N.C.): The hardest decision in 2027 will be deciding what not to invest in, and having the discipline to put the needs of the entire care pathway ahead of the growth of any individual service.
For spine, orthopedic and pain care leaders, that might mean not buying the newest and shiniest “toy” but instead investing in people or infrastructure that leads to better patient access, rehabilitation, nonoperative care and the teams that coordinate treatment.
As a spine surgeon who embraces enabling technologies, I believe innovation is essential. But every investment should answer three questions: Does it improve outcomes? Does it expand access? Does it create measurable value?
It will be important to align incentives around those questions. We need to reward appropriate patient selection, collaboration and durable functional improvement, including when the best outcome comes without a procedure. That requires difficult conversations about compensation, resource allocation and how we define “success.”
The strongest leaders will be those willing to forgo an attractive growth opportunity when a different investment would do more for patients. In 2027, choosing where to grow will matter as much as choosing how fast.
Owoicho Adogwa, MD. Neurosurgeon at UC Health (Cincinnati) and Associate Professor of Neurological Surgery at University of Cincinnati College of Medicine: The most consequential decision facing spine, orthopedic and pain care leaders in 2027 will be how to reconcile increasing financial pressures with the imperative to deliver high-quality, accessible and patient-centered care. As reimbursement continues to tighten, labor costs rise and care increasingly migrates toward ambulatory settings, leaders must determine where to deploy limited capital, clinical talent and technological resources to generate sustainable value. Artificial intelligence, automation and emerging surgical technologies offer tremendous opportunities, but the challenge will be distinguishing innovations that meaningfully improve clinical outcomes and operational efficiency from those that simply add cost and complexity. Ultimately, the organizations that succeed will be those willing to redesign traditional care delivery models, align incentives across stakeholders and prioritize measurable patient outcomes over procedural volume.
Amiethab Aiyer, MD. Chief of the Foot and Ankle Service and Professor in the Department of Orthopaedics at Johns Hopkins University (Baltimore): I think one of the most challenging elements we need to consider is how best to optimize access for patients, improve throughput and maintain those sacred relationships with them in an era where digital technology is rapidly accelerating and our efficiency, ability to communicate and demands at the administrative level are at an all-time high. Being able to integrate efficient workflow processes into our practices while, at the same time, educating those around us, whether they be learners, staff or fellow clinicians, becomes that much more imperative.
Zayed Almadidy, MD. Neurosurgeon at the Brain & Spine Institute at Advocate Lutheran General Hospital (Park Ridge, Ill.): The hardest decision in 2027 will be deciding when to hold back on a new procedure or technology, even when patients are asking for it and other practices are offering it. Leaders will need to make sure enthusiasm for innovation does not get ahead of the evidence or the individual patient’s needs. That means supporting clinicians who recommend nonoperative care when it is appropriate and giving them time to explain that recommendation clearly. Staying competitive will require earning patients’ trust through honest conversations about what a treatment can and cannot do.
Bridgette Berkeley, MSN. Clinical Director of Rocky Mountain Surgical Center (Bozeman, Mont.): I believe the greatest challenge facing spine, orthopedic and pain management leaders is maintaining high-quality patient care while ensuring long-term financial sustainability. Healthcare costs continue to rise, from staffing salaries to supplies, while reimbursement rates are not expected to keep pace. Leaders must make strategic decisions today to preserve the financial health of their programs and ensure continued access to quality patient care.
Rachel Bratescu, MD. Spine Surgeon and Assistant Professor at Johns Hopkins Medicine (Baltimore): The hardest decision spine, orthopedic and pain care leaders will face in 2027 is how to balance innovation, including things like AI and enabling technologies, with the delivery of high-value, evidence-based care. Leaders must determine where to invest limited resources without widening disparities in care, quality and outcomes. Ultimate success will depend on distinguishing innovations that meaningfully improve patient care from those that seem exciting and cutting-edge but add cost without measurable benefit.
Michael Briseño, MD. Orthopedic Physician and Surgeon at North Texas Orthopedics & Spine Center (Grapevine, Texas): The musculoskeletal landscape is moving rapidly right now, and navigating it can be daunting. Whether it is coming up with a roadmap to survive CMS-mandated reimbursement declines; incorporating rapidly shifting AI-driven support software that promises to improve office efficiency without sufficient long-term data to prove it; or managing declining physician morale and ever-increasing patient dissatisfaction with insurance company delays and the general healthcare experience, the challenge is unprecedented.
I believe the hardest decision for musculoskeletal leaders in 2027 will be how to keep the ultimate focus on clinical excellence while weathering this storm. This will take the shape of multiple small decisions that focus on all of these topics. However, the most important will be how to maximize physician morale and remind ourselves why we went into medicine in the first place. The ideal way to do this is to minimize the nonclinical work being piled on physicians by optimizing the enormous potential, even if not fully vetted, of AI-driven software to amplify our efficiency and allow us to focus on our patients.
Ray Brown. CEO and Director of Business Development at Lake Lucien Surgery Center (Maitland, Fla.): I think it is being honest with yourself about your ASC’s case mix, conducting a good examination of case costing with your staff and participating surgeons, and deciding on a path for the evolution of your case mix going forward in the near term.
Adam Bruggeman, MD. CEO and Surgeon at Texas Spine Care Center (San Antonio): I think the hardest issue facing leaders today is the tension between surgeons and pain management regarding who should do what procedures and when. The recent back and forth between the North American Spine Society and American Society of Pain & Neuroscience, as well as growing concern among the broader orthopedic community regarding peripheral stimulation, will lead to uncomfortable conversations. What is appropriate training? Who should perform what procedures? Who is responsible for policing that decision? I am hopeful that we can reach common-sense solutions that put the patient first.
Paul Bruning. Division Administrator of Sports Medicine and the Hand and Sports Sciences Institute in the Department of Orthopaedics at Duke University School of Medicine (Durham, N.C.): Unfortunately, one of the most difficult decisions practices may face is whether to continue accepting Medicare patients. The impact of Modifier 25 changes and reductions in the Physician Fee Schedule will further challenge practice financial sustainability, potentially forcing practices to reconsider their participation in Medicare. Ultimately, these financial pressures could limit patient access to care as practices struggle to balance the cost of providing services with declining reimbursement.
Bilal Butt, MD. Spine Surgeon at Cleveland Clinic (Cleveland): Having just returned from the NASS Annual Meeting, where I had the opportunity to see emerging technologies firsthand, I find this question especially timely.
I believe one of the greatest challenges spine care leaders will face in 2027 is balancing continued surgical innovation with financial sustainability while ensuring that advancements translate into meaningful benefits for patients.
Spine surgery is experiencing rapid technological advancement, from robotics and navigation to artificial intelligence, advanced implants and biologics. While these innovations hold tremendous promise, technological progress does not necessarily translate into improved clinical outcomes.
Leaders will need to take a thoughtful, evidence-based approach to technology adoption. Innovations that demonstrate improved outcomes, greater surgical efficiency and measurable clinical benefits will rise to the top.
Ultimately, optimizing patient care must remain at the center of these decisions. Success should not be measured by access to the latest technology alone, but by meaningful improvements in patient safety, functional recovery, quality of life and the overall patient experience.
Magalie Cadieux, MD. Assistant Professor of Neurosurgery at WashU Medicine (St. Louis): I think the hardest decision spine, orthopedic and pain care leaders will have to make is how to manage pathologies that overlap so much between subspecialties and decide the best treatment approaches for patients in a very neutral manner.
Shannon Cameron. COO of Anesthesia Foundation Services of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center (Boston): I believe the hardest decision spine, orthopedic and pain care leaders will face in 2027 is how to maintain access to clinically necessary care while operating within an increasingly unsustainable reimbursement environment. Declining margins, rising operational costs and growing payer scrutiny are forcing practices to evaluate not just how they deliver care, but which services they can realistically afford to continue providing.
From a revenue cycle perspective, the challenge goes well beyond reimbursement rates. Prior authorization requirements, medical necessity denials, payment delays and the administrative costs associated with appeals all affect the true financial performance of a service line. A procedure may appear profitable on paper, but once those costs are factored in, the economics can look very different.
I think leaders will have to make some uncomfortable decisions about site of service, payer participation, staffing models and potentially the viability of certain procedures or service lines. The critical distinction will be understanding whether financial underperformance is driven by reimbursement policy, operational inefficiencies or both. Those are very different problems requiring very different solutions.
Ultimately, the hardest decision will be how to balance financial sustainability with clinical judgment and patient access. Revenue cycle leadership needs to be part of those strategic conversations, not simply brought in after the decisions have been made. In 2027, understanding what it truly costs to deliver and collect payment for care will be just as important as understanding what a payer is willing to reimburse.
Annmarie Caulfield. Business Director of the Neurosciences Service Line at Cook County Health (Chicago): Equity must remain at the center of our investment decisions in 2027. As reimbursements decline and margins tighten, we must balance the significant investment required for multidisciplinary, outcomes-based care with financial sustainability. While our commitment to quality care remains unwavering, we must be strategic with where we expand to ensure that financial pressures do not come at the expense of quality.
Edward DelSole, MD. Spine Surgeon at Keystone Spine and Pain Management (Wyomissing, Pa.): The hardest decision spine, orthopedic and pain care leaders will have to make in 2027 is how to manage the growing challenges with insurers, both commercial and government. We continue to see clinical growth with simultaneous margin compression and expect this to worsen in 2027.
We are also seeing commercial payers push mandatory site-of-service determinations, forcing us to move patients from the hospital setting to the ASC setting, even when we feel this is clinically inappropriate. For these reasons, managing the payer environment could become life or death for small practices next year.
Travis Doering, MD. Orthopedic Hand, Upper Extremity and Peripheral Nerve Surgeon at Upper Extremity ATX (Austin, Texas): The hardest decision in 2027 will be how many Medicare patients a practice can afford to keep seeing. Adjusted for inflation, Medicare physician pay has fallen by roughly a third since 2001, according to the American Medical Association, and 2027 brings more cuts on top of that, with procedures hit hardest. Meanwhile, prior authorizations, denials and paperwork keep growing, so we’re paid less to do more administrative work before we’re allowed to treat anyone.
That’s care rationing in all but name, and for independent spine, orthopedic and pain practices, the math increasingly says to cap or close Medicare panels, leaving the seniors who need care most waiting the longest. Making that call goes against why we went into medicine, and that moral injury is burning out the people we need most.
Physicians need a far stronger collective voice, through organized advocacy or even unions where the law allows, because individually we’ve lost the ability to push back.
Thomas Fondren. CEO of Advanced Orthopedics of Oklahoma (Tulsa, Okla.): I think it’s twofold: whether to stay independent, and how to refocus payer strategy if you choose independence.
Every independent practice leader I know has been talking about this for a few years. In 2027, a lot of them will have to decide which model works for them. And physicians won’t all see it the same way. Their opinions will depend a lot on where they are in their careers.
The math keeps getting worse. Reimbursement goes down every year, while labor, rent and IT costs go up. Prior authorization and denials mean we spend more just to get paid for work we’ve already done. The margin for error is gone.
There are plenty of buyers: health systems, private equity, payers and large groups. The offers can look good. Buyers excel at the courtship. Selling isn’t always wrong, but once you sell, you may give up control of your schedule, your staff, your ancillaries and how care gets delivered.
There’s also a middle option: joining with other groups and sharing administrative services. You keep some semblance of independence while cutting overhead. I expect that model to become a lot more popular over the next few years.
If you stay independent, payer strategy must be part of the plan. Most practices take whatever contracts they’re offered and hope the rates hold. That doesn’t work anymore. Leaders need to know which contracts make money and which ones lose money once you factor in prior authorization and denials.
Some Medicare Advantage and narrow-network plans may not be worth keeping, and you must be willing to walk away from a bad contract. Direct contracts with self-funded employers should be part of the mix too because they can pay a fair price with far fewer hoops.
Staying independent also means investing in surgical hospitals, ASCs, physical therapy and other ancillaries, better data and technology that actually lowers overhead.
That’s what makes this decision so hard. Selling and staying independent both come with a cost.
Megan Friedman, DO. Chief of Anesthesiology at Adventist Health Southern California (Roseville, Calif.) and Pacific Coast Anesthesia (Los Angeles): The hardest decision spine, orthopedic and pain care leaders will face in 2027 is determining how to maintain access to high-quality care while managing increasing financial pressures. Reimbursement continues to lag behind rising labor, staffing and operational costs, forcing leaders to make difficult decisions about which services and procedures remain financially sustainable. As more procedures shift to the outpatient setting, leaders must ensure that reimbursement adequately supports the staffing, equipment and resources necessary to deliver safe, high-quality care. Ultimately, the challenge will be finding ways to improve operational efficiency without compromising patient outcomes or limiting access to necessary services.
Michael Gallizzi, MD. Partner and Robotic, Endoscopic Minimally Invasive Spine Surgeon at the Steadman Clinic (Vail, Colo.): The hardest decision in 2027 for leaders in orthopedic surgery, neurosurgery, interventional pain management and physical medicine and rehabilitation will be whether to embrace CMS’ mandatory Ambulatory Specialty Model, which starting Jan. 1 ties a portion of individual clinicians’ Medicare Part B payments to low back pain episode costs, or reduce Medicare exposure through selective opt-outs and cash-based services.
We must weigh investing now in AI-driven triage, predictive analytics, nonoperative pathways and data infrastructure despite limited early return on investment versus expanding cash-pay offerings that protect margins under continued fee schedule erosion but may limit access for some older adults.
Under-investing risks payment cuts, while premature shifts to unproven models or technology can further compress already tight margins.
George Galvan, MD. Founder and CEO of Texas Neuro Spine (San Antonio) and Regional Neurosurgery Director at Christus Health (Irving, Texas): Our most critical priority is identifying the appropriate strategy to ensure financial solvency as an independent practice. We need to evaluate operational restructuring to address several key challenges, including reimbursement reductions, stringent prior authorization requirements, increasing overhead expenses, site-of-service neutrality policies and the transition of procedures away from the inpatient-only list. I do not believe private equity provides a solution to this. While aligning with a hospital system remains an option, it presents potential risks, given that hospital objectives typically emphasize direct physician employment.
Ramis Gheith, MD. Medical Director of Interventional Pain Institute (Chesterfield, Mo.): The greatest challenge for spine, orthopedic and pain care leaders in 2027 will be balancing financial sustainability with quality patient care amid declining reimbursements and increasing regulatory restrictions. CMS’ new Ambulatory Specialty Model will introduce additional financial pressures and administrative burdens, while tightening coverage restrictions on peripheral nerve blocks threaten to limit treatment options and potentially increase reliance on opioids or more invasive procedures. Leaders must navigate these challenges while preserving physician autonomy, protecting patient access and ensuring that cost-containment policies do not compromise clinical outcomes.
Benjamin Gill, DO. Medical Director of Comprehensive Surgical Care of Reno-Tahoe and Interventional Spine and Pain Physician at Nevada Advanced Pain Specialists (Reno, Nev.): The hardest decision in 2027 will be choosing which growth opportunities to pursue and which to decline, even when they are financially attractive. Whether adopting a new procedure, expanding an ASC or entering an ownership partnership, leaders must ensure that the evidence and clinical infrastructure support the change while preserving physician authority over care. Growth should include investment in patient selection, clinician development and meaningful long-term outcomes.
Sean Gipson. Division CEO and President of Remedy Surgery Centers (Hurst, Texas): The hardest decision in 2027 will be whether to shift from a procedure-centered business model to coordinated, outcome-based spine and musculoskeletal care before the financial incentives fully catch up.
What does that mean? It means deciding how much to invest in earlier assessment, nonoperative and multimodal pain care, primary care coordination and tracking patient function, and being willing to reduce low-value imaging or procedures when they are unlikely to help. The difficult tradeoff is improving outcomes and controlling downstream costs without undermining access, clinician judgment or the financial viability of the practice.
The choice will become concrete for some leaders under Medicare’s Ambulatory Specialty Model. It starts Jan. 1, 2027, and selected orthopedic, spine and pain specialists treating low back pain patients will be assessed on quality, cost, care coordination and interoperability. Participation is mandatory for clinicians who meet CMS’ criteria in designated areas; 2027 performance will affect Medicare Part B payment adjustments beginning in 2029.
So the leadership question should not simply be “Which new technology should we buy?” Rather, it should be “Will we redesign the whole care pathway around patient function and value, or keep optimizing a fragmented, visit-by-visit model?” CMS’ model makes that a near-term operational question for selected clinicians, while broader orthopedic trends, including reimbursement pressure, workforce constraints and migration to outpatient care, make it a strategic one for the field.
Nicholas Grosso, MD. President of the Centers for Advanced Orthopaedics (Bethesda, Md.): The hardest decision orthopedic leaders will face in 2027 is whether we can continue providing the same level of access to care for Medicare patients in the face of continued reimbursement cuts.
Limiting access is not a decision any physician wants to make, but the financial pressures are becoming impossible to ignore. Since 2001, the cost of operating a medical practice has increased by 60% while Medicare physician reimbursement has declined by 33%, and the proposed 2027 cuts would only make matters worse. Independent practices have spent years finding efficiencies and absorbing these reductions, but there is only so much more we can do.
The unfortunate reality is that these policies are threatening the survival of independent medicine and ultimately limiting access to affordable, high-quality care for the very patients Medicare was designed to serve.
That’s why we recently joined other independent physician groups to run full-page ads in The Washington Post and Baltimore Sun, urging patients and communities to contact their representatives in support of the bipartisan Patient Access to Healthcare Act (H.R. 9693), which would permanently tie Medicare physician payments to inflation. Without meaningful action from Congress, patients will face fewer choices, longer wait times and potentially significantly higher costs as more independent practices are forced to limit access or join larger hospital systems.
Jodie Hadley. Administrator of Paramount Surgery Center (Meridian, Idaho): I believe the hardest decision facing spine, orthopedic and pain care leaders in 2027 will be determining how to maintain exceptional patient care while navigating increasing operational costs and reimbursement pressures. As more complex procedures transition to the ambulatory surgery center setting, leaders must carefully evaluate which cases and service lines are financially sustainable without compromising quality, safety or patient outcomes. The challenge isn’t simply doing more with less; it’s knowing where to invest, when to negotiate and when to say no to reimbursement structures that don’t support the true cost of care. Ultimately, the organizations that succeed will be those that recognize financial sustainability and clinical excellence are not competing priorities, but essential partners.
Nameer Haider, MD. Medical Director of Omni Surgery Center (Utica, N.Y.): The hardest decision spine, orthopedic and pain care leaders will face in 2027 is determining how aggressively to move increasingly complex care out of the hospital and into the ambulatory surgery center.
For appropriately selected patients and procedures, I believe the ASC is increasingly becoming the ideal environment for spine, orthopedic and interventional pain care. The benefits go well beyond lower facility costs.
A specialized ASC can provide a highly standardized clinical environment with dedicated teams, fewer unnecessary handoffs, greater procedural efficiency, reduced exposure to the complexity of a large hospital system and a more focused perioperative experience. These advantages can translate into faster mobilization and recovery, greater patient satisfaction and, when proper patient selection and safety protocols are maintained, excellent outcomes with reduced procedural and postoperative risk.
At the same time, minimally invasive spine surgery, endoscopic techniques, advanced neuromodulation, image-guided interventions and new technologies are allowing us to treat conditions in an outpatient setting that previously required hospitalization. This creates an enormous opportunity to reduce the total cost of care while improving the patient experience and clinical outcomes.
The difficult decision for leaders will be determining where that transition should occur. Moving too slowly leaves patients in higher-cost settings when equivalent or better care may be delivered more efficiently in an ASC. Moving too quickly without appropriate infrastructure, anesthesia capabilities, patient selection criteria and experienced clinical teams can compromise the very advantages that make the ASC model successful.
I believe the winning organizations in 2027 will be those that build ASCs not simply as lower-cost alternatives to hospitals, but as purpose-built centers of excellence for minimally invasive spine, orthopedic and pain care. They will combine specialized teams, advanced technology, AI-enabled diagnostics and outcomes measurement to determine which procedures and which patients can safely transition to the ambulatory environment.
The future of spine care is not simply about doing the same procedures in a less expensive setting. It’s about redesigning the entire episode of care around a setting that can be more efficient, less invasive, substantially more cost-effective and, most importantly, safer.
D. Kojo Hamilton, MD. Professor and Chief of Neurological Surgery at WVU Medicine at Latrobe, Westmoreland and Frick Hospitals (Latrobe, Pa.): Looking ahead to 2027, the single hardest decision facing spine, orthopedic and pain care leaders will be how to safeguard specialty margins and practice independence in the face of steep Medicare reimbursement cuts, including targeted relative value unit reductions for major joint and spine procedures, alongside rising labor and implant costs. Leaders must strategically weigh heavy capital investments in emerging surgical robotics and advanced neuromodulation against volatile payer policies that increasingly restrict coverage and slow operational revenue. Leaders will have to be very nimble in restructuring, consolidation and managing capital expenditure versus return-on-investment decisions across multiple fronts and threats simultaneously.
Sean Hayes. President of American Pain Consortium (Carmel, Ind.): The hardest decision facing spine, orthopedic and pain care leaders in 2027 will be whether we are willing to make the difficult investments and take the necessary stands to preserve physician independence. As consolidation accelerates, payers, hospital systems and regulators continue to gain influence over how and where physicians practice through restrictive coverage policies, prior authorizations, peer-to-peer reviews, certificate-of-need laws and other administrative barriers. Too often, these policies place broad, prospective restrictions on responsible physicians rather than targeting the bad actors they are intended to address.
As healthcare leaders, we have a responsibility not only to preserve meaningful physician ownership and leadership within our organizations, but also to challenge policies that undermine independent clinical judgment and patient access. If we fail, we risk creating a healthcare system where physicians have little choice but to work for large hospital systems or insurance-affiliated organizations.
The future of independent medicine depends on leaders who are willing to protect physician autonomy while building organizations with the scale, resources and alignment necessary to compete and deliver high-quality care.
Ugonna Ihekweazu, MD. Chief of Total Joints at Fondren Orthopedics (Houston): The hardest decision orthopedic leaders will face in 2027 is how to keep investing in better care as financial pressures increase. With robotics, AI and the continued shift toward value-based models, we will need to distinguish advances that improve outcomes and efficiency from those that simply add cost. These pressures will also force difficult choices about practice ownership and consolidation, including how much autonomy physicians are willing to give up for financial stability. The challenge is to build sustainable practices while keeping physicians and patients at the center of those decisions.
Tedrick Jackson. Practice Administrator of UCHealth Foot & Ankle Orthopedics and UCHealth CU Sports Medicine (Denver): I believe one of the hardest decisions spine, orthopedic and pain care leaders will face in 2027 will be balancing access to care with financial sustainability. As healthcare organizations continue to navigate workforce challenges, reimbursement pressures and growing patient demand, leaders will be asked to do more with limited resources while maintaining quality outcomes and patient experience. The organizations that succeed will be those that find innovative ways to improve efficiency, leverage technology thoughtfully and invest in care models that keep patients at the center of every decision.
Kent Kilbourn, PA-C. Director of the Ayer Neuroscience Institute at Hartford HealthCare (Hartford, Conn.): For us, one of the defining decisions in 2027 will be how to deploy capital in a market shaped by rising costs, reimbursement pressure and rapid technology change. As more appropriate spine and pain procedures move into lower-cost settings, leaders will need to be far more disciplined about which investments truly advance quality, access and long-term value. Strategy is not just about site-of-service shift; it is about intentionally moving the right care closer to home while preserving the level of quality patients expect from Hartford HealthCare.
Earl Kilbride, MD. Orthopedic Surgeon at Austin (Texas) Orthopedic Institute: With the changes coming to Medicare, the biggest decision a lot of physician groups are making is whether to remain a Medicare provider. Unfortunately, many of our commercial contracts are based on some percentage of Medicare rates. With Medicare rates dropping, that leads to other cuts in payments from commercial payers. Certainly some of the low-paying commercial insurers may struggle to find in-network physicians for their patient population.
Jessica Lam, PhD. Practice Manager at Pacific Coast Anesthesia (Los Angeles): One of the hardest decisions leaders will face is how to expand services while ensuring they have the physicians and support staff necessary to meet growing demand. From a practice management perspective, adding procedural volume is only beneficial if the appropriate staffing and infrastructure are in place to support it. Leaders will need to make difficult decisions about when to expand, when to consolidate resources and when to decline additional volume rather than risk overextending their teams. The challenge will be balancing growth opportunities with realistic staffing capabilities while maintaining the quality and consistency of patient care.
Stephen Lockey, MD. Assistant Professor of Orthopaedic Surgery and Director of the Orthopaedic Spine Fellowship at UVA Health (Charlottesville, Va.): One of the most difficult decisions facing spine, orthopedic and pain care leaders in 2027 will be how to respond collectively to increasing payer restrictions that threaten patient access to high-quality musculoskeletal care. As an industry, we must decide whether to continue navigating these challenges independently or develop a more unified and effective voice advocating for our patients and the value of the care we provide. We need to communicate more clearly with payers, policymakers and the public about the profound impact our interventions have on restoring function, preserving mobility, reducing disability and improving quality of life. Ultimately, our ability to protect patient access to care will depend not only on advancing clinical outcomes but also on our willingness to advocate for their value.
John Lucio, DO. President and Chief Medical Officer of SSM Health St. Mary’s Hospital (Jefferson City, Mo.): Spine, orthopedic and interventional pain care leaders face a difficult strategic decision in 2027: whether to preserve independent practice models or restructure through health system, ASC and value-based care partnerships. CMS’ proposed 2027 policies create simultaneous pressure through lower Medicare conversion factors, specialty-specific payment cuts, reduced relative value units for major joint replacement, lower payment for certain same-day services and reduced ASC reimbursement for common spine injection codes. These changes threaten margins for practices that rely heavily on Medicare volume, especially those performing high-cost surgical and interventional procedures.
The most consequential issue is CMS’ Ambulatory Specialty Model, which begins Jan. 1, 2027, and shifts financial risk for low back pain episodes to individual eligible clinicians. Because the model scores and adjusts reimbursement at the physician level, leaders must decide not only how to reduce institutional costs but also how to support each physician’s performance through better data, care coordination, conservative-care pathways and appropriate surgical referrals.
The central choice is whether to proactively redesign operations around lower-margin, risk-bearing, outpatient-first care, or wait until reimbursement cuts and accountability requirements force consolidation on less favorable terms.
Having served as a part owner of an ASC, an independent clinic-based pain practitioner and now as regional president of SSM Health in Mid-Missouri, I believe the solution will emerge from the lessons learned across all of these care delivery models. The central questions are how ASCs will secure the capital needed to invest in robust outcomes data and develop the leverage to negotiate effectively with payers, and how health systems, with their inpatient resources, will adapt to the growing demand for outpatient services.
Bruna Maggio. COO of Legacy Spine and Neurological Specialists (Little Rock, Ark.): The hardest decision spine, orthopedic and pain leaders will face in 2027 is how fast to say yes to complexity, and who they will trust to deliver it. CMS is clearing the runway for higher-acuity cases to move into the ASC, but reimbursement for the procedures we already perform is shrinking, the nonopioid add-on payment sunsets at year-end, and the surgeons and anesthesia providers who make those cases safe are harder to recruit and more expensive to keep than ever. Leaders will have to decide how much of a narrowing margin to invest in people, technology and culture, and which cases they should decline even when the volume is available.
At Legacy, a physician-led neurosurgery and spine practice that has served Arkansas for more than 65 years, we believe the answer is discipline: building a place surgeons want to practice for a career, and partnering on technology that lowers the cost of a great outcome rather than chasing every procedure that becomes eligible. The centers that win in 2027 will be the ones that choose their cases based on the outcome they can deliver for the patient, not on what the fee schedule pays.
And the leaders who want a say in that fee schedule will need to stop treating advocacy as someone else’s job. With the ASC market basket update expiring and the Outpatient Surgery Access Act pending in Congress, 2027 is the year to show up in Washington and in our state capitols.
Javier Marull, MD. Clinical Professor and Medical Director and Chief of Clinical Operations for Anesthesiology at the Outpatient Surgery Center at UT Southwestern Medical Center (Dallas): I think one of the hardest decisions leaders will face is how to balance the growing demand for outpatient spine, orthopedic and pain procedures with patient safety. As more complex cases move into ambulatory surgery centers, we need to be realistic about which patients and procedures are suitable for that setting. Patient safety must remain the priority when deciding which procedures belong in an outpatient setting and which are better suited for a hospital.
James Mooney, MD. Complex and Minimally Invasive Spine Deformity Surgeon at VCU Health and Assistant Clinical Professor of Neurosurgery at Virginia Commonwealth University (Richmond, Va.): The hardest decision in 2027 will be deciding which investments meaningfully improve patient care when every priority competes for limited resources. As a complex and minimally invasive spine surgeon, I see that challenge through the lens of advancing minimally invasive surgery and new technology while maintaining the expertise, staffing and infrastructure needed to care for patients with complex spinal conditions at an academic center.
Leaders will have to weigh investments in robotics, navigation and AI against equally important needs such as timely access, coordinated rehabilitation and a sustainable clinical workforce. The right choice will vary by program, but the standard should be consistent: Does this investment improve outcomes, expand access or make care more sustainable?
The most difficult leadership decision may be delaying a promising technology to strengthen the team and care pathways that allow it to deliver meaningful value. In 2027, I believe successful programs will be defined by how thoughtfully they connect innovation to the needs of the patients they serve.
Melissa Murphy, MD. Interventional Spine and Pain Physician at Ortho Texas (Carrollton, Texas): The hardest decision in 2027 will be determining when to recommend an interventional treatment, when to pursue surgery and when to hold off on either. We are entering a new era where interventional pain care, spine surgery and orthopedics increasingly intersect, with more minimally invasive options expanding what we can offer patients. That makes collaboration among specialties more important than ever. Leaders will need to build care pathways that bring these perspectives together, match treatment to each patient’s needs and prioritize durable improvements in function and quality of life.
Ramana Naidu, MD. Pain Physician and Anesthesiologist at MarinHealth Spine Institute and Medical Director of Pain Management for MarinHealth Medical Center (Greenbrae, Calif.): Should I continue to provide insurance-based care? With reimbursement going down, coverage policies flip-flopping, no-preauthorization/no-predetermination plays and negative attitudes toward physicians rather than the insurance companies, it is becoming ever more appealing to opt out of insurance-based care and offer clear and transparent cash-pay procedures. Can some providers take the leap?
Emeka Nwodim, MD. Orthopedic and Spine Surgeon at Centers for Advanced Orthopaedics (Bethesda, Md.): One of the many consequential strategic decisions facing spine, orthopedic and pain management providers and leaders in 2027 and beyond is whether we continue to address the challenges facing healthcare in a fragmented, organization-by-organization manner or adopt a more collaborative, coordinated and strategically aligned approach across the industry.
Providers, organizational leaders and health systems are confronting challenges of unprecedented pace, scale and magnitude. It is becoming increasingly evident that the traditional approach of addressing these challenges in organizational silos is no longer sufficient.
Angela Opalak. Vice President of Revenue Cycle Management at Commonwealth Pain & Spine (Louisville, Ky.): The hardest decision spine, orthopedic and pain care leaders will face in 2027 will be how to accelerate sustainable growth through thoughtful acquisitions and strategic investments without compromising financial performance, clinical excellence or the patient experience. Leaders must balance AI adoption and emerging technologies with a patient-centric approach while optimizing revenue cycle teams through strategic staffing, automation, enhanced productivity, clear accountability and proactive denial prevention, ensuring direct visibility into revenue cycle performance, revenue leakage and opportunities to improve cash flow. Equally critical will be recruiting and retaining exceptional physicians and anesthesia providers while building scalable, high-performing operational teams capable of supporting expansion, protecting margins and delivering an exceptional patient experience.
Stéphane Owusu-Sarpong, MD. Orthopedic Spine Surgeon at Hospital for Special Surgery (New York City): Among the many difficult decisions facing spine, orthopedic and pain care leaders in 2027, one of the hardest will be finding and maintaining the mental energy to continuously advocate for our patients amid intrusive prior authorization requirements, which are increasingly last-minute and, at times, merely days before a proposed procedure.
As administrative costs rise and delays to patient care worsen, surgeons, physicians and patients equally suffer. Without an actionable solution, there will be apprehension on the surgeon and physician side due to the risk of burnout.
Selene Parekh, MD. Professor of Orthopaedic Surgery at Rothman Orthopaedics (Philadelphia): The hardest decision facing spine, orthopedic and pain care leaders in 2027 will be how to balance financial sustainability with the responsibility to deliver high-quality, patient-centered care. With declining reimbursements, rising operating costs and increasing pressure for consolidation, leaders will face difficult choices about maintaining independence, investing in innovation and preserving access to care. Artificial intelligence, robotics and emerging technologies offer tremendous opportunities, but deciding which innovations genuinely improve patient outcomes versus simply adding costs will be critical. Ultimately, the leaders who succeed will be those who recognize that financial viability and clinical excellence cannot be competing priorities; they must be achieved together.
Daniel Park, MD. Orthopedic Spine Surgeon at Midwest Orthopaedics at Rush (Chicago): I think one of the challenges facing orthopedic and spine surgeons in 2027 hinges on what Medicare will do with its reimbursement model. With decreasing reimbursement and more cuts on the horizon, many smaller practices will have to grapple with the sustainability of seeing Medicare patients or being in private practice. Hopefully the government can figure out a solution to provide equitable reimbursement for physicians so the Medicare population will continue to have access to world-class care.
Neil Patel, MD. President, Board Chairman and Spine Surgeon at Spine Team Texas (Southlake, Texas): The hardest decision will be how to improve access and efficiency with limited resources while preserving the individualized attention and clinical judgment patients depend on. Leaders will need to find ways to reduce delays and make better use of their teams’ expertise without making care feel rushed or one-size-fits-all.
At Spine Team Texas, we are already working toward that balance through a coordinated, team-based approach that helps patients reach the right expertise for their needs. This supports a clearer path to care and helps our clinicians focus their time where it can make the greatest difference. As practices face growing demand, the goal should be to make care more accessible and efficient while ensuring every patient’s decisions reflect their condition, goals and circumstances.
Julian Price, MD. Orthopedic Spine Surgeon at Athens (Ga.) Orthopedic Clinic: The biggest challenge for 2027, especially for private practice spine surgeons, will be alignment. Decisions on mergers and acquisitions to gain leverage with payers, joint ventures with hospital partners or private entities, clinically integrated networks and more will be top of the list. For those who choose to remain fully independent, working directly with payers, employers and referral sources to demonstrate cost-effectiveness, clinical efficacy and strong patient-reported outcomes will be of utmost importance.
Ramin Raiszadeh, MD. Orthopedic Spine Surgeon at Spine and Brain Institute of San Diego: One of the hardest 2027 decisions for spine surgeons is where to do their surgeries: the hospital, an independent ASC or a joint venture ASC. Medicare keeps cutting surgeon pay while moving more cases and more money to outpatient facilities, so surgeons without a stake in the facility will keep losing income and control.
In my view, the best model is an ASC jointly owned by the hospital, an experienced ASC management company and surgeon investors. The hospital brings capital and payer leverage, the management company brings operating efficiency, and the surgeons bring the cases and share in the facility revenue. The key is getting the terms right, so surgeons have real ownership and a real voice in how the center is run.
Wilson Z. Ray, MD. Spine Surgeon at WashU Medicine Physicians (St. Louis): I think one of the biggest challenges we will face is the continued shift of spine procedures out of hospitals and into ASCs. In many ways, this is probably a positive change: lower costs, improved efficiency and a better experience for patients. The caveat is it also creates real financial challenges for hospitals, particularly large academic medical centers. As more routine, financially favorable cases move to outpatient settings, hospitals are increasingly left caring for the sickest and most complex patients while still having to support the infrastructure, staffing, research and educational missions that come with being a major medical center.
At the same time, private equity is playing a larger role in acquiring orthopedic, spine and pain practices. These groups are increasingly able to control where patients are referred and where procedures are performed, potentially drawing more business away from traditional hospital systems. Hospital leaders will have to think carefully about whether to compete with these groups, partner with them or develop their own outpatient strategies.
Ultimately, I think the hardest decision will be figuring out how to remain financially competitive without losing sight of our responsibility to complex patients. I am enthusiastic about the shift toward more efficient outpatient care, but we need to be cognizant and protect the resources and expertise needed to treat the most challenging cases. I suspect finding that balance, particularly in academic medicine, will be one of the defining leadership challenges in 2027.
Deepak Reddy, MD. Spine Surgeon at South Bend (Ind.) Orthopaedics: We’re in an age of unprecedented technology that can genuinely benefit our patients, but it is mired by antiquated reimbursement that will stifle adoption. Whether it is AI platforms, robots, endoscopy, patient-specific systems or new biologics, the costs are going to catch up to spine, and dollars will have to be conserved.
The hardest decision leaders will have to make in 2027 is where those dollars can be spent: which technologies are worth betting on when the payment model has not caught up to the medicine. We will have to make hard choices, and the winners will be the ones who invest in what actually moves outcomes, not just what is newest.
Praveen Reddy, MD. Physician and Owner of Center for Minimally Invasive Neurosurgery (Conroe, Texas): I think the biggest thing is dropping out of insurance plans, especially with Medicare’s 2027 reductions, the Transforming Episode Accountability Model and more.
Michael Redler, MD. Orthopedic Surgeon at Connecticut Orthopaedics (Fairfield, Conn.): The most challenging decision orthopedic, spine and pain medicine leaders will have to make in the ASC space in 2027 is determining how well we are able to adapt to new technology and the price tag that comes with it. There are so many excellent new surgical treatment options that can speed recovery, minimize discomfort and improve levels of healing. Unfortunately, many of those options come with the cost normally associated with the development of new technology. Leaders must evaluate the potential great benefit to patients versus the cost and its effect on the ASC’s bottom line. We want to provide patients with the most up-to-date, outstanding options while ensuring our ASCs remain financially viable.
Marjorie Reiter. Administrator and CEO of King of Prussia (Pa.) Surgery Center: One of the hardest decisions spine, orthopedic and pain leaders will have to make in 2027 is how to ensure we, as ASC leaders, remain profitable and, therefore, able to care for our patients while keeping up with new techniques and technology. The meeting point of these is a careful balancing act between providers, payers and financial reality.
The value of the ASC as a great venue for safe, efficient and effective patient care, given appropriate patient selection, cannot be underappreciated. This point of friction requires great working relationships with all of these entities.
Julie Samora, MD, PhD. Chair of Orthopedic Surgery and Sports Medicine at Akron (Ohio) Children’s Hospital: The hardest decision in 2027 will be determining how to do more with increasingly limited resources and lower reimbursement without sacrificing patient care or the well-being of our teams. As healthcare leaders, we are accustomed to pursuing growth, but we must become equally comfortable making difficult decisions about what not to do. Prioritizing sustainable growth, investing in our people and reimagining how we deliver care will be essential. The challenge will be balancing access, quality, financial stewardship and workforce sustainability, recognizing that success is not simply about doing more, but about doing what matters most.
Krishna Satyan, MD. Neurosurgeon at Dallas Neurosurgical & Spine (Dallas): The hardest decision spine surgeons and pain management physicians will face as we enter 2027 is how to provide adequate care to our patients while navigating an ever-changing reimbursement landscape. We continue to see reimbursements decrease and denials for treatments increase, and it will become more difficult to provide the care patients require in a timely manner.
Controlling patients’ pain often requires percutaneous procedures performed by pain management physicians, such as epidural steroid injections and rhizotomies. If those prove inadequate, surgery is often necessary. However, insurers are denying these procedures with increasing frequency, even when patients have documented neurologic deficits and a growing number of falls at home. That puts patients at risk of serious injury, and we can expect to see more injuries such as head bleeds and hip fractures as a result.
This leaves us in a quandary about how to appropriately manage our patients’ needs. Unfortunately, we don’t have a solution right now other than to keep fighting denials to ensure our patients receive the care we know they need. In the meantime, that fight places an undue burden on both patients and their physicians.
Alekos Theologis, MD. Director of Adult Scoliosis and Deformity Reconstruction at Sutter Health’s Advanced Spine Institute (San Francisco): As clinical demand, reimbursement pressure, technology and patient expectations collide in 2027, the hardest decision for spine, orthopedic and pain care leaders will be deciding what to stop doing, what to invest in and how to redesign care delivery. Leaders will need to think beyond whether to grow, consolidate or adopt new technology in isolation. They will need to strive to create a financially sustainable model of care that rewards clinical value rather than procedural volume alone by delivering better patient outcomes at a sustainable cost, without sacrificing access, clinical quality and physician alignment.
Juan Uribe, MD. Professor and Vice Chair of the Department of Neurological Surgery, Chief of the Division of Spinal Disorders and Volker K. H. Sonntag Chair of Spine Research at Barrow Neurological Institute (Phoenix): I believe the hardest decision for spine, orthopedic and pain care leaders in 2027 will be how to balance rapid technological innovation with sound clinical judgment and financial sustainability. Robotics, AI and minimally invasive techniques are transforming our field, but adopting new technology should never become more important than selecting the right patient and delivering meaningful outcomes. As leaders, we must recognize that not every technological advancement represents better care, and sometimes the most important decision is knowing when not to intervene. Ultimately, our responsibility is to ensure that innovation serves the patient, not the other way around.
Alex Vaccaro, MD, PhD. President of Rothman Orthopaedics (Philadelphia): The toughest decision for leaders of spine, orthopaedics and pain medicine organizations in 2027 will be whether to invest capital and governance to become the owners of the complete episode of care, including the risks, versus continuing to optimize their fee-for-service business models despite the clear signs of impending collapse. The 2027 data leaves no doubt about the trend’s direction and magnitude. According to the Centers for Medicare & Medicaid Services proposed rule, the Qualifying Alternative Payment Model Conversion Factor would drop by approximately 1.19% in 2027 compared to 2026 to $33.1693, and the Non-Qualifying APM Conversion Factor would drop by approximately 1.68% in 2027 compared to 2026 to $32.8409. This decrease reflects the expiration of the temporary 2.5% increase that was applied in 2026. Additionally, according to the CMS proposal, CMS would continue to apply the Efficiency Adjustment to all non-time-based services, and apply it to new or revised codes if CMS determines that American Medical Association/Specialty Society Relative Value Scale Update Committee values do not already account for expected efficiency gains. Those adjustments will likely fall heaviest on specialty areas, including our own. With the introduction of two conversion factors, the gap between APM participants and everyone else is now enshrined in law. As a result, each year a group remains outside of risk-bearing agreements is costing them slightly more than the previous year.
That is why this is a tough decision; both choices could harm an organization. Participating in risk-based contracting requires investing in building or acquiring additional ASCs, data analytics platforms and post-acute service management capabilities. It also means assuming responsibility for spinal fusion bundles under the Transforming Episode Accountability Model while operating within a declining payment base. Moreover, participating physicians may need to forgo distributions today to fund an uncertain future, and that kind of decision-making can split physician partnerships by generation. Conversely, waiting or partnering with a health system or private equity investor would preserve short-term income; however, doing so would mean giving up control over where services are delivered, who gets referrals, and how capital is allocated. That loss of control is what gave independent musculoskeletal practices value in the first place.
Pain and interventional spine programs have their own version of this decision. As utilization management becomes increasingly automated through tools like the Wasteful and Inappropriate Service Reduction model’s prior authorization process for epidural injections, stimulators, vertebral augmentation, and cervical fusion, program leaders must decide whether to invest in prospective documentation and appropriateness infrastructure or absorb denial claims one at a time.
The global surgical package is also under downward pressure. CMS proposed cutting payments when the same physician or practice performs a separately identifiable evaluation and management visit on the same day as a global procedure, another indication that the traditional revenue model for surgeons is being dismantled piece by piece rather than all at once.
Those who succeed will treat these decisions as strategic identity decisions rather than simply questions of reimbursement. The fundamental decision-making question here is: what does your organization want to be reimbursed for in 2030? Procedures? Outcomes? Total cost of care for populations suffering from musculoskeletal conditions?
This means having honest conversations with your partners about the deteriorating economic environment for spine and joint surgery, driven by volume, and choosing which risk you want to assume rather than letting payers and hospitals make those choices on your behalf. This also means recognizing that the safe-haven option, i.e., standing still, is actually a slow transfer of value to whoever is willing to bear that risk. For those large enough groups with sufficient scale, ASC footprints and outcomes data to act first, 2027 is likely to be the last year they can make this decision on their own terms as opposed to doing so out of necessity due to financial pressures.
Michael Verdon, DO. Neurosurgeon and Chief Medical Officer of Dayton (Ohio) Neurologic Associates: The hardest decision in 2027 is whether to own the whole spine episode, including the nonsurgical pathway, or keep owning only the operation.
I own shares in an ASC, so I’ll say it plainly: The economics of an outpatient spine center depend on cases moving through the building. Everything before the surgical consult has been treated as someone else’s problem: the early MRI, repeated injections, therapy that doesn’t match the pathology and the weeks of waiting. That is where most spine dollars are spent and where most of the waste is.
Payers have noticed. Spinal fusion is now in mandatory episode-based payment, procedures keep moving to lower-cost sites of service, and prior authorization keeps getting tighter. The money is following the episode, not the incision.
Owning the episode comes down to three disciplines.
Simplify. Triage by severity at the front door and send each patient to the right level of care on day one, whether that is therapy, interventional pain or surgery. Most patients don’t need a complicated pathway. They need the correct first step without delay.
Observe. Measure the whole episode, not just the procedure: time to the right clinician, conservative care completion, outcomes, appropriateness and total cost. You can’t manage a nonsurgical pathway you can’t see.
Optimize. Use that data to tighten the pathway: Remove steps that don’t change outcomes, close open-ended loops in conservative care and identify true surgical candidates sooner.
None of this is comfortable. It means investing in and owning care that doesn’t fill an OR schedule, and sometimes it will reduce surgical volume. Leaders who say otherwise are not being candid.
The alternative is worse. If we don’t own the nonsurgical pathway, payers and benefit managers will, using criteria written by people who don’t treat spine patients. Organizations that can show the full episode, including who needed surgery, who didn’t and how well both groups were served, will set contract terms in 2028. Everyone else will be handed them.
The surgeon’s value is no longer just the operation. It is stewarding the entire episode.
Jestin Williams, MD. Assistant Professor of Orthopaedic Surgery, Director of Musculoskeletal Oncology and Orthopaedic Spine Division Chair at Ochsner LSU Health Shreveport (La.): One of the hardest decisions spine surgeons will face in 2027 is determining when and how to adopt emerging surgical techniques and technologies. In an era dominated by social media and direct-to-consumer marketing, patients are increasingly exposed to new procedures and technologies. As a result, patients may seek out surgeons who offer specific techniques, even when those approaches have not demonstrated superior clinical outcomes.
This creates a growing challenge for surgeons as they balance patient expectations, market competitiveness and evidence-based medicine. Surgeons must decide whether to invest the time, training and resources necessary to adopt these innovations or risk losing patients to competitors who offer them.
However, newer does not always mean better, and innovation should not come at the expense of patient safety or outcomes. Ultimately, the greatest challenge will be distinguishing meaningful surgical advancements from market-driven trends while maintaining the integrity of clinical decision-making.
Ashley Williamson. Director of Strategic Initiative in the Department of Orthopaedic Surgery at the University of Alabama at Birmingham: The hardest decision orthopedic leaders will have to make in 2027 is this: Do we continue optimizing a hospital-based, fee-for-service musculoskeletal enterprise, or do we aggressively shift volume, risk and operations into outpatient, value-based care models, even if it cannibalizes our traditional revenue streams?
Right now, many hospitals, especially many academic medical centers, generate substantial margins from inpatient orthopedic and spine services; however, payers are steering patients toward outpatient ambulatory surgery centers. An immediate shift to an outpatient setting will put pressure on hospital revenue, but if AMCs refuse to shift, independent and private equity-backed groups will control that market and we will lose out. Making the decision to shift, and choosing the appropriate patients to shift without compromising quality, will be difficult for many spine, orthopedic and pain care leaders.
Tian Xia, MD. Director and Pain Management Specialist at American Health Care Centers and CEO of Integrated Pain Management (Chicago): The hardest decision will be the type of surgery to be performed at the surgery center due to equipment, implant cost and complexity of the surgery itself.
Siamak Yasmeh, MD. Spine Surgeon at DISC Tarzana and DISC Marina del Rey (Calif.): I think the hardest decision spine surgeons will face in 2027 is knowing when to embrace new technology and when to step back and ask whether it truly benefits the patient. We have more treatment options than ever, but more technology and more procedures don’t always mean better outcomes.
As surgeons, we have to resist the pressure to do more and instead focus on what will genuinely help each patient, whether that means surgery, a less invasive treatment or no surgery at all. Ultimately, our responsibility is to put the patient first, even when that means choosing the option that is less profitable or less technologically exciting.
Daniel Zanotti, MD. Chief of Orthopedics at University Hospitals Elyria (Ohio) Medical Center: The hardest decisions facing orthopedic leaders, especially in the ASC setting, will be navigating the changes to patient insurance coverage and government plans. Additionally, staffing challenges and anesthesia reimbursement will continue to plague ASC bottom lines. Finally, the general economy has made the price of business significantly higher overall, contributing to lower net revenues.
Aqib Zehri, MD. Neurosurgeon in Portland (Ore.): I think one of the hardest decisions spine leaders will face in 2027 is how to balance the pressure to improve efficiency and reduce costs without compromising patient care. We’re seeing more complex spine procedures being performed, while hospitals are dealing with increasing financial and staffing constraints. The challenge will be deciding where to invest resources, particularly in technology, surgical teams and infrastructure, while making sure surgeons have what they need to deliver safe, high-quality outcomes. Ultimately, I think the organizations that prioritize long-term patient outcomes over short-term financial gains will be the ones that succeed.
Andrew Zhang, MD. Orthopedic Spine Surgeon at Penn Medicine (Philadelphia): I think the hardest decision spine, orthopedic and pain care leaders will have to make in 2027 will be how we navigate reimbursement for endoscopic spine care. As CPT code 62380 is still considered “experimental,” the code carries no relative value units despite its increased capital costs and higher technical demands.
While several studies have shown that endoscopic spine surgery confers several benefits for patients over traditional open surgeries, the lack of appropriate reimbursement threatens to limit broader adoption, discourage investment in the technology and training required to perform these procedures and ultimately restrict patient access to a potentially less invasive surgical option.
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.
