The competitive landscape for orthopedic and spine practices is changing rapidly. As value-based care expands, AI advances and more procedures move to the outpatient setting, leaders say success will depend on far more than surgical expertise alone.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What do you believe will be the single biggest competitive advantage for orthopedic and spine practices over the next five years, and why?
Here is what several leaders shared with Becker’s:
Bryce Basques, MD. Spine Surgeon and Director, Minimally Invasive and Endoscopic Spine Surgery, Brown University (Providence, R.I.): The single biggest competitive advantage will be ownership and equity investment in ASCs because of the ongoing migration of high-value orthopedic and spine cases to the outpatient setting. Practices that own their ASCs have a durable revenue stream that insulates them from declining physician reimbursement and diminishing margins on other ancillary revenue such as therapy and imaging. Ownership lets surgeons control scheduling, case selection, implant costs and the patient experience, which drives both efficiency and the kind of outcomes and satisfaction that increasingly determine referral patterns and value-based contracts. Orthopedic and spine practices that own the setting where surgery is performed will be the ones that stay independent, profitable and in control of their future.
Tan Chen, MD. Orthopaedic Spine Surgeon at Inova Orthopaedics & Sports Medicine (Fairfax, Va.): Over the next five years, the biggest competitive advantage for orthopedic and spine practices will be delivering an exceptional patient experience. While technology such as minimally invasive surgery, AI and robotics will continue to advance, what truly sets a practice apart is making patients feel heard, informed and supported throughout their entire journey. Patients want to be treated with respect and decency, to feel listened to and to know they are being cared for as a person, not just a diagnosis or an MRI. The practices that combine outstanding clinical outcomes with compassionate care, easy access and clear communication will earn the greatest trust and become the first choice for patients seeking spine care.
Quentin Durward, MD. Neurosurgeon at CNOS (Dakota Dunes, S.D.): The single best competitive advantage for spine practices, whether in neurosurgery or orthopedics, will be experience. Surgeons with long-established practices have climbed the learning curve, managed most spinal conditions many times over, learned to handle complications and unexpected surgical findings, and become more efficient and cost-effective. Many newly trained surgeons, especially those without mentorship, will likely struggle for a while. Their results will be scrutinized by referring physicians, patients, colleagues, hospital quality committees, insurers and government payers.
I believe the most successful practices will support new surgeons through case discussions, involvement in surgical planning, experienced partners’ attendance at complex cases, help during unexpected intraoperative events and diligent postoperative care.
Those foundational principles will always outweigh trying to be first with a new technology or relying on gimmicks. Old dogs can learn new tricks, and if a technology offers significant benefit, everyone will adopt it soon enough.
Andrew Fanous, MD. Chair of Surgery at Inova Mount Vernon Hospital and Medical Director of the Inova Eastern Region Spine Program (Alexandria, Va.): I believe the single biggest competitive advantage for orthopedic and spine practices over the next five years will be delivering a seamless, data-driven, patient-centered continuum of care, not simply providing excellent surgery. The landscape is shifting from volume-based care to value-based care, with patients prioritizing convenience, transparency, access, communication and long-term outcomes. At the same time, payers and employers increasingly reward providers that demonstrate high-quality outcomes while controlling costs. Practices that integrate advanced analytics, AI, digital patient engagement, remote monitoring and standardized clinical pathways will be best positioned to differentiate themselves. These tools enable earlier intervention, more personalized treatment, better patient adherence, fewer complications and stronger outcomes reporting.
Equally important is coordinating care across the entire patient journey, from referral and diagnosis through surgery, rehabilitation and long-term follow-up. Practices that reduce friction, shorten wait times and communicate proactively will build stronger patient loyalty and referral relationships. Ultimately, the practices that succeed will become trusted, high-value care organizations that consistently deliver measurable outcomes, exceptional patient experiences and operational efficiency. That combination will provide a lasting competitive advantage.
Ziya Gokaslan, MD. Chair in the Department of Neurosurgery at The Warren Alpert Medical School of Brown University (Providence, R.I.): I believe the single greatest competitive advantage over the next five years will be the delivery of highly specialized, AI-enabled, precision spine care that is personalized, outcomes-driven and increasingly delivered in the outpatient setting.
Andrew Kersten, MD. Orthopedic Surgeon at EmergeOrtho (Asheville, N.C.): The main advantage that orthopedic doctors still in private practice will have is that they can offer care at a much lower rate than the equivalent employed doctor. As patients become more cost conscious, and insurances cover less, the out of pocket expenses will matter more. Those of us able to work in the patient’s best interest clinically and financially will have a huge advantage over those tied to set referral patterns and expensive site of care options.
Philip Louie, MD. Spine Surgeon and Medical Director of Research and Academics at Virginia Mason Franciscan Health (Seattle): We still need to provide excellent patient care, but I believe the single biggest competitive advantage will be the ability to measure and prove value at the episode level. Most practices can tell you what they charge, but how many can tell you what an episode of care actually costs to deliver or what outcomes that spending achieved? As payers, employers and CMS continue shifting financial risk downstream, that risk often falls on whoever can accurately price it. Practices that understand their costs can enter bundled payment contracts with greater confidence, make technology investments based on data rather than anecdotes and identify which surgeons and care pathways deliver the most value.
I think of it this way: Imagine two restaurants. One knows its food cost per plate, while the other only knows its monthly revenue. Both can survive when business is booming, but only one can negotiate with suppliers, decide which menu items to keep and remain profitable when margins tighten, much like healthcare is experiencing today.
Joshua Prickett, DO. Neurosurgeon at LewisGale Regional Health System (Salem, Va.): I think the biggest advantage will be for practices that can offer spine patients a comprehensive range of care options. Many patients are referred for surgical evaluation before they have had a complete workup or a meaningful trial of conservative treatment. In busy surgical clinics, patients who are not clearly operative candidates may not always receive the time or direction they need. Practices that can provide comprehensive spine care, including non-operative management, are well positioned to build patient volume and trust. As patients progress through appropriate conservative care, the operative cases tend to declare themselves, and those patients already have an established relationship with the surgeon and care team.
In addition, practices that offer a broad spectrum of surgical options will have an advantage. This includes minimally invasive decompressive techniques, endoscopic approaches, motion-preserving instrumentation when appropriate and reserving larger non-physiologic fusion operations as a last resort. This is why I work to stay up to date with the latest updates in technology and approaches to improve outcomes for my patients.
Johnathon Shaffer, MD. Division Director of Neurosciences at IU Health South Region (Bloomington, Ind.): Disciplined execution around details that were previously treated as secondary in many settings. Particularly with CMS’ Ambulatory Specialty Model impacting Part B reimbursement next year, success will increasingly depend on how well programs operationalize outcomes and site‑of‑care strategy. That model also introduces a mandatory, two‑sided risk corridor on all Medicare Part B claims, with performance scored against other low back pain specialists and payment adjustments that ramp from roughly plus or minus 9% to 12% over the life of the model. Many spine programs are not yet fully attuned to how significantly this will reshape financial performance.
Practices that are already aligning around ultra–minimally invasive and endoscopic techniques are better positioned. These approaches reduce excess days and length of stay, minimize complications, and enable a greater proportion of cases to transition safely into the ASC setting, which directly supports both cost containment and the quality metrics that will drive reimbursement under ASM and commercial payer models. Standardized care pathways, better real‑time data visibility and tight perioperative coordination will be equally important. Spine programs that treat these elements as core strategy will have a meaningful competitive advantage as payers increasingly reward measurable value delivered in lower‑cost settings.
Benjamin Weisenthal, MD. Orthopedic Surgeon at Knoxville (Tenn.) Orthopaedic Clinic: Scale, gained through deliberate consolidation, will be the biggest competitive advantage for orthopedic and spine practices over the next five years. Reimbursement keeps falling while staffing, technology and overhead costs keep rising uncapped, and an independent practice has no way to offset that math on its own.
A larger group can [offset], in two ways: it can negotiate from comparable footing against insurance markets that are already consolidated to a handful of dominant payers, rather than accept whatever rate it’s offered. Scale also funds the ancillary infrastructure, ASCs, imaging, physical therapy, that increasingly generates the margin Medicare no longer will. The practices that consolidate deliberately, on their own terms, will be the ones still standing five years from now; the ones that stay small and wait will have that decision made for them.
Adolph Yates Jr., MD. Professor and Vice Chair for Quality in the Department of Orthopedic Surgery at the University of Pittsburgh School of Medicine: To quote Niels Bohr, or debatably, Yogi Berra, “It is hard to make predictions, especially about the future.”
Orthopedic and spine practices are about to leave a long punctuated technological equilibrium with the explosion of new advances in biologics, nanotechnology, robotics and AI. The competitive advantage is that current surgeons and those in training have mastered arthroscopic, endoscopic and minimally invasive techniques, allowing them to fully leverage these new technologies in outpatient settings, where they will have increasing control over safety and efficiency.
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.
