Christian Pean, MD, assistant professor of orthopaedic trauma surgery at Durham, N.C.-based Duke University School of Medicine and executive director of AI and IT innovation for Duke Orthopaedic Surgery, is looking at 2026 with a pragmatic but urgent view of the obstacles that await orthopedic programs.
For him, the principal challenge will be expanding access and capacity while protecting quality amid accelerating pressure to shift complex procedures out of the hospital.
“In orthopedic surgery, we’re trying to really expand access and growth while balancing that with maintaining quality,” Dr. Pean told Becker’s. “There’s a huge shift and pressure to de-platform inpatient surgery and move to the outpatient setting, and we want to absolutely do that as a health system. The goal is to do it quickly, safely and learn as much as we can.”
Dr. Pean, who also serves as a core faculty member at the Duke Margolis Institute for Health Policy, said the coming year will test how well health systems can navigate that balance.
Managing the accelerating push to outpatient care
As CMS continues to move fracture and arthroplasty cases toward shorter-stay and outpatient pathways, orthopedic leaders face both operational and financial strain, particularly as documentation and billing scrutiny intensifies.
“In addition to trying to stay up to speed with the trend towards outpatient and ambulatory care, we now feel real financial pressure to rigorously document,” he said. “We have to make sure the cases that do need to be in the inpatient setting are appropriately billed and documented.”
Still, he views the shift as an opportunity, especially for programs ready to redesign how care is delivered. Duke’s hip fracture program offers a clear example.
“We feel well-positioned to use this as an opportunity to shorten length of stay, identify patients who can be discharged home (rather than to a skilled nursing facility) and rethink how we deliver care,” Dr. Pean said. “There’s an imperative to embrace care transformation.”
That mindset will be crucial as hospitals prepare for the Transforming Episode Accountability Model and the Ambulatory Specialty Care Model, both of which he expects to reshape how teams think about episode-based and longitudinal care.
AI’s most immediate value: relieving burden and closing gaps
While AI is dominating industry conversations, Dr. Pean has zeroed in on practical use cases already proving their value, beginning with ambient clinical documentation.
“We’ve been utilizing conversational AI and large language models primarily around ambient documentation,” he said. “To us, that’s low-hanging fruit. Physicians are increasingly burnt out, and the ability to automate documentation is fantastic.”
He sees patient-facing AI as the next major lever for improving access.
“We’re starting to look at patient-facing artificial intelligence that can bridge the gaps in our digital front door,” he said.
One priority: reducing call-center abandonment rates and improving first contact.
“Patients should not just feel like they have access to us at all times, they truly should,” he said, noting the potential for virtual AI assistants to collect patient information and create more context-rich interactions for care teams.
Critically, AI should not replace human contact but help systems triage it.
“Patients who truly need that human touch should be prioritized,” he said. “Those who are comfortable getting their questions answered by an AI agent don’t need to take up the time of a nurse or clinician.”
He expects 2026 to be the inflection point where results must match enthusiasm.
“It’s time to get to work,” he said. “And to measure whether the return on investment of these technologies is going to be realized.”
The growing importance of social needs in surgical care
Dr. Pean has published extensively on health equity and social drivers of health, an area he believes orthopedic programs can no longer treat as peripheral.
“It’s clear from the literature and from our experience that screening for social needs and addressing them in parallel with the clinical needs of surgical patients improves outcomes and contains costs,” he said.
Yet many systems hesitate, unsure how to leverage the data once collected.
“If you don’t measure something, you can’t change it,” he emphasized.
Duke’s hip fracture data underscores the stakes: one in five patients had at least one unmet social need, cutting across demographics. Those patients were more likely to visit the emergency department, miss follow-up calls and experience readmissions.
“Health systems that embrace the uncertainty and start measuring these factors won’t regret it,” he said. “This isn’t just about equity-conscious care, it’s about realizing an opportunity to contain costs and expand margins.”
Reimagining the front door to orthopedic care
Dr. Pean’s vision for the digital front door is simple: open every channel and let patients choose how they engage.
“Reimagining the digital front door to care means opening up every channel,” he said. “If patients prefer texting instead of logging onto a portal, or want to call and actually have someone pick up the phone — or an AI agent pick up the phone — that’s extremely important.”
He believes patients increasingly expect a consumer-grade experience, something healthcare has been slow to deliver. AI can help systems stay “always on,” he said, but only if deployed thoughtfully.
“We’re going to find that there are areas where AI has no business being implemented,” he cautioned. “Patient trust is what we’re dealing with.”
“In 2025 and now 2026, there’s really no excuse for not having your patients’ voices heard — whether through text, phone, portal or AI agent.”
The year ahead will bring tighter mandates, rapid outpatient migration and the first real reckoning with AI’s tangible value.
For Duke, Dr. Pean said the focus is not merely on compliance, but redesigning care to center on access, quality and equity.
