Orthopedic surgery is rapidly migrating into ASCs and other outpatient settings. But despite advances in surgical technique, anesthesia and perioperative care, along with strong patient demand for lower-cost settings, leaders across orthopedics have said economic, policy and operational misalignment is slowing broader adoption, even as the specialty remains one of the fastest-growing areas of outpatient care.
Here are five factors holding back outpatient orthopedic surgery:
1. Reimbursement uncertainty, especially with respect to Medicare, is slowing outpatient orthopedic momentum.
As orthopedic procedures continue shifting to the outpatient setting, reimbursement remains a key constraint.
Brett Shore, MD, an orthopedic surgeon at Marina Del Rey, Calif.-based DISC Sports and Spine Center, told Becker’s payer partnerships between ASCs and commercial insurers are expanding and can improve access, efficiency and physician reimbursement. However, Medicare remains a wild card for outpatient orthopedics, with some procedures reimbursed adequately and others falling short.
Dr. Shore said that without meaningful Medicare rate adjustments, surgeons and ASCs will continue facing difficult decisions about which procedures and payer mixes are financially sustainable in ambulatory settings.
2. Workforce shortages and administrative burden are limiting patient access.
Orthopedic leaders have said workforce constraints and mounting administrative demands are increasingly threatening patient access and practice sustainability. Staffing shortages, including anesthesia, perioperative and support roles, are colliding with prior authorization delays, AI-driven denials and rising documentation requirements, diverting time from patient care.
“Prior authorization is interfering with timely, evidence-based musculoskeletal care,” Elizabeth Matzkin, MD, chief of the Women’s Sports Medicine Program at Boston-based Brigham and Women’s Hospital, told Becker’s. “Delays in orthopedic surgery after conservative care has failed can result in progressive conditions, downstream costs or more complex surgery.”
3. Technology gains are colliding with operational and reimbursement headwinds.
Orthopedics is benefiting from rapid advances in robotics, AI and data-driven tools that are transforming surgical precision, personalization and postoperative monitoring.
AI-enhanced robotics, smart implants and wearable technologies are improving alignment, recovery tracking and outcomes, while accelerating the shift of complex cases into outpatient settings. At the same time, these gains are unfolding amid shrinking reimbursement, tightening ASC margins and growing administrative demands, forcing practices to rethink workflows, automation and scale to remain viable. Leaders have said the tension between technological progress and economic pressure will define orthopedic strategy heading into 2026.
4. Economic incentives are slowing outpatient orthopedic migration.
The biggest barriers to moving more procedures into ASCs are increasingly economic rather than clinical.
Advances in minimally invasive techniques, anesthesia and pain management have made many orthopedic procedures safer in outpatient settings, but reimbursement structures and hospital financial incentives continue to favor inpatient care. Leaders have noted hospitals generate significant revenue from inpatient orthopedic and spine cases, creating resistance to shifting volume into lower-cost ambulatory settings even when outcomes and safety are comparable. As a result, some orthopedic procedures that are clinically ready for ASCs are slower to migrate.
5. Site-neutral payment reform could fundamentally reshape outpatient orthopedics.
Site-neutral payment is emerging as one of the most consequential policy shifts for orthopedics, with the potential to alter practice economics, ASC strategy and patient access.
CMS’ proposed 2026 site-neutral payment policies would narrow long-standing reimbursement disparities between hospital outpatient departments and ASCs, reducing hospital payments rather than increasing ASC rates. As site-neutral rules expand across Medicare and commercial payers, the changes could accelerate case migration to ASCs, pressure employed physician models and drive consolidation, while forcing practices and surgery centers to rethink partnerships, contracting and revenue cycle strategy.
