Orthopedic leaders agree: What’s holding musculoskeletal care back in 2026 isn’t a lack of innovation, it’s the system around it.
From prior authorization bottlenecks to fragmented care pathways and misaligned incentives, surgeons say administrative friction and outdated workflows are delaying treatment, driving up costs and worsening outcomes. Fixing MSK care, they argue, means rethinking how patients access care, how decisions are made and how success is measured across the entire episode, not just in the operating room.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: If you could change one thing about how MSK care is delivered in 2026, what would it be?
Kasra Ahmadinia, MD. Director of Minimally Invasive Spine Surgery at Advanced Orthopedics of Oklahoma (Tulsa): As an orthopedic spine surgeon, I believe the one area of change I’d want is eliminating or radically streamlining prior authorization for evidence-based spine procedures.
Insurance-driven delays harm patients with neurological conditions and waste hours of a surgeon’s week on paperwork instead of care. What if we had a system where high-performing surgeons get pre-approval for guideline-concordant procedures? This would incentivize great outcomes and would be the most meaningful fix, benefiting patients, surgeons and the healthcare system alike.
Bryce Basques, MD. Assistant Professor of Orthopedics and Director of Minimally Invasive Spine Surgery at Alpert Medical School of Brown University (Providence, R.I.):
The prior authorization process is ripe for disruption. Right now, patients with clear, evidence-based indications for imaging or surgery still face delays that add no clinical value and often worsen outcomes.
Decisions are often made by non-specialists using rigid criteria and a tedious appeals process. Streamlining or eliminating prior authorizations would reduce delays, lower administrative burden and let us focus on treating patients rather than navigating approvals.
Kevin Bozic, MD. Professor and Chair, Department of Surgery and Perioperative Care at Dell Medical School at the University of Texas (Austin): If I could change one thing, it would be to fully align musculoskeletal care around the outcomes that matter most to patients.
That means organizing care around the full episode, not just procedures, measuring outcome, including patient-reported outcomes, as part of routine care, and tying payment to results, not volume. We know how to do this. The opportunity now is to scale it.
Cory Calendine, MD. Orthopedic Surgeon and Founding Partner at Bone and Joint Institute of Tennessee (Franklin): I would give patients full ownership of, and complete access to, their own MSK data. Imaging, implants, patient-reported outcome measures, outcomes: portable, readable and truly theirs.
Today that information is scattered across hospitals, registries and device manufacturers. This slows shared decision-making and keeps patients dependent on whoever holds the pieces of their story. Putting data back in patients’ hands would accelerate better decisions and better outcomes across the board.
Earl Kilbride, MD. Orthopedic Surgeon at Austin (Texas) Orthopedic Institute: The process of pre-authorization including site of service and procedures approved are onerous, time consuming and expensive for a practice while the companies who are in control are literally bathing in profits. The denial rates are real and only serve to delay or even deny needed care.
Philip Louie, MD. Spine Surgeon and Medical Director of Research and Academics at Virginia Mason Franciscan Health (Seattle): If I could change one thing, it would be this: Redesign the reimbursements of MSK care at the point of surgery and improve the reimbursements for upstream activities, in the conservative care, prehabilitation and early diagnostic work that determines whether surgery is even the right answer.
Appropriateness will be under a closer lens. If we can improve accountability for appropriateness, we can reduce some of the unnecessary and costly variation that exists in MSK care, while protecting the variation that should, that being the clinical judgment that tailors care to the patient in front of us.
So, upstream investment, appropriate intervention, purposeful variation.
Rory Murphy, MD. Neurosurgeon at Barrow Neurological Institute (Phoenix): If I could change one thing about how MSK care is delivered in 2026, it would be to have more objective conservative care, AI-driven surgical planning and smart implants enabling continuous, data-based postoperative monitoring and improved long-term patient outcomes.
Emeka Nwodim, MD. Orthopedic and Spine Surgeon at The Centers for Advanced Orthopaedics (Bethesda, Md.): If I could change one thing about musculoskeletal care in 2026 and beyond, it would be to better unify physicians and surgeons. As a collective, we have the [potential] scale, expertise and influence to strategically navigate the wave of changes that threaten our clinical autonomy and financial sustainability. This need for alignment spans all practice settings, academic, employed, private equity-backed and independent practice.
Khalid Odeh, MD. Assistant Professor at Rochester, Mich-based Oakland University William Beaumont School of Medicine and Attending Spine Surgeon at Corewell Health (Royal Oak, Mich.): If I could change one thing about how MSK care is delivered in 2026 as a spine surgeon, it wouldn’t be a new implant or surgical technique, it would be how patients enter the system.
The current pathway is inefficient: surgical patients are delayed in prolonged nonoperative care, while non-surgical patients are over-imaged and referred too early, largely due to limited triage tools at the primary care level. I would shift to a structured, front-end triage model led by trained MSK clinicians and supported by AI-driven decision tools, with rapid access and standardized pathways to direct patients early to the right care, surgical pathology to spine surgeons, mechanical pain to therapy-first care and chronic pain to multidisciplinary management, while using imaging more selectively. This would lead to higher-quality consults, earlier identification of true pathology and improved patient outcomes.
Brandon Ortega, MD. Orthopedic Spine Surgeon at Long Beach (Calif.) Lakewood Orthopedic Institute: If I could change one thing, it would be removing prior authorization as a barrier to guideline-concordant spine care. We have patients with clear surgical indications waiting weeks or months while paperwork cycles through reviewers who have never examined them. That delay doesn’t just frustrate surgeons, it causes real harm and drives up downstream costs. Streamlining that process would have an outsized impact on outcomes across the entire MSK space, particularly, spine.
Philip Schneider, MD. Orthopedic Spine Surgeon at The Centers for Advanced Orthopaedics-Montgomery Orthopaedics Division (Chevy Chase, Md.): MSK care should be under the control and domain of the orthopedic surgeon. If this would occur, there would be better quality care, more efficient care and less cost. This would eliminate unnecessary MRI’s and referrals.
Rajiv Sethi, MD, PhD, Professor of Orthopedic Surgery, Chief of Orthopedic Spine Surgery and Co-Director of the UCSF Spine Center at the University of California, San Francisco: Streamlining MSK care, so that patients can access the right care at the right time, would enhance the satisfaction of all stakeholders involved in the process. This might involve the use of algorithms, technology and advanced practice providers. Using methods like time-driven activity based costing and lean management methods could be used to define the value proposition and guide teams at all of our institutions.
Jason Silvestre, MD. Resident Physician at Medical University of South Carolina (Charleston): Greater use of multidisciplinary care pathways where orthopedic surgeons work with physical medicine and rehabilitation, pain specialists, physical therapists, primary care physicians, nutritionists and mental health professionals in unison rather than in silos
Walter Virkus, MD. Director of Orthopedic Trauma at Indiana University Health (Indianapolis): Eliminating the need for prior authorizations, or dramatically decreasing the requirements. They take too long.We also need to authorize care that clearly needs to be done. Fractures, infections, ligament tears, cancer, all kinds of conditions that are crystal clear it needs to be done.
If they want to overview things more prone to fraud and abuse, like Medicare does for about 15 procedures, that would be fine, but that is a very small part of the authorization process.
Brian Waterman, MD. Chief and Fellowship Director of Sports Medicine and Professor of Orthopaedic Surgery at Wake Forest University School of Medicine (Winston-Salem, N.C.): In 2026, the biggest opportunity in orthopedic care is moving beyond episodic, transaction-based decision-making toward standardized, outcomes-driven care pathways that reduce unwarranted variation. Today, patients with the same diagnosis can experience vastly different care trajectories depending on geography, payer, or provider, with prior authorizations and peer-to-peer reviews acting less as safeguards and more as blunt instruments that often delay time-sensitive, evidence-based care.
While progress has been made through gold carding, expedited reviews and improved peer interactions, these efforts still operate within a fragmented system that relies on outdated, diagnosis-level criteria rather than real-world outcomes. In 2026, orthopedic care should be anchored in longitudinal data, validated care pathways and accountability for functional outcomes, allowing high-performing teams to practice at the top of their expertise while improving access, consistency and value for patients.
Peter Whang, MD. Professor in the Department of Orthopaedics and Rehabilitation at Yale University School of Medicine (New Haven, Conn.): Considering how applications utilizing “big data” like machine learning and AI have already started to permeate our daily lives, my hope for 2026, and beyond, is that we will start seeing greater implementation of these technologies in order to address ongoing challenges that continue to plague our healthcare system.
Even if I don’t necessarily expect these technologies to be a panacea for us — and, in fact, they will likely need to be employed judiciously as we struggle to understand their potential as well as their pitfalls — my hope is that these strategies will allow us to deliver more innovative, evidence-based MSK care in a safe and cost-effective manner, while at the same time serving to minimize the-ever increasing administrative burden of health care providers.
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