The next spine practice to sell may not be the weakest independent group. It may be the one a buyer can scale fastest.
Health systems and physician-led pain and spine platforms have both acquired independent practices in 2026. Recent transactions suggest buyers are prioritizing groups with strong regional brands, established referral networks, outpatient assets and enough procedural volume to anchor broader expansion.
At the same time, reimbursement pressure, rising overhead and administrative burden are making it harder for many independent groups to fund that growth alone.
Based on recent spine and orthopedic deals tracked by Becker’s, five types of practices appear most likely to attract the next wave of buyers.
1. The regional group that already resembles a health system: Large independent groups with multiple locations, specialties and established referral networks are difficult, and expensive, for health systems to replicate.
Sioux Falls, S.D.-based Avera Health’s acquisition of The Center for Neurosciences, Orthopaedics & Spine illustrates the appeal. The Dakota Dunes, S.D.-based group includes more than 100 physicians, advanced practice providers, therapists and athletic trainers across nine specialties and eight clinic locations. It also provides outreach services at 29 satellite locations across South Dakota, Iowa and Nebraska.
Charlotte, N.C.-based Atrium Health followed a similar playbook when it absorbed Carolina NeuroSurgery & Spine Associates, one of the nation’s largest independent neurosurgery groups. The organization had more than 70 physicians and advanced practice providers and an 80-year presence in the region.
The next major system acquisition is therefore likely to involve more than several surgeons and a clinic. Buyers are seeking established regional platforms that provide immediate market coverage, specialist recruitment and downstream procedural volume.
2. Pain and spine groups with ASC access: Physician-led platforms are targeting a different type of asset: interventional pain and spine practices that can feed procedures into an expanding outpatient network.
Thomasville, Ga.-based Summit Spine & Joint Centers acquired Southeast Neurology & Pain Management, an interventional pain management practice with clinics in Thomasville, Tallahassee, Fla., and Panama City, Fla., in July. The transaction expanded Summit to 55 clinics and 21 ASCs across five states.
Elgin, Ill.-based DxTx Pain and Spine partnered with SEPA Pain & Spine, a seven-physician Horsham, Pa., group performing spinal injections, nerve blocks and spinal cord stimulation. Atlanta-based Resolve Pain Solutions also acquired Southcoast Spine and Pain in Aiken, S.C.
These deals suggest the next targets do not necessarily need to be large. A smaller practice can be valuable when it gives a platform entry into a new market, adds procedural volume or fills a geographic gap between existing clinics and ASCs.
3. Practices without control of the surgery site: Outpatient migration is creating a widening divide between practices that own or control surgical capacity and those that rely on hospitals for access.
Brian Blackwood, MD, an orthopedic surgeon at Boulder (Colo.) Centre for Orthopedics & Spine, told Becker’s that continued reimbursement cuts will drive more practices to sell or merge. He said surgeons without ASC ownership may ultimately be forced toward employment.
The pressure could intensify as CMS moves more procedures out of hospitals while proposing lower reimbursement for common spine and pain interventions. Spine leaders have warned that the combination of site neutrality and insufficient professional or ASC payments could accelerate consolidation.
Practices without ASC ownership, imaging, therapy or other ancillary revenue streams may consequently have fewer ways to offset declining professional reimbursement. For a hospital, ASC operator or physician platform, acquiring the group can secure both its surgeons and the outpatient volume they generate.
4. Mid-sized groups caught between independence and scale: Small practices can remain lean. Large groups can spread administrative costs, negotiate stronger payer contracts and access capital. Mid-sized groups can become trapped between those models.
Shobhit Minhas, MD, a physician partner at Fox Valley Orthopedics in Geneva, Ill., wrote in Becker’s that small and mid-sized practices have limited leverage against consolidated health systems. He said the traditional independent model increasingly lacks the capital, scale and negotiating leverage needed to compete, prompting his group to partner with a private equity-backed management services organization. These practices may be among the most likely sellers because they are often successful enough to attract buyers but not large enough to independently fund recruiting, technology, payer contracting, data infrastructure and regional expansion.
The buyer may not always be private equity. Health systems, physician-owned platforms and independent group aggregations are competing for many of the same practices.
5. Groups that are already operationally tied to a hospital: Some of the next acquisitions may begin as partnerships rather than sales.
Some of the next acquisitions may begin as partnerships rather than outright sales. Atrium Health and Carolina NeuroSurgery & Spine Associates collaborated for years before formally combining, illustrating how referral relationships, joint ventures and shared outpatient initiatives can evolve into full integration. The next practice to sell may already be closely aligned with a health system through its facilities, referral network or operational partnerships.
Who may be least likely to sell?
Large, sophisticated independent groups with ASC ownership, ancillary services, strong payer relationships and access to conventional financing may have more options.
Stephen DeBiasi, CEO of Northeast Orthopaedic Alliance in Waltham, Mass., recently told Becker’s that larger orthopedic groups are increasingly able to finance growth through internal cash flow or bank financing rather than private equity. Other leaders have similarly argued that independent practices can strengthen their position by controlling their facilities, expanding ancillary services and negotiating directly with payers.
The dividing line may not be between thriving and struggling practices. It will increasingly be between groups that control their capital, contracts, referral networks and sites of service, and those that need a larger partner to do it.
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.