Orthopedics enters 2026 at a crossroads. Demand is rising, outpatient migration is accelerating and new technologies are reshaping how surgeons diagnose, operate and monitor recovery.
Yet the same forces driving progress are also exposing sharp vulnerabilities, from reimbursement cuts and staffing shortages to tightening ASC margins and expanding administrative requirements. The result is a year defined by both meaningful tailwinds and mounting headwinds.
Good news
1. Regulatory shifts, technology and patient demand are rapidly pushing orthopedic surgeries into ASCs: Orthopedic migration to outpatient settings continues to accelerate as CMS removes more procedures from the inpatient-only list and payers push lower-cost sites of care.
By late 2023, outpatient orthopedic volume was 33 times higher than inpatient volume. Surgeons say minimally invasive techniques and improved anesthesia now make complex cases safely outpatient, while patients increasingly prefer ASC recovery. With payers exploring site-neutral payments and projections showing orthopedic ASC growth of about 6% annually through 2030, the shift is expected to intensify in 2026.
2. New physician-led practice models are giving surgeons more autonomy and flexibility for 2026: Amid growing consolidation, orthopedic surgeons are gaining access to new practice structures that preserve independence while offering the scale needed to operate efficiently.
Leaders told Becker’s emerging physician-led platforms, which integrate clinic, ASC, imaging and administrative support, are creating a “third option” between hospital employment and fully independent private practice. These models allow surgeons to control clinical decisions, operate in ownership-driven ASC environments and reduce administrative burden, all while benefiting from shared infrastructure. For many orthopedic surgeons, this renewed ability to practice autonomously represents a meaningful bright spot heading into 2026.
3. Robotics, AI and smart implants are transforming orthopedic precision and personalization: Robotics has been used in orthopedics for decades, but surgeons say AI is fundamentally changing how robotic systems are applied.
Michael Seem, MD, orthopedic surgeon at Winchester (Va.) Orthopaedic Associates, part of The Centers for Advanced Orthopaedics, told Becker’s AI is prompting surgeons to rethink long-standing approaches to joint replacement by analyzing alignment, component placement and outcomes with far greater sophistication.
New data streams, including wearable devices and smart implants that report cadence, range of motion and recovery progress in real time, are giving surgeons unprecedented insight into postoperative healing. These tools enable earlier intervention, personalized recovery pathways and, over time, more predictive models of which techniques work best for each patient.
Bad news
1. New and proposed payer policies are tightening margins and threatening access in 2026: Orthopedic surgeons are bracing for a new wave of reimbursement pressures as commercial and government payers introduce policies that further strain practice economics.
CMS’ 2.83% cut to the 2025 conversion factor, ongoing prior authorization hurdles, prepayment reviews and rising overhead costs are delaying care and eroding financial stability, particularly for independent and rural groups.
These policies consume significant administrative time, accelerate consolidation and worsen access as inflation continues to outpace reimbursement and workforce shortages deepen.
2. Rising outpatient costs, reimbursement gaps and administrative hurdles are squeezing ASC margins: Even as outpatient orthopedic volume expands, financial pressures in the ASC setting are intensifying.
Medicare typically reimburses ASCs at only about 50% of HOPD rates, creating persistent margin challenges. Implant pricing remains a major cost driver, with vendor contracts and surgeon preference heavily influencing case profitability.
Administrative burdens, especially prior authorization, add delays and expense, and upcoming CMS rules will impose new prior authorization requirements for several orthopedic and spine procedures. Combined with policy-driven reimbursement cuts and rising overhead, these pressures are narrowing margins and increasing the cost of care for patients and providers alike.
3. Shrinking reimbursement and shifting payer behavior are forcing orthopedic practices to automate and restructure: Orthopedic surgeons report declining reimbursement and increased payer scrutiny are reshaping daily operations.
As payers intensify documentation requirements and expand claim reviews, many practices have turned to automation, workflow redesign and staff reductions to stay financially viable.
Accurate coding and billing are now essential as CMS cuts for procedures like total knee and hip arthroplasty heighten the risk of underbilling. In response, some groups are joining larger ASC networks to improve contracting leverage.
