The center of orthopedic care is shifting, and faster than many expected.
For Leo Spector, MD, orthopedic spine surgeon and CEO of OrthoCarolina, the move away from hospitals and into ambulatory and office-based settings represents one of the most significant changes in musculoskeletal care in decades.
“I think the biggest shift that’s occurring in musculoskeletal care is the shift from inpatient, hospital-based surgery to outpatient, ambulatory or office-based surgery,” Dr. Spector said.
The shift is changing not only where procedures are performed, but how patients experience care.
A fundamental shift in expectations
Not long ago, joint replacement procedures often required multi-day hospital stays followed by extended rehabilitation.
Today, many of those procedures are being performed as same-day cases, increasingly in ASCs.
“We’re seeing hip and knee procedures done as same-day procedures, not just at the hospital, but now in freestanding ambulatory surgery centers,” Dr. Spector said.
The change reflects improvements in surgical technique and perioperative care, as well as a broader shift toward delivering care in lower-cost, more focused environments.
“When you’re having elective musculoskeletal procedures, it’s great to be in an environment that’s different,” Dr. Spector said.
For many patients, that means a more streamlined experience and a quicker return home.
Rethinking ASC strategy
At OrthoCarolina, the transition to outpatient care is shaping long-term strategy.
Recent changes to North Carolina’s certificate-of-need laws have opened new opportunities for physician groups to develop and operate ASCs more independently.
“We now have two ASCs that we wholly own, and we manage ourselves,” Dr. Spector said.
That shift is prompting a reevaluation of traditional partnership models with hospitals and management companies.
“How is that partnership going to benefit our patients? How is it going to benefit our teammates? And how is it going to benefit the practitioners?” Dr. Spector said.
For Dr. Spector, those questions now guide how partnerships are structured moving forward.
Redefining value around the patient
As care moves into new settings, the definition of value is also evolving.
For Dr. Spector, value-based care begins with understanding what matters most to patients.
“It really should start with what’s valuable to the patient,” he said. That includes access, convenience and affordability, alongside clinical outcomes.
Patients increasingly expect more flexible access to care, including extended hours, digital scheduling and virtual options. At the same time, rising healthcare costs continue to create financial pressure.
That change challenges a long-standing assumption in healthcare.
“Less expensive doesn’t mean less better,” Dr. Spector said. “Less expensive can actually be a better product.”
The goal is to lower costs while maintaining or improving outcomes.
What value looks like in practice
At OrthoCarolina, value-based care is reflected in several initiatives.
Through direct-to-employer partnerships, the organization offers bundled pricing for orthopedic procedures, reducing or eliminating out-of-pocket costs for patients while maintaining quality standards. In addition, some procedures have moved from hospital settings to ASCs and, in certain cases, into office-based environments.
“They walk into the office, have the procedure done and walk out,” Dr. Spector said.
These changes can improve convenience for patients while reducing the total cost of care.
What will separate leading organizations
Looking ahead, Dr. Spector expects differences in performance across organizations to become more pronounced.
“I think you need economies of scale, and you need to deliver a superior product,” he said.
That includes expanding access, adopting new tools and building systems that can effectively serve broader patient populations.
It also requires a willingness to adapt.
“What got us here may not get us there,” Dr. Spector said, adding that even for successful organizations, change can be difficult.
“Sometimes the hardest time to change is when you’re doing well,” he said.
Technology as an enabler
New technologies, including AI, are expected to influence how care is delivered. But Dr. Spector emphasized that technology alone is not a strategy.
“AI is not a strategy. It is simply a tool,” he said. “It helps enable us to succeed, but it’s still just a tool. We have to be willing to adopt new technologies, and that means making sure people are trained to use them.”
Organizations must still determine how to apply those tools effectively and ensure their teams are prepared to use them.
Keeping the focus on patients
Despite the changes underway, Dr. Spector returns to a consistent principle.
“Patients need to be at the center of everything we do,” he said. “Our strategy is simple: Provide value, expand access and care for our communities. We’ve been committed to that for 20 years, and that won’t change.”
For OrthoCarolina, that means continuing to focus on access, affordability and outcomes, even as how care is delivered continues to evolve.
“How we deliver that is going to have to change,” Dr. Spector said.
Healthcare, he added, remains both challenging and deeply worthwhile, with a future that continues to evolve alongside those demands.
The shift toward outpatient care is already underway. How organizations respond may define what orthopedic care looks like next.
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