As orthopedic care continues to migrate from hospitals to ASCs, the landscape is rapidly evolving.
Here are five key orthopedic ASC trends to watch:
1. The rise in single-specialty ASCs
Orthopedics is one of the most capital- and equipment-intensive specialties, which some leaders say is driving more development toward single-specialty ASC models.
“We’re seeing probably more single-specialty ASCs for orthopedics,” Sean Rambo, co-founder and president of Compass Surgical Partners told Becker’s. “To really do orthopedics right — from the less acute to the most acute — it’s a heavy equipment investment. You also want to create as much efficiency as possible just to drive throughput. For that reason, orthopedic surgeons themselves tend to focus on that single-specialty model.”
While some multispecialty ASCs continue to add orthopedic services, the majority are leaning toward specialization, Mr. Rambo said.
“Quite frankly, that’s not unique to orthopedics — as you expand the number of specialties, you have to be careful not to eliminate efficiency.” he said.
2. Orthopedics remains the ASC powerhouse
Orthopedics continues to lead all ASC specialties in revenue generation. According to HST Pathways data, average net revenue per case increased from $6,141 in 2023 to $6,419 in 2024, reflecting both patient demand and stronger payer reimbursements.
Net revenue per case grew 11% year over year, while case volume rose 5.5%, signaling sustained growth.
“As technological advancements continue, we expect the volume of higher-acuity orthopedic procedures to migrate to ASCs in 2025,” Andrew Lovewell, CEO of Columbia (Mo.) Orthopedic Group, told Becker’s. “Total joint replacements, particularly knee and hip replacements, will remain a primary growth driver in most orthopedic/[musculoskeletal]-focused ASCs. Shoulder replacements will grow more in the ASC space as well since we have a year of data demonstrating the excellent outcomes that ASCs produce on this procedure.”
3. Complex case migration continues to accelerate, but payer barriers persist
Advances in robotics, endoscopy, anesthesia and enhanced recovery protocols are enabling more complex spine and joint procedures to move safely to outpatient settings, Les Jebson, regional administrator at Greenville, S.C.-based Prisma Health, told Becker’s.
“The five-year horizon for outpatient spine and orthopedics will continue to experience significant growth, estimated at 8% to 10% from 2025 to 2030,” he said. “As the population ages, the prevalence of musculoskeletal conditions — from degenerative shoulder issues to herniated discs — will drive demand for innovative, minimally invasive surgical solutions.”
However, reimbursement remains the biggest challenge. Persistent issues with Medicare’s inpatient-only list, prior authorization and commercial payer denials remain major barriers.
“There have been increasing denials for medically necessary procedures and imaging, even after patients have exhausted conservative treatments,” Anthony Giuffrida, MD, surgeon at Cantor Spine Center at the Paley Orthopedic & Spine Institute, told Becker’s. “This not only delays care but also undermines physician autonomy and erodes the physician-patient relationship. The cumulative effect is a healthcare environment where administrative burdens compromise timely, effective treatment, leading to poorer outcomes and heightened physician burnout.
4. A new type of consolidation emerges
Independent orthopedic groups are rethinking growth through collaboration rather than acquisition. Networks such as Pelto Health Partners represent a new model that aligns independent practices on payer advocacy, group purchasing and technology adoption while maintaining autonomy.
“In private equity and hospital models, it’s about pushing volume or, in the case of private equity, preparing for a second sale. The patient gets lost in that — it becomes profit over the patient. We prioritize patients over profits,” Frank Aluisio, MD, spine surgeon at EmergeOrtho and chair of Pelto’s board, told Becker’s. “Autonomy is key. In independent practice, you set your own schedule, see as many or as few patients as you want, and structure your work life as you see fit.”
5. Technology is redefining outpatient orthopedics
Artificial intelligence, robotics and smart implant technology are transforming the outpatient orthopedic landscape. AI is improving imaging accuracy, documentation and billing, while robotics enhances surgical precision and outcomes.
“The implementation of smart implants alongside robotics in joint replacement has made the biggest impact in my practice in 2025,” Sean Sutphen, DO, orthopedic surgeon at Illinois Bone and Joint Institute, told Becker’s. “Smart implants allow us remote monitoring during the recovery period, collecting range of motion, gait dynamics and walking speed. This allows us to give our patients a very personalized recovery by providing us data that may allow us to make personalized adjustments to their rehab post-op.”
