The trajectory of outpatient spine surgery continues, some of the unexpected shifts ahead could come from developments in AI, policy and operational efficiencies.
Leaders discuss what might surprise ASCs when it comes to spine care in five years.
Note: Responses were lightly edited.
Question: Five years from now, what changes in spine care and practice management will surprise most people in the field today?
Charlene Cioe, CNO at Summit Center for Surgery (Oakbrook Terrace, Ill.): Five years from now, I think some of the biggest surprises in spine care will come from how much technology and outpatient care continue to evolve. One change that may stand out is the growing use of artificial intelligence to support clinical decision-making. AI tools are already being developed to analyze imaging, patient history, and outcomes data, and they will likely become more common in helping providers determine which patients may benefit most from surgery versus conservative treatment. While clinical judgment will always remain essential, these tools may help guide more personalized care and reduce unnecessary procedures.
Another change that may surprise many providers is how many spine procedures will move into outpatient or ambulatory surgery center settings. As minimally invasive techniques, anesthesia practices, and pain management continue to improve, procedures that once required inpatient hospitalization may increasingly be performed safely in outpatient environments. This shift could help reduce healthcare costs while also improving recovery time and patient satisfaction.
From a practice management standpoint, value-based care will likely continue to grow. Spine practices may rely more heavily on patient-reported outcomes, quality metrics, and coordinated care models. Reimbursement may increasingly be tied to measurable results rather than the number of procedures performed.
Finally, telehealth and remote monitoring will probably become a more routine part of follow-up care. Digital tools and wearable devices may allow clinicians to track recovery and mobility more closely after surgery or therapy. Overall, these changes could reshape both how spine care is delivered and how practices manage patient care over time.
Brian Cunningham, MD. Director of ambulatory surgery at TRIA Orthopedics and vice chair and director of inpatient orthopedics at Methodist Hospital (Minneapolis): More than half of spine patients will be in risk barring payment models. Prior authorization will give way to alignment on outcomes and resource utilization. Everything will move downstream with large payments at risk for practices.
Bruce Feldman. Former Administrator of Eastern Orange Ambulatory Surgery Center and Founder of an ASC Consulting Firm (Cornwall, N.Y.): I think we’re going to see more complex and higher acuity spine surgery being done in the ASC setting. Innovations in healthcare technology such as the use of AI will allow for more precision surgical techniques to be performed, which will shorten procedure/operative time and recovery. Knowing your procedure costs will become more and more important regarding contract negotiations with insurance companies.
Megan Friedman, DO. Chair and medical director at Pacific Coast Anesthesia Consultants (Los Angeles): Most people expect clinical innovation to drive change, but the bigger shift will be operational. More complex spine [surgeries] will move into ASCs, but success will depend on predictable scheduling, aligned incentives and stable anesthesia coverage. The surprise won’t be what cases can be done, it will be which organizations can actually run them efficiently.
Andrew Lovewell. CEO at Columbia (Mo.) Orthopaedic Group: Five years from now, spine care and practice management are going to look quite a bit different. Non-operative spine care will continue to have massive growth in the future. Not because surgery disappears, but because it gets more selective, and models like ASM will limit the ability or timeline for operations. Advanced diagnostics, better biologics, and high-functioning MSK care pathways will be the play in the future. The winners will be groups that own the entire full care continuum: PT, injections, imaging, remote patient options, not just the surgical event.
In addition, the cases being performed in the hospitals today will continue migrating to ASCs at scale. Not because the outcomes are poor, but because the economics will force the migration. Minimally invasive spine is going to look a lot more like joints did 10-15 years ago. If you don’t control or partner in an ASC, you’ll feel it in both volume and margin.
The business model shifts from volume to managed outcomes. Call it bundles, call it value-based, call it risk-sharing, it’s coming whether people like it or not (prime evidence is ASM from Medicare for 2027). The groups that can track outcomes, standardize pathways, and prove cost efficiency will win contracts. Everyone else becomes beholden to the price and takes what they get. I also look for independent groups to either get bigger or get squeezed out. Mid-sized practices that don’t have ancillaries, data, or negotiating leverage will feel pressure from both PE-backed platforms and health systems.
Cheraire Lyons, PhD. Vice president of revenue cycle at Alliance Spine & Pain Centers (Atlanta): Over the next five years, spine care will move from early AI adoption to fully AI‑enabled operations. Intelligent documentation, predictive RCM driven by real‑time KPIs, and unified technology platforms will significantly reduce administrative burden and strengthen financial performance. At the same time, patient engagement will advance through personalized digital experiences that expand access and improve continuity of care, creating a smarter, more connected, and more patient‑centered spine care environment.
Paul Lynch, MD. Founder and CEO, US Pain Care (Phoenix): Five years from now, what will surprise most people is how quickly musculoskeletal and pain care — now exceeding $1 trillion annually when you include joints, spine, mental health, and opioid use disorder — shifts toward true value-based models. These will not be pilot programs, but full-risk, capitated contracts that reward groups capable of managing the entire patient journey. What’s not yet on many people’s radar is that this transition will require a return to physician ownership, with tighter alignment between clinic practices and surgery centers.
The groups that succeed will be those led by physicians who integrate care delivery across settings and take accountability for both outcomes and cost. At U.S. Pain Care, this is exactly the model we are building — empowering physician owners to serve as the gatekeepers of the future MSK and pain spend.
Melissa Rice. Administrator at Loyola Ambulatory Surgery Center, part of Trinity Health (Oakbrook Terrace, Ill.): Five years from now, one of the most surprising changes in spine care will be how quickly care has shifted out of the hospital and into high-performing ambulatory settings. Advances in minimally invasive techniques, anesthesia protocols, and post-op pain management will make same day discharge the norm rather than the exception for many spine procedures.
Data-driven decision-making will play a much larger role, with real-time outcomes, cost transparency, and patient-reported metrics guiding both clinical and operational choices. Artificial intelligence will increasingly support preoperative planning, case selection, and documentation, reducing variability and administrative burden for providers. From a practice management standpoint, spine programs will look less like traditional physician practices and more like integrated service lines with strong operational leadership. Alignment between surgeons, ASCs, anesthesia, and technology partners will be essential for sustainability.
Reimbursement pressure will accelerate the need for efficiency, forcing practices to better understand cost per case and margin by procedure. Workforce models will evolve as well, with greater reliance on advanced practice providers and cross-trained staff. Patients will also expect a more consumer-centric experience, including digital engagement and predictable pricing. Ultimately, the biggest surprise may be how quickly adaptability becomes the defining trait of successful spine practices.
Ken Rich, MD. President of Raleigh (N.C.) Neurosurgical Clinic: I think the type of cases we can do in an ASC are going to grow over the next five years. Hopefully insurers will keep up with approving movement of those cases from the hospital setting. What we can do outside of hospitals and in ASCs would make a huge difference in the economics of spine care.
David Russo, DO. Columbia Pain Management (Hood River, Ore.): Five years from now, what will surprise most people isn’t a new device; it’s how incentives will have shifted. We’ll see a major change in spine care from hospital systems to physician-led ASCs, driven by site-neutral payment pressures and increased cost transparency. AI won’t replace physicians, but it will quietly improve and transform everything from documentation to prior authorization to risk stratification, easing processes in some areas while increasing payer control in others. The biggest surprise, however, will be the comeback of independent, physician-led practices that have figured out how to grow without giving up control, by combining operational discipline with aligned incentives. In other words: less consolidation than expected, but more polarization between top-tier independents and everyone else.
The leaders featured in this article are speaking at Becker’s 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, set for June 11-13, 2026, at the Swissotel Chicago.
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
