Becker's ASC Review

14 ORTHOPEDICS actually measure what quality is, and we're hopeful that it will resonate because it'll lead to more cost effective care as well. e net benefit is that it creates an ecosystem that is supportive of delivering healthcare and maintaining access. Being bigger is not always better, but being bigger and putting in infrastructure that involves more granular data is going to be our focus in the next year to have a more fertile dialogue on the payer side that will also improve the quality of care. Q: What other healthcare trends will you be following into 2026? BC: e thing to focus on is continued consolidation. Consolidation is in many ways, one of the only ways that we can survive the economic trends that we're seeing. ere's just going to be an increased focus on sharing data, and AI can be used to help make us better. I really believe that in this coming year, the things you're going to see are probably continued consolidation. We'll probably see some continued shake out, at least in the orthopedic space, as far as the impact that private equity had on consolidation. I'm not sure that has been all good, and we're still trying to figure our way to what the ultimate outcome is going to be aer a number of recent transactions. I think we'll start to see the results of those. Something we'll have to sort of pay attention to on the ASC side, to maintain a sort of private, independent practice, it really does require physicians to participate in the entire patient journey. at is what's most likely to maintain quality. It's most likely to keep all the data in a place that can be analyzed, looking at all the variables that relate to patient care. It's not just a surgical experience, it's the resources that are dedicated to maybe prevent surgery. How long should those resources be allocated for? What do you do postoperatively? What are the most efficient pathways to get a patient safely back to achieve their goals? All that stuff requires access to the patient journey. So that's sort of an element of consolidation, but it's also part of how I think practices will sort of maintain themselves. ose are the things we'll probably see play out in 2026 in a continued way. It's already starting. n Spine surgeons wait for 'second bite' in PE deals By Carly Behm A surge of private equity deals in the spine and orthopedic space during the last few years have yet to see solid payoff, some surgeons say. Editor's note: Responses were lightly edited for clarity. Question: We're now several years into the first wave of PE-backed orthopedic deals. What are spine surgeons still waiting to see play out? Adam Bruggeman, MD. Texas Spine Care Center (San Antonio): Private investment in orthopedic practices has not returned significant revenue on "second-bite" transactions. If those occur, we could see a greater interest among surgeons. Given the quick transition to employed practice, there are less physician practices available for private investment. In the near-term, there doesn't appear to be a great market for private equity, but that could quickly change with major policy shifts like enacting site- neutral payments. Pierce Nunley, MD. Louisiana Spine (Shreveport): Several years into the first wave of private equity-backed orthopedic and spine deals, many spine surgeons are still waiting to see whether these consolidations can deliver sustainable long-term value. The early excitement around liquidity events and operational efficiencies has largely faded, as fewer groups are achieving the promised "second bite of the apple." Many of the initial deals were built on aggressive growth projections and debt structures that are now straining under tighter margins and declining private equity appetite for new acquisitions. This slowdown has made recruiting more difficult, as younger surgeons hesitate to join practices with uncertain ownership structures or limited equity potential. In some markets, valuations have flattened, and physician partners are questioning whether short-term payouts justify the long-term loss of autonomy and exposure to financial risk. The parallels to the 1990s physician practice management collapse are hard to ignore — overleveraged groups, inflated valuations, and administrative overreach ultimately leading to bankruptcy or forced unwindings. Spine surgeons are watching closely to see whether current portfolios can adapt before history repeats itself. Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: The private equity consolidation wave in orthopedics, including spine practices, began accelerating around 2018 to 2020. Key unresolved questions include whether the promised operational efficiencies actually materialize without compromising care quality, how physician autonomy evolves under these models, and whether the typical five to seven year exit timeline aligns with sustainable practice development. Early data on outcomes is mixed, with some reports of improved administrative efficiency but concerns about pressure to increase case volumes or procedure selection bias. The sustainability question becomes particularly acute as these investments reach their exit windows and require either IPOs or secondary sales to achieve targeted returns. Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): This year has seen the many parlays and actual sale of spinal implant companies to private equity firms after many years of contractual agreements and customary service that definitely withstood all the ratcheting down of pricing and merger. We are seeing only a transference of leadership and consolidation/removal of duplicity, which is always necessary and welcome. With the current state of healthcare policy, governmental shutdown, payment stalls and a system so stressed and fragile, does this cold actuality forebode further diminishment or the inflection point of further socialization that all fear is coterminous. Conversely, is the correction in over usage and unnecessary application of treatment to diagnosis render its coming day. Perhaps. n

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