Practice Economics · Becker’s June 2026 Panel, Translated
THE SECOND WAVE IS HERE. YOUR BILLING DATA IS NOW YOUR VALUATION.
At Becker’s 23rd Spine + Ortho ASC conference, leaders from HOPCo, OrthoAlliance, Vector Medical Group, and Baker Donelson laid out how MSK practice economics are being rewritten: a second consolidation wave, multiparty joint ventures, and payment models that finally work because the analytics finally exist. The full Becker’s writeup is here. Below: each takeaway, translated for the practice that is not a platform — and does not want to become one by accident.
Where the Money Moves in 2026
KNEE HOLDS. HIP SLIPS. SHOULDER FALLS OFF A CLIFF.
VMG Health’s projection of ASC Medicare payments for the top-10 procedures, MSK and pain rows below. Total shoulder arthroplasty is the outlier of the entire top ten — an 18% single-year decline in the ASC Medicare pool, while the pain-management codes quietly grow. Nominal-flat knee and hip are a real-terms decline once inflation eats its share.
| CPT | Procedure | 2025 est. | 2026 est. | Change |
|---|---|---|---|---|
| 27447 | Total knee arthroplasty | $428M | $437M | +2% |
| 27130 | Total hip arthroplasty | $215M | $213M | −1% |
| 23472 | Total shoulder arthroplasty | $150M | $123M | −18% |
| 63685 | Spinal neurostim generator | $385M | $400M | +4% |
| 63650 | Neurostim electrode (epidural) | $223M | $227M | +2% |
| 64590 | Peripheral neurostim generator | $146M | $156M | +7% |
ASC Medicare payment pools, estimated 2025 vs projected 2026. Source: Becker’s ASC Review, citing VMG Health’s 2025 report. Pool size reflects rates and volume together — your practice’s exposure depends on case mix.
When the pool shrinks and rates stagnate, the levers you control are the ones that don’t need a payer’s permission: codes you earned but didn’t capture, monitoring revenue on patients you already treat, and outcomes data someone else will pay for. That is the entire design brief of Wonder Bill, RTM, and PROM capture.
The Infrastructure Gap
PLATFORMS BUY THIS INFRASTRUCTURE. EVERYONE ELSE HAS BEEN TOLD TO GO WITHOUT.
HOPCo’s president called claims-analytics infrastructure something “most small practices cannot build alone.” He is right. Roughly four in five rehab and MSK practices operate with 16 or fewer providers — below the scale any platform will onboard, and squarely in the blast radius of the reimbursement cuts driving the second wave. The self-serve version of that infrastructure — billing intelligence, payer-network monitoring, PROM capture, prior-auth drafting — is what this platform is.
Two Honest Paths
If you might transact in 24 months
Six large groups are already in market. Diligence starts with your data: coding accuracy, denial rates, payer mix, network status. Every missed code found now is found by you instead of by their accountants — at your multiple, that difference compounds.
If you stay independent
The panel’s answer to reimbursement pressure was new revenue, not new owners: RTM pays $147.01/month per monitored patient under the CY2026 fee schedule, and direct-to-employer contracts reward exactly the outcomes data your patients already generate.
The value is leaving the knife.
CY2027 moves money out of the procedure and into the site, the episode, and the longitudinal relationship. Three numbers, all from the proposed rules themselves:
The lines that rise are attached to the site of service and to accountable, longitudinal work. So the independent play is not to absorb the cut — it is to follow where the money went: capture the site-of-service shift instead of watching it, negotiate a real share of any episode or shared-savings distribution rather than accepting a flat professional fee, and build episode-management capability before the bundle follows the joint into the ASC. The surgeons who stay independent will be the ones who own a layer above the procedure.
Kevin Bozic — past AAOS president, and the surgeon who brought value-based care into musculoskeletal medicine — makes the strongest case against everything above. Moving a low-value procedure into a cheaper setting doesn’t create value; it just performs the wrong operation more efficiently. His words: “a race to the bottom.” And on bundles: “you don’t get paid for the bundle unless you do the surgery”— which drove procedure volume up, not down.
He is right, and it bounds this page honestly: capturing the site-of-service shift is a revenue strategy, not a value strategy. It only holds where the procedure was indicated in the first place. Efficiency applied to an inappropriate operation is just a cheaper mistake.
The structure that resolves it is the one Bozic runs at Dell Medical School: a condition-based bundle— paid to manage osteoarthritis for a year whether or not an operation happens, held accountable to patient-reported outcomes. Not capitation, because withholding care shows up in the PROMs. His reported result is a surgery rate roughly 20% lower per capita at the same disease severity. That is what owning the layer above the procedure looks like when it is done honestly: you get paid for the condition, not for the cut.
All of the above is proposed, not final. Comments on the physician fee schedule (CMS–1848–P) close September 14, 2026; the outpatient and ASC rule (CMS–1850–P) closes August 31, 2026.
Both of those models — the episode bundle and the condition bundle — depend on the same unpaid step: the 60–90 day program that moves a patient from inpatient-bound to ASC-eligible. Medicare pays for the clearance, not the optimization →
And the evidence that argues for either bundle — your own patients’ outcomes — is about to be a payment-tied CMS mandate. The outcome is now the measure →
STRUCTURE IS A STRATEGIC LEVER. SO IS YOUR DATA.
The panel’s through-line was control. Surgeons who treat partnership structure as a lever keep their autonomy; surgeons who treat their billing and outcomes data the same way fund it.