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.
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.