Payer frustrations and anesthesia coverage are among the headwinds facing spine and orthopedic leaders in 2025. But growing outpatient case volume and integrating new technologies is becoming easier for many practices.
Physicians, executives and CEOs discuss what's top of mind for them.
The 21 leaders featured in this article are speaking at Becker's 22nd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, set for June 18 to 21, 2025, at the Swissotel Chicago.
If you would like to join the event as a speaker, please contact Carly Behm at cbehm@beckershealthcare.com.
As part of an ongoing series, Becker's is connecting with healthcare leaders who will speak at the event to get their insight on thought-provoking questions within the industry. The following are answers from event speakers, lightly edited for clarity.
Question: What are the headwinds you're facing in your market in 2025? What's getting easier about running your business?
Caleb Ashmore, PT, DPT. Orthopedic rehabilitation services supervisor at Harris Health System (Bellaire, Texas): The biggest challenges we are facing in outpatient rehab at Harris Health is patient access. We have far more need for our services than we have clinicians to treat the patients. We have to make sure that we are maintaining our departmental productivity targets in order to justify hiring more FTEs to meet those needs, but we are currently challenged by having a tight budget in ACS, and we have to make sure that we are being as fiscally responsible as possible. By tracking and monitoring our growing wait list, it helps us to more easily show how much need there is for what we do. In a sense, this is great for employee morale, because it provides a better feeling of job security and value added to the organization.
Michael Boblitz. Outgoing CEO of Tallahassee (Fla.) Orthopaedic Clinic: I start my next chapter as CEO with Athens Orthopedic Clinic (AOC) on Feb. 3. The headwinds remain - managing inflation while Medicare pays less and commercial insurers pay private medical groups the same. With this said, being a career strategist, all markets are different and require a tailored strategy. Accelerating growth in revenues is the best way to outrun these headwinds.
Nothing gets easier, but I am blessed to have built an executive competency in strategy over my career. My first order of business with AOC is to carefully review the local market forces in the Greater Athens region, along with the existing strengths and weaknesses at AOC. Then, working with the AOC Board define the desired future vision with the logical steps (i.e. strategic initiatives) to take in order to advance toward the new vision. We will leverage our strengths and address any weaknesses along the way to accelerate our growth agenda.
Strategic partners remain mission critical and I am especially excited about the great things happening with the University of Georgia. In addition, I remain focused to partner with payers, and the emerging NewCo models seeking direct to employer solutions that simplify access and reduce the overall cost of care.
AOC is well positioned to bend the cost curve through our robust Orthopedic Platform that integrates world class physicians with comprehensive ASCs, MRI and CT imaging centers, a robust network of outpatient therapy centers, orthopedic urgent care centers, and the region's top occupational health program.
The organization has served Northeast Georgia for 58 years, I am proud and ready to partner with AOC to build the new industry standard for others to follow.
Ernest Braxton, MD. Vail (Colo.) Summit Orthopaedics and Neurosurgery: In 2025, the spine surgery market faces headwinds like declining reimbursement rates from Medicare, rising costs of the workforce and increasing regulatory pressures on surgical outcomes. Colorado has now joined California as the second state to have legislated caps for pain and suffering in medical liability cases significantly raised, and new the CO law HB24-1472 is even worse and more damaging than CA law AB 35. Damages for subjective values like pain and suffering will increase to $1.5 million up from $250,000; and noneconomic damages will increase to $875,000 from $300,000 over several years. The changes will ultimately increase cost for physicians while reimbursement continues to decline. On the bright side, shifting cases to the surgery centers will decrease the administrative burden of physicians while decreasing costs for payors and patients.
Robert Bray Jr., MD. DISC Sports & Spine Center (Newport Beach, Calif.): Contracting with insurers as an individual has progressively become more difficult with lower reimbursement rates. Hospitals, in general, unless the physician is on salary, don't use their pull on behalf of the doctors. The result has driven doctors to the PI market or cash basis as out of network providers. Working together with the insurers to globalize both professional fees and outpatient technical fees has significantly bridged that gap with emphasis placed on cost efficient quality care and outcomes data to drive a good working relationship.
John Brown. Administrative Director at the Musculoskeletal Institute of AdventHealth (Fort Worth): The primary barriers we are facing are the demand for anesthesia and anesthesia providers associated with rapid growth. We were not thinking quite far enough ahead in the last couple of years as we negotiated contracts with our anesthesia provider group. We've recently gotten much more aggressive in the growth plan, but our anesthesia partner is having a difficult time hiring quickly enough.
It's become considerably easier to recruit new surgeons in the orthopedic space. We partner very closely with an orthopedic and spine surgery group and as they've grown (now 20 providers), they and we have become very attractive to new prospects.
Alfonso del Granado. Administrator and CEO at Covenant High Plains Surgery Centers in Lubbock, Texas: The main headwind I'm facing in my market for 2025 is anesthesia coverage. We have an outstanding relationship with the independent anesthesia group that covers our centers, but even with a good payer mix they simply cannot afford enough CRNAs and anesthesiologists to cover all of our ORs so we have had to dig into our pockets for the first time this year to subsidize our coverage. Our area is geographically isolated, so we don't have access to as many providers as other regions do, and what happens is a natural result of demand exceeding supply. CMS cuts to physician compensation will affect us directly as a consequence, so it was very disappointing to see that the version of the continuing resolution Congress passed to avert the government shutdown did not include the draft bill's provision to offset this year's Medicare conversion factor decrease. The draft version of the continuing resolution included a 2.5% increase to the Medicare Conversion Factor to offset the scheduled 2.8% cut. In a year with a projected increase in healthcare operating costs of 7.5% to 8%, any cut in compensation is especially egregious, and we urge the incoming administration to prioritize addressing this shortfall.
Somewhat offsetting this concern is a slight relaxation in the nurse labor pool constriction that we have experienced since the COVID-19 pandemic, but which began many years earlier. I should clarify that it's not suddenly become easy to hire an experienced circulating, pre-op, or recovery nurse, but it is not as difficult as it was even a year ago. Surgical techs are still hard to come by, but we're hopeful that the shorter pipeline may help to partially alleviate that shortage in the next year as well.
Harel Deutsch, MD. Rush University Medical Center (Chicago): Headwinds include the increasing number of patients on Medicare Advantage programs. Medicare Advantage programs routinely deny all claims and generally refuse to authorize many treatments that would be covered under Medicare. Increasingly we have to have patients un-enroll and then return in the future for needed medical treatment.
Lee Fleisher, MD, ML. Attending anesthesiologist at the Hospital of the University of Pennsylvania (Philadelphia): The major headwind facing market access for medical device companies is the lack of market clarity regarding evidentiary requirements for coverage by the U.S. payers. As companies come to market, they will need to navigate a complex network of payers and not rely on their FDA authorization/clearance as a marker for market access. Given economic constraints of Venture Capital and Private Equity, it will be imperative that companies seek cost efficient novel ways of developing real world evidence to demonstrate patient improvement that both delivers outstanding care and lowers cost for the commercial payers. Evidence continues to be critical as I practice anesthesiology at the University of Pennsylvania. At my firm, Rubrum Advising, we also work with medical devices companies to strategize and execute on innovative methods of seeking broad market access within the increasingly complex healthcare landscape.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: In a large urban market there's two main issues. One of them is consolidation and purchasing of practices. There's obviously larger and larger entities to contend with. Being in a small practice, it's a little bit daunting to be up against very large institutions. But I'm overall very happy with my practice because we fill a niche. We're able to see patients who are not getting seen on time or getting pushed out for weeks. We're usually able to accommodate them fairly quickly, and we offer longer appointments. So it's quite nice for patients to come in and have a consultation. We love it when patients decide to have surgery with me, but obviously there's financial constraints sometimes. But overall, we're really happy to provide a service. We also get to spend more time with patients, which means that you get to understand their pathology better, and a lot of the questions out of the gate are answered. They don't really go into surgery with any unanswered things.
The second headwind is definitely going to be payers. Payers remain a very poor partner in taking care of patients and insurance despite what some of the people in the healthcare economic space are saying. As an example, and this is the second time this has happened in six months, we had a young patient who had a significant disc herniation with a neurologic deficit, and the insurance refused to schedule an urgent peer-to-peer for the patient. Because of that the patient had to be admitted to the hospital. We did an urgent surgery on him, and I'm happy to report he's 80% better after about five days of surgery. But the payers still refuse to even acknowledge the fact their patient has a problem, and they're unwilling to discuss surgery as an urgent thing, and willing to just let the patient go to the ER and end up paying a lot of their medical bills. We're not even sure the insurance will not retroactively try to claw back money from the hospital or the patient. We're really disappointed with the way payers have been acting. We want to be a good steward of healthcare, but when the payers are refusing to be partners with us, it makes it very hard, and everyone just gets frustrated.
Sean Gipson. Division CEO and president at Remedy Surgery Centers (Fort Worth): 2025 proves to be another exciting year in the ASC space, with noted improvements in our market. Some things that are worthy of mention are the evolution of technology, improved supply chain and improved patient volume and reimbursement have been some highlights noted in our short time noted in the new year. With improvements we also are facing additional challenges such as increased aging of our population, increased staffing shortages and increase market competition.
Supply Chain and Equipment Costs - While supply chain disruptions have been a challenge in recent years, ASCs are leveraging group purchasing organizations (GPOs) and more efficient inventory management systems to control costs and ensure adequate supply levels.
The maturation of GPOs, along with AI-powered inventory management systems that track usage patterns and forecast needs, are helping ASCs better manage costs and streamline their operations.
Patient Volume and Demand - The demand for outpatient surgery is rising due to the growing preference for lower-cost, same- day procedures. ASCs can now serve a higher volume of patients more efficiently, thanks to better operational workflows and technologies.
The trend toward outpatient procedures continues to grow as both patients and payers seek cost-effective care options. ASCs can handle larger patient volumes by optimizing scheduling and improving operational efficiency.
Financial Management and Reimbursement - As reimbursement structures evolve, many ASCs are seeing more favorable payment models. The shift towards bundled payments, value-based care, and increased insurance coverage for outpatient procedures is making financial sustainability more achievable.
Improved payer relationships, more favorable reimbursement rates for outpatient procedures, and enhanced billing software that automates coding and reduces errors all contribute to this easing challenge.
However, with success, we also have our share emerging challenges to face as well. Topics such as aging population, staffing shortages and increased competition in the ASC market are a few things to consider.
Changing Demographics - As the baby boomer generation ages, there will be an increase in demand for surgical procedures. However, elderly patients often have more complex comorbidities, which can make outpatient procedures riskier, requiring ASCs to manage these complexities.
Patients with chronic conditions are increasingly undergoing outpatient surgeries, necessitating advanced care models and close post-operative monitoring, which may strain ASC resources.
Staffing Shortages - The demand for highly skilled medical professionals, such as surgeons, anesthesiologists, and nurses, is rising. The healthcare industry overall is experiencing a workforce shortage, which has a direct affect the ability of ASCs to easily deliver quality care.
Healthcare professionals are facing burnout due to high patient volumes, administrative burden, and increased emotional toll, which is impacting the recruitment and retention of staff in all areas.
Competition from Hospitals and Other Healthcare Providers - As more healthcare providers enter the ambulatory surgery market, ASCs may face increased competition, particularly from hospitals that are expanding their outpatient surgery offerings or from private equity-backed ventures.
Hospitals and health systems may form strategic partnerships with ASCs or acquire them, which could alter market dynamics, affecting independence and revenue generation potential.
As we all see, 2025 will have us all working to advance with our successes and our ability to master past challenges yet cause us to adjust our "thinking caps" for new and more in-depth challenges posed by our evolving industry. Keep your feet on the ground and your minds open to change! A mentor once told me "Challenge builds character!"
Anthony Giuffrida, MD. Cantor Spine Center at the Paley Orthopedic & Spine Institute (Fort Lauderdale, Fla.): Physicians are facing significant headwinds due to the rising costs of medical supplies and real estate, which continue to put pressure on their practices' bottom lines. These escalating expenses make it harder to maintain affordability and quality of care. However, having a seasoned and well-trained staff, including nurse practitioners, nurses, and medical assistants, has been key in streamlining operations. This experienced team helps improve efficiency, reduce wait times, and create a more seamless patient experience. Having such a great team has enhanced satisfaction even in the face of growing challenges. Their expertise allows physicians to focus on care while ensuring that the practice runs smoothly and patients feel well-supported.
Alexandria Hammond. Principal at BrandNEWS PR (Mt. Laurel, N.J.): As a marketer specializing in traditional public relations, one of the biggest challenges I face year after year is helping people understand the true value of PR in their overall strategy. Because it's tough to assign a tangible number to its worth, PR often becomes the last consideration and the first to go. But PR is so much more than a feature in a top-tier news outlet — it's about perception, relationships, and awareness. PR shapes how your brand is seen, and it's essential. Point blank. Having PR already integrated into your marketing strategy can be the critical factor in how you recover and thrive after a crisis. That said, I wouldn't say this challenge gets easier, but you learn to manage expectations. Running a business is hard enough without unrealistic goals weighing you down. Setting practical expectations allows you to perform better without the unnecessary stress of perceived failure. I enjoy being in control of my success, but I've learned that honest conversations with yourself are key to achieving it.
Corey Hollmann RN, MSN. Administrator and director of nursing at Complete Surgery (Mesquite, Texas): In 2025, we are facing declining reimbursements in select service lines, more competition to get market share, and challenges in rising supply costs, not to mention difficulty in getting certain supplies. In addition to these items, our center deals a lot with LOP (letter of protection) patients which comes with challenges in partnering with the attorney that is going to best represent your business. One final challenge is the ability to get anesthesia coverage is starting to become an issue.
As far as getting easier, we are seeing rising volumes and a shift of more patients going to our ASC over local hospitals.
Les Jebson, Regional administrator at Prisma Health (Greenville, S.C.): We are fortunate to enjoy market dominance as the largest comprehensive spine program in South Carolina and one of the highest quality programs in the Southeast. Market headwinds for us are our ongoing efforts to have immediate access for patients with acute or chronic back issues.
Our program is continuing to grow and through an expanded site of care offerings, outpatient therapy services, and non-operative and surgical physicians recruitments – running our business is getting easier.
Jeff Lehmen, MD. Spine Surgeon at SSM Health Spine Surgery Center (Jefferson City, Mo.): The major headwind for 2025 continues to be insurance denial/preauthorization. At this point, the insurance companies are effectively the providers and physicians have very little say anymore. Most if not all of us got into this to take care of people the best we can based on our education and experience. The insurance companies are in this to make money. This is a major disconnect, and we have to work on getting this resolved.
I'm not sure anything has gotten easier about running a business but I think down the road with advancing technology and AI there is certainly opportunity to do so – the trick is how to incorporate it.
Andrew H. Lovewell. CEO of Columbia (Mo.) Orthopaedic Group: There are several headwinds for 2025 - reimbursement pressures, increased costs, and staffing challenges are top of mind for me. The reimbursement pressures and continued Medicare physician pay cuts are a concern. In addition, we are working harder today to collect our revenue than ever before due to poor payer policies that do not align with patient care. Increased costs are a given in our inflationary climate. However, there are some services that we are seeing massive increases in, electronic health record costs, staff benefits (insurance, admin costs, etc.), and overall increases from tertiary service providers we work with. Staffing challenges are real! Finding staff that are motivated and qualified to work in both practices and ASC are a huge challenge. In addition, retaining our staff is difficult. We have worked on various programs to recruit and retain staff but with some roles none of these are extremely successful. Anesthesia, surgical technicians, and business support roles are difficult to fill and are key essential roles to assure things run smoothly for patients and other staff.
I'd love to have a larger list here but in reality the two things we are finding easier are the adoption of technology and data mining. By investing in new technology we are getting better data that helps us run our business and deliver better care to patients. With a younger physician workforce in our practice we find that implementing technology is relatively "'seamless"' and things can be implemented on a shorter schedule than ever before.
Brett Maxfield. Director of Anesthesia and Surgical Services at Teton Valley Health Care (Driggs, Idaho): Currently the biggest headwind we are facing is maintaining profitability with stagnant or decreasing reimbursement in the face of rising operational costs. We have also been challenged by the pharmaceutical and supply shortages, and by the difficulty of finding qualified staff who are willing to work.
We are encouraged though by the continued shift of cases from the hospital setting to the surgery center. Through increasing volume, we have been able to offset some of the financial difficulties we face.
Mick Perez-Cruet, MD. Professor and Vice Chairman of the Department of Neurosurgery at Oakland University William Beaumont School of Medicine and President and Founder of Michigan Minimally Invasive Neurosurgical Institute (Waterford): I feel the major headwinds are obstacles to appropriate reimbursements for surgical care provided, in light of rising cost. Every time CMS decides to reduce reimbursements it has a seriously detrimental effect on the quality of health care provided to Americans. Few things are getting easier but I continue to enjoy providing high quality minimally invasive spine health care to my patients.
Ken Rich, MD. President of Raleigh (N.C.) Neurosurgical Clinic: The biggest headwind in our experience is the gimmick insurance companies are using to deny payments. We seem to constantly be fighting the latest games they are playing. This takes a considerable amount of time and money, which, when combined with the denials, simply makes our profitability much more difficult.
I think our brightest note for this calendar year will come from taking over managing our practice by ourselves. It is not only less costly than contracting for management, but also allows for much quicker responses to changes that occur in our industry.
Zeeshan Tayeb, MD. Pain Specialists of Cincinnati: Every year holds new challenges. From fighting for more reimbursement to spending hours obtaining prior authorizations, our job as physicians is much more than providing care. I am hopeful that this year we will see changes to many of the processes that delay patient care. If there is no change, we will continue to battle the same obstacles that have hindered us in the past.
Maria K. Todd, PhD. Administrator and Health Law Paralegal, Robotic Orthopaedic Institute and Director of Business Development at St. George (Utah) Surgical Center: As an experienced ASC administrator now charged with business development and surgeon recruitment for a much smaller, new ASC, I am concerned about recruitment and retention of skilled staff, including surgical techs, RNs, and anesthesiologists, and wage competition with the hospital. Prior authorization is also slowing the pace of surgical bookings, and rising costs and supply chain disruptions for surgical implants, disposables, and equipment maintenance, impacting margins. Since I am responsible for creating the cash pay bundles and price integrity across all specialties, it's very difficult to set cash pay prices if the volatility is off the charts on supply chain and shipping costs.
What's Getting Easier About Running ASCs:
After 26 years of direct to employer contracts with self-funded employers, it has become easier than ever. The ERISA employers and union benefit plans are increasingly interested in partnering with ASCs for bundled pricing and transparent cost structures, creating new revenue opportunities. Also, Southern Utah's growth as a Southwestern U.S. regional medical tourism hub is growing my self-pay market, with uninsured and health expense sharing patients attracted to our competitive pricing for documented high-quality care and a 0% infection rate. Pre-op and post-op telehealth services with surgeons and physical therapy will reduce logistical burdens for rural and remote patients with the potential to increase case steerage to ASCs. We're also fortunate to have a new VA Community Care Network in town, which includes ASCs. This simplifies access to surgical care for veterans, which will bring more veterans to our ASC.