Fractured Autonomy: The Cost of Orthopaedic Practice Consolidation.

The financial sustainability of orthopaedic private practices is under major threat due to continuous reductions in Medicare physician reimbursement, particularly for hip and knee arthroplasty procedures. These cuts, driven by health care policy over the last few decades, have had dramatic effects on joint arthroplasty surgeons, resulting in an 18% decrease in real dollar reimbursement between 2020 and 2026, and a 43% decrease in real dollar reimbursement from 1994 to 2026. As professional fees fall and inflation-adjusted practice costs rise, surgeons face mounting pressure from increasing overhead expenses, regulatory burdens, and administrative demands. This squeeze with reduced revenue and increased costs has accelerated consolidation trends across the orthopaedic field, shifting practice models from independent and small groups toward hospital employment, multispecialty mergers, and private equity-backed organizations. The resulting health care consolidation has major downstream effects, including increased health care costs to the broader system, reduced patient access, potential declines in care quality, and ultimately a loss of physician autonomy. Recent mergers and acquisitions illustrate a national trend toward a concentrated orthopaedic market, as shown by the rising Herfindahl-Hirschman Index. Advocacy efforts by the American Association of Hip and Knee Surgeons aim to address these systemic issues by pushing for inflation-adjusted reimbursement, site-neutral payments, and other initiatives, with a goal of preserving physician autonomy. Without meaningful reform, arthroplasty surgeons risk losing control over clinical decision-making, and patient access to high-quality, efficient health care stands to be compromised.