Practice management pathways for long-term growth

At a Glance

Independent orthopaedic practices can strengthen long-term sustainability through strategic growth, service diversification, and operational scale.
Hospital alignment, membership-based care models, and ancillary services offer potential pathways to increase revenue and reduce reliance on traditional reimbursement.
Practice leaders should develop a long-term strategic roadmap grounded in market data, operational benchmarking, and realistic growth opportunities.

Read time: 4 minutes

Independent orthopaedic groups entered 2026 facing familiar headwinds: macroeconomic uncertainty, reimbursement pressures, and increased labor costs that continue to challenge the business of delivering orthopaedic services. Embracing these headwinds and planning for growth can be daunting, but industry changes can create opportunities for practices to evolve how they provide care to run their business most effectively.

To navigate these conditions successfully, orthopaedic leaders can focus on several strategies to achieve their goals, most notably aligning with hospitals to access system-level rates, leveraging membership and cash-pay models, and expanding ancillary services to generate sustainable revenue.

Market forces drive the need for scale
In 2025, roughly 40% of all physician groups remained independent, with 54% of orthopaedic physicians in private practice. The American Medical Association (AMA) found that more physicians are moving away from private practice for financial reasons, namely due to complex bureaucracy and regulatory demands.

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With these persistent pressures on independent practices, scale becomes a critical differentiator— not just in terms of size, but also the ability to adapt strategically and create sustainable advantages.

Strategic scale enables practices to:

broaden market presence and strengthen brand recognition;
access capital for organic growth or acquisitions;
attract younger physicians, who increasingly seek collaborative and stable environments;
enhance payer contracting, including opportunities for risk-based and value-based care models; and
drive operational efficiencies through shared services, technology, and staffing optimization.

By leveraging opportunities for strategic scale, orthopaedic practices can make greater investments in required administrative infrastructure and complementary ancillary services that provide incremental profit streams, ultimately positioning the practice for long-term success.

Pathways to growth
Independent orthopaedic groups have multiple levers to capitalize on market growth opportunities and diversify offerings, building scale and resilience amid a rapidly evolving market. The following three strategies represent high-impact opportunities.

1) Access system-level rates through hospital alignment: Many health systems are consolidating and investing in outpatient orthopaedic services, creating opportunities for independent outpatient practices to enter into joint venture models. By partnering with a health system, practices can gain access to system-level reimbursement rates, operational support, and broader market visibility.

There are more “one-stop-shop” models where physicians, surgical centers, imaging, and labs are integrated to give patients a seamless experience. For independent practices, this kind of alignment provides financial stability and positions the practice to compete effectively in an increasingly value-driven health care market.

2) Meet patients where they are with membership and cash-pay models: Healthcare trends point toward a rise in consumer-driven healthcare where patients are increasingly accepting of a cash-pay concierge model, paying incremental membership fees for higher-touch, on-demand services. This is a shift away from traditional health insurance models where patients pay a monthly fee to providers. Membership-based models allow practices to offer expedited appointments, longer visits, or digital access to providers.

Consumer expectations are changing fast; patients want convenience, transparency, and access. For physicians, the upside is clear: predictable revenue and less dependence on traditional payers. For patients, it’s a better experience that drives loyalty. These models are becoming a critical way to differentiate orthopaedic practices and strengthen patient engagement.

3) Generate sustainable revenue with ancillary services: More than 50% of orthopaedic groups offer ancillary services to create a more comprehensive patient offering and capture more patient spending. By adding physical therapy, imaging, durable medical equipment, labs, and outpatient

surgery centers, practices can capture more of the care continuum and diversify revenue streams.

Integrating services like physical therapy can deliver high patient satisfaction, cost savings, and operational efficiency. According to Ziegler’s “2025 Physical Practice Management Outlook,” outpatient physical therapy can generate substantial savings for payers, with hospital-based physical therapy services costing up to three times more than comparable outpatient services.

Beyond cost savings, these kinds of ancillary services increase enterprise value, strengthen patient-centered care, and give practices long-term resilience.

Build a strategic roadmap
As the orthopaedic landscape continues to evolve — marked by reimbursement pressure, shifting patient expectations, and accelerated consolidation — there is no “one-size-fits-all” path to growth. Each practice must evaluate which combination of strategies aligns with its resources while factoring in market dynamics and long-term objectives.

Whether considering hospital alignment for stability, a concierge model for flexibility, or ancillary service expansion for diversification, practice owners should begin with a clear assessment of their current position.

Strategic best practices include subjecting strategic decisions to SWOT analyses (strengths, weaknesses, opportunities, and threats) while benchmarking against a set of key performance indicators to measure a practice’s performance. Here are some key questions to consider:

What sets the practice apart?
How can the practice optimize patient retention and repeat visits?
Where are gaps in resources, offerings, or operations?
Is the provider’s compensation consistent with industry standards?
Are there emerging markets, new service lines, or consolidation trends on which to capitalize?
How much is the practice spending on overhead relative to peers?
What economic, regulatory, or payer factors could limit growth?

From this assessment, practice leaders can then develop a five- to 10-year roadmap, focusing on initiatives that best drive value creation for the practice.

The orthopaedic industry is moving toward service diversification, with outpatient care, consumer-driven models, and value-based alignment as leading drivers of growth. Hospitals want a role in outpatient surgery. Patients want transparency and access. Physicians want autonomy and fair compensation.

A strategic roadmap that connects these interests allows independent orthopaedic groups to thrive in 2026 and beyond. Practices that adapt early will be better positioned for growth, strengthening their sustainability and resilience in an increasingly dynamic industry landscape.

Andrew Colbert is a senior managing director and founding member of Ziegler’s Healthcare Investment Banking practice.

References

Garvey G. Smaller share of doctors in private practice than ever before. American Medical Association. June 24, 2025. www.ama-assn.org/practice-management/private-practices/smaller-share-doctors-private-practice-ever. Accessed July 14, 2026.
Colbert A, Braucht D. 2025 Outlook: Physician Practice Management (PPM). Ziegler. February 2025. www.ziegler.com/media/f21ngbnz/ziegler-2025-ppm-outlook-white-paper.pdf. Accessed July 14, 2026.