Alexander Vaccaro, MD, PhD, MBA, President of Rothman Orthopaedics

Summary

Podcast Summary

Becker’s Healthcare Podcast

Guest: Dr. Alexander Vaccaro, President of Rothman Orthopaedics
Host: Sophie Aedes, Becker's Healthcare
Date: January 17, 2026
Topic: The Future of Orthopedic and Spine Care — Innovations, Workforce Evolution, Leadership, and Growth Strategies

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Main Theme & Purpose

In this episode, Dr. Alexander Vaccaro gives a comprehensive look ahead at what 2026 holds for orthopedic and spine care. The discussion covers innovation, the evolving workforce, leadership philosophy, and Rothman Institute’s growth model. Dr. Vaccaro also shares candid insights about regulatory headwinds, malpractice reform, and the increasingly pivotal role of technology in clinical and operational excellence.

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Key Discussion Points & Insights

Dr. Vaccaro’s Role & Introduction (01:25)

• Positions: President, Rothman Orthopaedics; Chairman of Orthopedic Surgery; Professor of Neurosurgery, Thomas Jefferson University.
• Service Area: Southeastern Pennsylvania, Northern Delaware, Southern New Jersey, attracting patients regionally and nationally.
• Core Approach: Blending research, teaching, and clinical care as part of a collaborative, high-performing team.

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Opportunities and Headwinds for 2026 (02:31)

Opportunities

• Talent Acquisition:
  • Private practice offers “flexibility and autonomy” versus hospital systems and private equity.
  • “Our job is to get those that are interested in being entrepreneurial, not interested in an employed model who understands the concept of risk.” (02:36)
• Passive Income & Ownership:
  • Surgeons can “have ownership of passive income sources…facilities, ASCs, specialty hospitals, ancillary lines”—including innovative models like concierge medicine.
• Work at Top of License:
  • Ensuring every team member “works to the level of their license…maximize everyone's schedule.”
• Technology Adoption:
  • AI, robotics, and advanced tech to “make surgery safer, more accurate, more precise, but more reproducible.”
  • Tech is also vital for operations—“We use it literally multiple times every day…not only in the business side…but also in the operating room.” (03:59)

Headwinds

• Prior Authorization:
  • Encounters with insurance employees who lack “education in the fields that they oversee,” often resulting in denials not reflective of patient needs.
• CPT Downcoding & Policy Changes:
  • Frustration with insurers “downcoding” CPT codes, frequent denials, and burdensome contract renewals.
• Economic Pressures:
  • Rising overhead due to inflation while “reimbursement can go down every year”—seen as a contradiction.
• Partnerships and Payer Landscape:
  • Instability when partners change insurance participation, affecting patient care access.

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Innovations & Care Models Shaping 2026 (08:42)

• Ancillaries & Cost Control:
  • Bringing non-operative services (bracing, injections, etc.) in-house to “control that business aspect and take it away from high cost vendors…we can dramatically drop the costs.”
• Orthopedic Stores & 3D Printing:
  • Suggestions for “creating orthopedic stores” and using “3D printing to create things that we may need to brace a patient.”
• Concierge Medicine:
  • Proposes MSK-focused concierge services to streamline the patient journey: “organize their imaging studies…physical therapy…injections…support for their family, maybe a meal service, maybe transportation.” (09:15)
  • Distinguishes between quality of care versus patient experience and frustration.
• Bundled Payments & Race to the Bottom:
  • Bundled models have “really [been] a race to the bottom,” with new strategies needed once cost-cutting limits are reached.

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Evolving Workforce & Team Support (12:31)

• Importance of APPs (Advanced Practice Providers):
  • APPs crucial for clinical workflow: “They interface with our patients, they see patients in clinic, they have their own office hours.”
  • Facilitate outreach into new regions; APPs serve as “tentacles” of Rothman Institute to scale care.
• Team-Based Education:
  • Dr. Vaccaro personally rotates residents and fellows in the OR, emphasizing teaching and team loyalty.
• Resource Allocation:
  • Uses data to balance provider ratios: “Analyze the days out to see a PA and…the days out to see a surgeon…if those days go above a certain number, we say, okay, we need more PAs or we need more surgeons.”

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Strategic Growth & Investments (15:35)

• Organic Growth and Culture:
  • “Culture trumps strategy any day of the week” (15:40)—focus on bringing in providers who share Rothman’s values.
  • Strong emphasis on training “my best partners are those that came out of our training program.”
• Local Economies:
  • When expanding, keep operations local: “Our job isn’t to manage the back office…Contracting is state specific.”
• Technology as a Driver:
  • “Technology. Technology. Technology is where it's at.” (17:45)

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Leadership Lessons from 2025 (18:39)

• Malpractice Crisis:
  • Deep concern over “the nuclear verdicts” and escalating malpractice risks, especially with high-profile patients.
  • Advocates for federal and state tort reform—calls for the protection of competent, non-negligent providers.
• Specialized Medical Courts:
  • Pushes for courts specialized in medicine to ensure fairness, suggesting that current systems lead to defensive medicine.
• Cybersecurity Threats:
  • Describes a ransomware incident that crippled their system: “We need federal support for that and federal protection.”
• Need for Systemic Federal Help:
  • On provider challenges: “We basically need the federal government to come out and help us and protect those that care for people.” (21:35)

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Notable Quotes & Memorable Moments

• On Risk and Autonomy in Practice:
  • “If you join a healthcare system today, you basically join a risk free compensation model…I'm not sure that's in the best interest of the patient.” (02:55)
• On AI and Technology:
  • “I use it literally multiple times every day in everything I use…not only in the business side…also in the operating room, I use robotics.” (03:59)
• On the Race to the Bottom:
  • “Bundle payments were really a race to the bottom. And once you reach the bottom…you can't squeeze any more juice out.” (10:52)
• On Team Building and Culture:
  • “Culture trumps strategy any day of the week.” (15:40)
• On Litigation Fears:
  • “There has to be at the federal level and at the state level, tort reform that's sober, that protects those that provide competent care…Sometimes actions are brought against physicians that did the right thing, but the patient may have a bad outcome.” (18:47–19:45)
• On Federal Intervention:
  • “So we basically need the federal government to come out and help us and protect those that care for people. We were decimated…during COVID while we gave our time and our lives to take care of patients.” (21:35)

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Timeline of Important Segments

| Timestamp | Topic/Highlight | |------------|-------------------------------------------------------------------------------| | 01:25 | Dr. Vaccaro’s role, geographic scope, clinical/academic focus | | 02:31 | Opportunities: entrepreneurial practice, tech, autonomy in practice | | 04:00 | Challenges: prior authorization, payment denials, reimbursement cuts | | 08:42 | Innovations: in-house ancillaries, 3D printing, concierge medicine | | 12:31 | Evolving Workforce: APPs roles, team-based care, resource allocation | | 15:35 | Rothman’s growth strategy—organic growth, culture, technology, local focus | | 18:39 | 2025 Reflection: malpractice, tort reform, cybersecurity, need for reform |

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Takeaways

• Dr. Vaccaro foresees decisive growth for innovative orthopedic practices that blend entrepreneurial culture, technology, and team-based care.
• Major barriers include insurer bureaucracy, policy volatility, increasing costs, and systemic vulnerabilities (e.g., malpractice verdicts, cyber threats).
• Strategic growth hinges on aligning local cultures, continuous professional training, and a relentless focus on embracing technology.
• Dr. Vaccaro advocates for sweeping reforms, especially in malpractice law and cybersecurity, to safeguard modern healthcare practices.

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Listeners seeking a candid, leader-level perspective on the forces shaping orthopedic care in 2026 will find Dr. Vaccaro’s insights and prescriptions highly actionable and thought-provoking.

Transcript

[A]

Hi, everyone, and welcome to the Becker's Spine and Orthopedic Podcast. I'm Sophie Aedes, orthopedic reporter with Becker's Healthcare. And today we're honored to be joined by Dr. Alexander Vaccaro, one of the most respected leaders in spine surgery and orthopedic care. He serves as president of Rothman Orthopedics and is the Richard H. Rothman professor and Chairman of Orthopedic Surgery, as well as professor of Neurosurgery at Thomas Jefferson University. Dr. Vaccaro's career spans clinical excellence, academic leadership, and health system strategy. His work in spine trauma and research has helped shape modern spine care, earning the trust of surgeons, institutions and patients around the world. In this episode, we're going to explore what lies ahead for orthopedic and spine care in 2026, from innovation and workforce evolution to leadership lessons and the strategic growth of one of the nation's largest orthopedic platforms. Dr. Vaccaro, we're so happy to have you to start. I'll give you the opportunity to introduce yourself and also share a bit about your role.

[B]

Sure, sure. I am a professor of orthopedic surgery and neurosurgery. I'm the chairman of the Department of Orthopedic Surgery at Thomas Jefferson University and the Sidney Kimmel Medical center. And I'm the president of the Rothman Institute. And my role at Jefferson, in terms of my clinical responsibilities is that I'm one of the many spine surgeons. And we have a great bunch of guys here that do research, we teach, and we do spinal care, and we serve the southeastern Pennsylvania community, northern Delaware, southern New Jersey, and those that want to travel far and near to have service through Rothman Institute. So that's my current role at the present time.

[A]

Awesome. Well, with that we'll dive right into it. Obviously, we're coming upon a new year here. So as you look ahead to 2026, can you talk a little bit about just what's top of mind for you? What some of those opportunities and headwinds that you're looking out for are? Sure.

[B]

So there's a battle for top notch orthopedic providers, and that battle is between private practice, multispecialty groups, hospital systems, and private equity. So our job is to get those that are interested in being entrepreneurial, not interested in an employed model who understands the concept of risk. I mean, if you join a healthcare system today, you basically join a risk free compensation model. Risk free. The more bricks you break, the more RVUs you generate. The more you get paid. And I'm not sure that's in the best interest of the patient or the best interest of the provider itself or the physician. So we try to give doctors the opportunity to be innovative in the care they provide, to have the flexibility and autonomy they need. And that's what represents private practice. So that's my opportunity. Another opportunity is the ability outside of a hospital employed system to have ownership of passive income sources. I mean, such as facilities, ASCs, specialty hospitals, ancillary lines. And there's so many different creative, productive answer lines all the way up until concierge medicine that you can provide. And these are things that the employed model really does not allow the individual surgeons to aid, reap the rewards of, or be incentivized by. So I think that's something that we have to do. Another one is we have to sort of establish to make sure everyone works up to whatever their productivity standards are. So have everyone in our group work to the level of their license. If you're a page and you're licensed to do certain things, in my group, you should be doing those things. You shouldn't be relegated to a medical assistant, you shouldn't be relegated to a secretarial role. You should actually be out there doing what you need to do. And we try to maximize everyone's schedule. I mean, if you want to be part time teaching, part time research, that's fine. But the times that you have allocated to these roles, we want to make sure that you're efficient and you get things done. And we have to make it so you can be efficient. And then the last opportunity, I think, is really taking advantage of advanced technologies. Now, I hate to say the buzzword agentic AI, but that's the buzzword now because I use it literally multiple times every day in everything I use, and not only in the business side to decrease employment costs, but I also use it in the operating room, I use robotics. So we're using advanced technologies to not only make surgery safer, more accurate, more precise, but more reproducible. We use it in educational realms also, but also in terms of our business, you know, responding when we get our submissions for surgeries rejected by the insurance companies, immediately responding, saying, you know, here's the information, any type of appeal process, making sure we follow what the patients require in terms of the different offices we have, make sure we're full, make sure we're maximizing our staff. So that is what I think is the best in terms of our opportunities, in terms of our headwinds. That's a challenging thing. The biggest problem we have as providers is that we have to deal with prior authorization by those individuals not educated in the fields that they oversee. Those that do the prior authorizations abiding by certain clinical practice guidelines that don't really take into consideration the individual patient. And sometimes you have to think out of the box because at times it may lead to worse patient care and things that are not in the patient's interest. And we're constantly being inundated by denials, policy changes. The recent insurance companies that decided on their own to down code CPT codes from level four to level three, these are the things that we have to do. And we go through a periodic process, payer contract renewals and sort of letting the world know that every day my overhead costs go up, we have to deal with inflation, we have to deal with the cost of capital, salaries, staffing that doesn't get cheaper every year. So it doesn't make any sense that reimbursement can go down every year. So we have to come up with some consistent methodology to make sure that both the insurance company, the patient, the government and the physician are protected in terms of maximizing whatever limited dollars are available for everybody. And then we have to look closely at our partners. We have multiple healthcare partners, and if one of our healthcare partners has a disagreement with insurance company and decides at the last minute, I'm not going to take this particular insurance, what affects our patients is private practice. So we have to deal with that and then we have to deal with the inflationary pressures that everyone has to deal with at the present time. I mean, the cost of goods are going up, my secretarial support, my nursing staff, my medical assistant's going up and how I provide adequate care when every year, due to congressional mandates reimbursement goes down, it just doesn't make any sense. So we have to fight that.

[A]

Yeah, great points there. I think you, you mentioned a ton of what is on, you know, leaders across the board's mind in terms of orthopedic, you know, opportunities in the next year and also the headwinds. And I think the first time we talked, I think you did mention that idea of prior authorization and claims being denied because a lot of these insurance companies are using AI and things like that. So we're definitely still seeing that continue to be a problem. And it's definitely something that leaders like yourself are going to have to navigate into the new year. I'm wondering, Dr. Vaccaro, from a clinical standard standpoint, which innovations or care models do you think will meaningfully shift how orthopedic care is delivered in 2026?

[B]

So if you look closely at what we provide patients anywhere from surgical skills to non operative care such as injections, stem cells, hyaluronic acid injections for knees bracing, if we as orthopedic surgeons can sort of control that business aspect and take it away from high cost vendors and bring that in house, like all the different ancillaries you see that don't pose a direct conflict, like you never want to provide an ancillary where you can increase the cost of care. If it's something that you have to prescribe to a patient, why can't we be the owner of that business? So then we can not only dramatically drop the costs, but also provide what we think is best in class. I'll give you an example. When you order a brace from a hospital, an orthotist, it may cost $1,000 and that patient may say, well listen, let me go to Amazon online and get it cheaper. So creating orthopedic stores where you could say, listen, we can do better than that. We can be the manufacturer and the distributor and we can provide that service and use technologies that may support that, like use 3D printing to create things that we may need to brace a patient, which be a great idea. So that's an opportunity that we can strive to decrease the cost of care. I think another innovation in the care model is introducing the concept that the medical doctors came up with and that's concierge medicine. I mean it is so frustrating now to guide someone into an integrated healthcare system and why can't we make that easy for MSK care? Just say someone comes in, we can organize their imaging studies, we can organize their non operative care, we can do their physical therapy, we can do their injections and then we can take them to the journey. If they require surgery, make sure that we have support for their family, maybe a meal service, maybe transportation. After that, give them premium opportunities to come in when they need to be seen by someone and not to roll their eyes and have a headache. I just spoke to one of my partners today who presented grand rounds discuss his journey after brain surgery. And it was so frustrating to see the surprise billing this and that. Why can't we facilitate that for the patient, for those patients that have the ability to pay extra so we can make their lives so much more comfortable. So I think that's those are the innovative things we can do in terms of shifting the care model. We've already moved to Bundled payments. We went through that exercise. We realized what costs too much and what doesn't cost too much. But bundle payments were really a race to the bottom. And once you reach the bottom of, you can't squeeze any more juice out. Orange. Now we're looking for ways of saying, okay, this is the bottom line cost. And those people that can afford to pay more may have the ability to have less frustration. Everyone gets the same quality of care, but less frustrations in terms of navigating that care.

[A]

Super important points there. And it's a phrase that I often hear talking to orthopedic surgeons like yourself is the race to the bottom. And yeah, I mean, I think that obviously the innovations that you just talked about would be, you know, great. And I think that 2026 is really going to be the year of putting those things to practice. Right. Everyone was excited about AI and all this new technology and stuff in 2025, but now it's time to, to get to work. So super great stuff there. Obviously, the orthopedic workforce is continuing to evolve from surgeon to apps to care teams. What are you prioritizing in 2026 to support your teams and really help them thrive?

[B]

Well, that's a great question because I think really, as we expand our care, we have to do it through apps. And they're such an important part of the provider network. They interface with our patients, they see patients in clinic, they have their own office hours, they select those that may need to experience higher level of care IEC a surgeon. So they're fantastic. And then a lot of physicians have apps that come to the operating room. Now I'm an academic professor, so I don't have a PA in my operating room. So every two months I have a different chief resident and every three months I have a different spine fellow. So I go through the same routine where I have to teach them how to position a patient, how to do this or that, how to close the patient, stuff like that. If you have an app or physiatrists that you work with, once they learn it and they, they're loyal and they stick with you for a long period of time, it dramatically decrease, decreases your anxiety, the headaches, you don't have to think twice about it. It's like having a mirror image of yourself in the operating room helping you with older procedures. So we have to continue to get people motivated and train the extenders. Now, the extenders can also reach out to geographic territories that we don't have the ability to be in. So again, having extenders Go out to geographic regions that we want to have our tentacles in as the Rothman Institute, but have them meet patients that want our care. And if we need to speak to that patient while they're seeing a pa, use telemedicine and if they need a higher level of care, see us. So in order for us to scale our operations, we have to figure out what the ratio of those providers are, ratios of MAs, PAs and physicians, and what supports a growing practice. So we analyze the days out to see a PA and the days out to see a surgeon, and then we look at those that need to see a surgeon. And if those days go above a certain number, we say, okay, we need more PAs or we need more surgeons. So it helps us build our workforce appropriately and it helps us build our PA support. We also have our PAs do things a lot of the non operative care. So as we build a strong non operative physician force, such as non operative sports medicine physiatrists and so forth, they need support also from PAs to set patients up for injections and so forth. And so we really want to make sure we invest in those apps so we can support our professional growth.

[A]

Yeah, I think that's such a big topic too, just across the board with orthopedics. I know I've again talked to a lot of different surgeons who have mentioned just the importance of apps to, you know, your everyday work. So really great, great points there. You kind of got into this that Rothman has sort of tentacles in different places, which is a really fun way to put it. But Rothman really does have such a broad footprint. What changes or investments are you planning to make next year?

[B]

So first of all, I'm a big supporter of organic growth, so let me tell you what that is. So we years ago began to associate with other practices. We brought them into the Rothman Institute. And I always say culture trumps strategy any day of the week. And I, we train, we train, I train four spine fellows a year. We train 36 residents, all the different specialties of fellows. And my best partners are those that came out of our training program that know exactly how we think, not only in the operating room, but how we think in terms of a team. And we have a great, we're sort of a high performing team. You have people that get together. There's pseudo teams, good teams, there's high functioning teams. So they watch how we, how we perform as a high functioning team. And plus they respect their professors and their teachers. So we want to invest in additional providers, number one. Then we Also want to make sure that we have the appropriate footprint and make sure that we expand strategically in the right areas. Again, focus on technologies and forecasting reports and population growth and stuff like that, and use all the old tools available to say where we have to have patients, where we have to have providers grow. And then we want to geographically expand now that, as I said, we grow a core market. But if we decide to do and get together with a group that has a similar value system as the Rothman Institute, we publish our mission statement, we publish our values, we publish all that and we make it public what we plan to do. We're here for not only clinical excellence, but teaching, research and education. So we want to make sure that we team up with like minded people, but leave economies local. So if we team up with a group in Ohio, our job isn't to manage the back office. Our job is to scale those resources that make their back office effective. But contracting is state specific. So they're going to have different reimbursement models, they're going to have different workman's comp laws and stuff like that. We can't get into the weeds with that, but we can get into the weeds when it comes to how to scale, how to use the resources that we have, how to negotiate insurance contracts, how to use the expertise that we've gathered over time. So I think those are the things that we have to do and invest in the future. And technology. Technology. Technology is where it's at.

[A]

Yep, absolutely. I think again, another common theme is technology. And again, I'm going to say it again, but 2026 is really going to be the time to get to work and use that technology like you've been sort of expl. Thrive. And I really like what you said too, just about culture and culture really trumping strategy at the end of the day. And I think that's an important mindset to have not only in your workspace, but in any workspace. Looking back now, we're going to reflect a little bit. Looking back now on 2025, what's one lesson or moment that surprised you or reshaped your thinking as a leader?

[B]

Okay. And this is, this is everyone's problem in medicine today. And that's how crazy the malpractice situation is around the country. The nuclear verdicts, taking care of professional athletes that make 70, 100, $200 million. And to go out and to treat these individuals with the best care you know how, and then if something goes wrong, have that particular risk that can close down an institution there has to be at the federal level and at the state level, tort reform that's sober, that protects those that provide competent care. I'm not talking about negligent care, I'm talking about competent care because as you and I know, sometimes actions are brought against physicians that did the right thing, but the patient may have a bad outcome. So we have to protect those doctors and we can't leave it up to the whimsical of those that may not be educated in understanding how that care was delivered and what is the expected outcome. And I'm a big supporter of medical courtrooms, where these courtrooms are designed just like we have it for arbitration for brokerage, legal matters and other more specialized courts. We have to really, really, really protect the provider because there's only so much money that can go around. And if you, on top of the fact that you're getting your reimbursement cut and you have to do more with less, and then on top of that your malpractice cost goes up and then there's a nuclear verdict, I'm only focusing on when there isn't negligence and there's a verdict against you that can really affect all the patients in the community that require care. And then you have to close up shops. So we've seen that happen in high risk specialties and we have to protect against that. And I think medical malpractice is all political. I say everyone's supportive if there's harm, patients have to be compensated in the setting of negligence. But that's not what I'm talking about. I'm talking about the egregious amount of money that's spent on defensive medicine and on settlements and verdicts when there's no medical malpractice and there's no protection in some states and it doesn't make any sense to me. So we have to protect against the financial risks. Another risk again in the legal realm is when people can come and drop ransom viruses on your healthcare system and hold you hostage. That happened at our healthcare system and there again, you do the best you can. You follow all the established rules on, you know, don't, don't click on a email you don't recognize and do this or that. But these, these people are sophisticated and they use AI generated strategies to infect your computer. And then all of a sudden you're locked out and then you have to pay the price. So we need, we need federal support for that and federal protection. So we basically need the federal government to come out and help us and protect those that care for people. We were decimated in terms of a profession during the COVID while we gave our time and our lives to take care of patients. So we need to have that type of support from the government for these issues that we have no control over.

[A]

Absolutely. Again, super important points there. And Dr. Beccaro, this has been an incredibly insightful conversation and I want to thank you again for sharing your perspective and leadership insights with us. That is all we have today.

[B]

Pleasure to speak with you.

[A]

Always a pleasure to speak with you too. Thank you so much for for joining us and offering valuable insights into the future of spine care, orthopedic innovation and physician leadership.