A Healthy Health Care EcosystemPatients Need Choices.
Patients are best served when they have meaningful choices — in physicians, hospitals, ambulatory surgery centers and health plans. Consolidation removes those choices, drives up costs and erodes quality.
An Open, Competitive Marketplace for Orthopaedic Care
The Texas Orthopaedic Association actively supports policies in both Austin and Washington that promote competition and reduce the harmful consolidation of health care.
When markets consolidate, prices rise, choices shrink and the doctor-patient relationship suffers. TOA advocates for a marketplace where patients can choose the orthopaedic surgeon — and the practice setting — that best fits their needs.
An environment in which patients have access to many different types of orthopaedic surgeons — private practice, academic and hospital employment models — in every region of Texas.
Why Choice Matters Competition delivers better prices, better quality and better access.
Choice is more than a convenience — it is a safeguard. When patients can pick from multiple orthopaedic surgeons, hospitals, ambulatory surgery centers and insurers, market forces work in the patient’s favor. Costs are disciplined. Quality is rewarded. And patients keep the most important right of all: the ability to seek a second opinion.
A diverse marketplace of orthopaedic surgeons — spanning private practice, academic medicine and hospital employment — ensures Texans have real options when an injury or musculoskeletal condition disrupts their lives.
Lower Costs
Competition pressures every provider and payer to deliver value. Consolidated markets routinely produce higher prices for the same procedures.
Higher Quality
When patients can vote with their feet, surgeons and facilities compete on outcomes, experience and access — not just contract leverage.
Second Opinions
Major orthopaedic decisions deserve more than one perspective. Patients can only seek a second opinion when there are independent surgeons to consult.
What’s Driving Consolidation? It is not orthopaedic surgeons. It is government policy and health plans.
The narrative that physicians are choosing to consolidate misses the cause. Orthopaedic surgeons overwhelmingly value independence and the doctor-patient relationship. What pushes them out of private practice — or out of medicine altogether — is a tide of external pressures generated in Washington and the boardrooms of major health plans.
Government Policy
Well-intended policy at the state level can have the opposite of its intended effect — reducing, rather than expanding, patient choice and lower-cost options. For example, a 2025 Texas law gives health plans more power to steer patients to the plans’ preferred providers, a shift that will not necessarily lead to better outcomes or lower costs for patients.
Health Plans
A handful of national insurers now control the lion’s share of commercial coverage in many Texas markets. That concentration gives plans leverage to cut physician reimbursement, impose burdensome administrative requirements and steer patients into narrow networks — squeezing independent practices out.
The High Cost of Operating a Private Practice Overhead is rising. Reimbursement is falling. Red tape is multiplying.
An orthopaedic practice is a small business — and a capital-intensive one. From imaging equipment and ambulatory surgery centers to clinical staff and medical liability insurance, the cost of running a high-quality orthopaedic practice has climbed sharply. Meanwhile, commercial and Medicare reimbursement has not kept pace, and the administrative load required to operate inside that system grows every year.
The result is a financial squeeze that disproportionately harms independent practices. Without meaningful relief, consolidation is not a choice — it is the only path left for many practices.
TOA Stands for a Competitive Health Care Marketplace
From the Texas Capitol to Capitol Hill, TOA advocates for policies that promote competition, protect independent practice and preserve patient choice across every orthopaedic care setting in Texas.
State Policy
Supporting balanced regulations, fair contracting protections and policies that allow independent orthopaedic practices, ASCs and physician-led hospitals to thrive across Texas.
Federal Policy
Advocating for Medicare physician payment reform, site-neutral payment integrity, prior authorization relief and protection of physician-owned hospitals so patients keep real choices.