Becker’s Healthcare -- Spine and Orthopedic Podcast
Alexander Vaccaro, MD, PhD, MBA, President of Rothman Orthopaedics
14 Jan 2026
Chapter 1: What is the main focus of Dr. Vaccaro's role at Rothman Orthopaedics?
Hi, everyone, and welcome to the Becker's Spine and Orthopedic Podcast. I'm Sophie Atis, orthopedic reporter with Becker's Healthcare, and today we're honored to be joined by Dr. Alexander Vaquero, 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. So to start, I'll give you the opportunity to introduce yourself and also share a bit about your role.
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 medicine.
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 at the Rothman Institute. That's my current role at the present time.
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?
So here's the battle. 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.
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Chapter 2: What innovations in spine surgery does Dr. Vaccaro discuss?
The biggest problem we have as providers is that we 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 downcode
cpt codes from level four to level three these are the things that we have to do and we go through you know 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 do with the cost of capital salary
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 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.
Yeah, great points there. I think you mentioned a ton of what is on leaders across the board's mind in terms of orthopedic 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 standpoint, which innovations or care models do you think will meaningfully shift how orthopedic care is delivered in 2026?
So if you look closely at what we provide patients anywhere from more surgical skills to non-operative care, such as injections, stem cells, hyaluronic acid injections for knees, bracing,
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 cost, but also provide what we think is best in class. I'll give you an example.
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Chapter 3: How does Dr. Vaccaro view the future of orthopedic care in 2026?
So we want to invest in additional providers, number one.
Then we also want to make sure that we have the appropriate footprint to expand strategically in the right areas.
And again, focus on technologies and forecasting reports and population growth and stuff like that. I use all the 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, 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
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 in the future. And technology, technology, technology is where it's at.
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 explaining to really 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?
Okay. And this is everyone's problem in medicine today.
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