In May 2026, the Journal of Bone and Joint Surgery published a study of perioperative communication at one high-volume orthopaedic practice. From 2016 to 2022, the practice logged 277,729 telephone calls and 16,966 electronic messages across 45,216 hip and knee replacements, counted in the 30 days before surgery and the 90 days after. The authors call each of these calls and messages a touchpoint: a single contact between a patient and the practice about their care. Alan Lam, Chad Krueger, and their co-authors trended the volume year over year. Touchpoints per knee-replacement patient rose from a mean of 8.7 in 2016 to 17.8 in 2022, a 105% increase; for hip replacement, from 7.3 to 16.1, a 121% increase. The communication load more than doubled in six years, and most of the growth came in post-op care.
the burden falls on care teams
2016 → 2022
2016 → 2022
by 2022 — most post-discharge
These are recovery questions: whether a wound looks the way it should, whether the swelling is normal, what to do about the constipation the pain medication brought on, and why the knee still will not bend. These inquiries fall upon transition teams, nurse navigators, and advanced practice providers. They respond to each dialogue individually, though frequently these contacts remain stalled or ignored, creating a communication burden that the researchers suggest is nearing the functional capacity of any surgical practice.
Outpatient Surgery Is the New Normal
Ambulatory care is now the American surgical standard, with over 80% of procedures performed on a same-day basis. Each year, roughly 150 million surgeries are processed through hospital outpatient departments, ambulatory centers, and medical offices, a volume that has climbed from 129 million in 2018 as hospitals and payers migrate care to lower-cost environments.1 Procedural efficiency has improved; recovery infrastructure has not.
Following their discharge, patients assume the responsibility for their own recovery, bearing the associated risks at home with minimal outside support. Half of discharge guidance is forgotten within two weeks.2 One in five patients has an unplanned provider contact or a complication within 30 days. A single post-operative episode consumes about 151 minutes of clinician time, close to 40% of the entire episode of care.3 Post-operative complications add an estimated $60 billion to annual U.S. healthcare spending, with credible estimates ranging from $43 billion to $73 billion. Forty percent of readmissions trace to early warning signs missed in the at-home window, the stretch where the surgical team has no eyes.4
The economics pull against the practice from three directions at once. Demand is climbing as the population ages. Reimbursement is falling: CMS has cut inflation-adjusted surgeon payment for primary hip and knee replacement by more than half since 2000,5 on the logic that a patient who recovers at home costs the system less. And accountability for that recovery is rising, even as the payment for it shrinks. The Transforming Episode Accountability Model (TEAM), mandatory for roughly 741 hospitals since January 1, 2026, puts the hospital and its surgeons at financial risk for the 30 days after discharge across five surgical episodes, lower-extremity joint replacement among them. The proposed CJR-X model would push that accountability to 90 days, cover outpatient hip and knee replacement directly, and reach more than 2,500 hospitals nationwide if finalized.6 Demand is climbing, reimbursement is falling, and accountability is rising, all converging upon an unmonitored recovery window.
the payment for it falls
2000 → 2024, real dollars
2000 → 2024, real dollars
every year, for two decades
The at-home window requires what the surgical center once guaranteed: the persistent reach of clinical oversight, available regardless of the clock, that expands alongside procedural volume rather than reaching its functional breaking point.
What the Virtual Care Assistant Does
RecovryAI developed the Virtual Care Assistant (VCA) specifically to address the challenges of the at-home recovery window. Each VCA is procedure-specific, offering tailored support for total hip or total knee replacements, and maintains a real-time connection between patients and their care teams. Through clinical dialogue, the VCA guides patients through established recovery protocols while monitoring for any deviations from expected progress. If the system detects a potential complication, it synthesizes the clinical context and provides the care team with an actionable summary, allowing them to apply their medical judgment efficiently.
In our pilot study, ahead of a much larger pivotal trial, experienced orthopaedic surgeons independently reviewed 525 completed post-operative conversations following total knee and total hip replacement and agreed with the system’s assessment 97.7% of the time. The VCA provided protocol-compliant guidance in 93% of those conversations and escalated only 7% to the care team. These automated interactions address the typical recovery inquiries that constitute the bulk of the communication burden identified by researchers. Of the 17.8 individual touchpoints a knee patient currently initiates, the majority can be resolved without the direct intervention of clinical staff. Consequently, the team’s capacity is preserved for those cases that truly demand expert medical judgment.
What Separates a Prescription From a Suggestion
A system capable of advising a post-surgical patient on whether their swelling is normal is exercising clinical judgment, which demands a rigorous safety standard. This standard represents the boundary between a wellness chatbot and a regulated medical device under FDA review. Much like the distinction between an over-the-counter remedy and a prescription drug, both may offer benefits, but only the latter is required to demonstrate safety for its prescribed purpose within a defined indication for use and specific labeling.
Those familiar amber bottles carry a higher degree of scrutiny: prescribed by a physician, backed by the regulatory bodies that protect the public, and trusted because of both.
Medicine operates on a currency of trust. A Prescribed AI, software ordered by a clinician just like a traditional medication, is built upon a dual foundation of that trust. Its first layer is the clinician: a licensed professional whose training and judgment led them to determine that this specific device was appropriate for the patient’s recovery. The second layer is the FDA, whose regulatory clearance provides the very framework that allows a clinician to issue such an order. While a wellness app is used at a patient’s own discretion, a Virtual Care Assistant is utilized because a regulator has authorized it and a healthcare provider has personally selected it.
The Weight of the Order
The bond of trust a patient shares with their surgical team extends directly to the Virtual Care Assistant they prescribe. Just as a patient follows a medication regimen or discharge instructions backed by the FDA, they rely on this AI without audit, especially during those anxious hours at two in the morning when a surgeon is unavailable and recovery progress feels uncertain.
We believe this inherent authority is the key to achieving the consistent engagement and adherence that has eluded digital health for years. When a surgeon frames the AI as a clinical prescription, a formal extension of the team’s oversight into the home, the instruction carries the weight of a medical order. Patients follow what their doctors prescribe, and Prescribed AI leverages that clinical force to ensure a safer recovery.
Ultimately, a VCA maintains its place in the care pathway only by proving its clinical value. It must be accurate when it matters most and seamlessly transition the patient to a human clinician the moment medical judgment is required. By holding this line, the Virtual Care Assistant grants overburdened care teams, like those highlighted in the JBJS study, the breathing room they need while providing patients with 24/7 access to their clinical team’s reach.
The period following hospital discharge has become an unmonitored void in outpatient surgical care. The data from JBJS highlights exactly why we developed the Virtual Care Assistant and why we have chosen a rigorous, deliberate path for its creation. We are actively seeking De Novo Class II authorization as a Software as a Medical Device, conducting the necessary clinical trials to validate its safety and ensuring the device meets the high standards a clinician would personally endorse. For a recovery assistant to be effective, it must be accountable within that critical window. This is the essential tool for the future of surgical care, one designed to be in a patient’s hands when concerns arise and the surgeon is unavailable.
1. Sg2, Impact of Change surgical volume forecast; American College of Surgeons NSQIP; Centers for Medicare & Medicaid Services. U.S. surgical volume and outpatient share.
2. Kripalani et al. JAMA, 2007. Retention of discharge instructions.
3. Centers for Medicare & Medicaid Services, physician time data, 2023–2024. Clinician time per post-operative episode.
4. Horwitz et al. Annals of Internal Medicine, 2013. Readmissions and missed early warning signs.
5. Palmer et al. “Medicare Reimbursement for Primary and Revision Total Hip and Knee Arthroplasty: An Updated Analysis From 2000 to 2024.” The Journal of Arthroplasty, 2025.
6. Centers for Medicare & Medicaid Services. Proposed CJR-X model; Transforming Episode Accountability Model (TEAM), effective January 1, 2026.