Orthopedic boom: Eastern Iowa’s aging population drives surge in demand for care

As Iowa’s population ages and the last of the Baby Boomers reach 65 years old, orthopedic health care providers expect an increase in demand for services related to joint replacement, bone fractures and sports injuries. It’s leading to an orthopedic boom here in Eastern Iowa.

More than 18% of Iowa’s population is aged 65 years and older, according to the U.S. Census Bureau. What’s more, that number will rise to 20% by 2050, according to Leading Age Iowa. This demographic shift brings new demands across the state’s health care system, and orthopedic providers are already feeling the increase in pressure. 

Eastern Iowa orthopedic organizations say the increase in older Iowans means providers see more knee and hip replacements, sports injuries and arthroscopic surgeries, among other needs. 

That’s a trend taking place nationwide. More than one-third of Americans received orthopedic health care services in 2021, according to consulting firm McKinsey & Company. This makes it the largest expenditure category for individuals with employer-based insurance plans and the second largest for Medicare enrollees.

All of this means that new orthopedic facilities are being built across Eastern Iowa to meet demand.

• Iowa City’s Steindler Orthopedic Clinic is building a new 83,000-square-foot Ambulatory Surgery Center (ASC) in North Liberty. The new space will include six operating rooms, recovery rooms, physical and occupational therapy space and office space. The 36-acre campus has room for further expansion in the future. The project carries a $29.3 million maximum price tag and is set for completion by early 2025.
• ORA Orthopedics in Bettendorf is building a new $50 million, 113,000-square-foot clinic and ASC, including 10 operating rooms; physical and occupational therapy space with an aquatic therapy pool; imaging suite; clinical offices and an Urgent OrthoCARE. 
• University of Iowa Health Care is more than halfway through building a new 60-acre medical campus that will include orthopedic and sports medicine services. The facility is expected to open in 2025. It will also include clinic exam rooms, operating rooms and emergency care rooms, indoor and outdoor physical therapy space, urgent care for orthopedic injuries, and lab and imaging services.

Among Medicare beneficiaries, the National Institutes of Health estimates that total hip replacements will increase by 42% by 2040 and 101% by 2060; while total knee replacements will increase 149% by 2040 and 520% by 2060.

“With the aging of the population, there is a significant increase in projected total hip and knee replacements,” said ORA Orthopedics CEO Ken Brockman. “Seniors are staying more active in their later years – traveling, hiking, biking, gardening and yes, pickleball. They want to be active, and they want to feel good when they are active.” 

That means they’re seeking out orthopedic care so they can get back to the things they love to do, he added.

Joint pain, sports-related injuries, and bone fractures will also lead older Iowans to seek orthopedic care, said Steindler president and CEO Patrick Magallanes.

“Efforts to enhance orthopedic care delivery, including advancements in surgical techniques, rehabilitation protocols, and patient education, will be essential to meet the evolving orthopedic needs of Iowa's aging population,” he said.

ASCs vs hospital care

Over the past decade, low-risk surgical procedures have moved into lower-cost settings of care, such as an ASC.

ASCs are specialized health care facilities that focus on providing same-day surgical care, including diagnostic and preventive procedures. These centers can provide surgical services across a variety of medical specialties, including orthopedics, gastroenterology and ophthalmology. 

ASCs typically have state-of-the-art equipment and facilities tailored to meet the needs of outpatient procedures, ensuring efficient and safe surgical care.

“Unlike a hospital, our ASC will be 100% focused on orthopedic and pain procedures,” Mr. Brockman said. “It is all about creating an optimal surgical experience for the patient.  Everyone – from reception staff to operating room staff to recovery staff – specializes in orthopedics.”

This change has happened largely due to advancement in surgical procedures, such as minimally invasive robotic surgery, better pain management and improved post-surgery recovery, Mr. Brockman said.

Five years ago, joint replacements usually required multi-day hospital stays, Mr. Magallanes agreed, but now it’s not uncommon to check a patient in for a joint replacement in the morning and have them recovering in their home by mid-afternoon. 

“ASCs are a more cost-effective venue for many orthopedic procedures, which reduces patient copays and deductibles as well as cost to the overall health care system,” Mr. Brockman said. “However, hospitals will continue to be an important partner for us. There are certain cases, including orthopedic trauma, complex surgical procedures, and patients with medical conditions where the hospital will be the right venue for their orthopedic care.”

Patient-centered care

Whether patients receive their care in an ASC or hospital, providers are emphasizing improved patient care. ORA Orthopedics, Steindler and UIHC have all reported that their new facilities will focus on an improved patient experience and convenience.

“It is our goal to create a patient-centered, coordinated, and comprehensive approach to musculoskeletal care, building on the university’s nationally recognized research, education, and clinical care in orthopedics excellence,” said Lawrence Marsh, MD, chair of the UIHC’s Department of Orthopedics and Rehabilitation, in a news release.

Patients will have a streamlined experience from their first clinic visit to surgery and inpatient services – if needed – in addition to ancillary services such as on-site labs, imaging, durable medical equipment and pharmaceuticals.

ORA Orthopedics and Steindler have added physicians and services over the years to their current practices, respectively, and are both looking forward to all the benefits their new and improved medical campuses will offer. 

“We have enhanced our services to provide the full spectrum of orthopedic care, including in-house physical and occupational therapy, advanced diagnostic imaging, and an ASC for surgical procedures,” Mr. Brockman said. 

The organization has also added orthopedic urgent care and expanded its presence in outlying communities including Clinton, DeWitt, Silvis, Geneseo and Muscatine, Mr. Brockman said.

“The growth in our practice and the increasing trend of more orthopedic surgical cases that can be performed in an ASC facility have really prompted us to expand our orthopedic center,” he said.   

Likewise, Steindler has grown significantly over the past several years, now employing 18 physicians – including 15 surgeons – and has plans to bring on additional surgeons next year, Mr. Magallanes said. Building its own ASC makes sense for Steindler and its patients.

Its new clinic and ASC are specifically designed to offer a one-stop destination for patients where Steindler can better manage their care according to their standards.

“We’ve always depended on a medical facility managed by someone else,” Mr. Magallanes said. “The growing preference for ASCs among patients and health care providers underscores our move's significance in today's evolving health care landscape.”