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Fred Lerche, director of CoxHealth's musculoskeletal line, says research, including projections for a 673 percent increase in knee replacements by 2030, led the health system to open the Meyer Orthopedic Center.
Fred Lerche, director of CoxHealth's musculoskeletal line, says research, including projections for a 673 percent increase in knee replacements by 2030, led the health system to open the Meyer Orthopedic Center.

Need pushes orthopedic growth

Posted online
Propelled by an aging population and a projected demand for specialized services, Springfield’s major health systems have taken significant steps to expand orthopedics care.

Following the completion last spring of the Meyer Orthopedic Center, a $48 million specialty care facility on CoxHealth’s South National Avenue campus, St. John’s broke ground March 30 on a $105 million, 48-bed orthopedic hospital at the southwest corner of Evans Road and U.S. Highway 65.

CoxHealth’s decision to open the Meyer center was in response to ongoing research by the American Academy of Orthopedic Surgeons, which has projected a 673 percent increase in knee replacements and a 174 percent hike in hip replacements by 2030, according to Fred Lerche, director of CoxHealth’s musculoskeletal service line.

Lerche said orthopedics are on the upswing due to an active older generation that show no signs of slowing down.

“As the baby boomers (age), hip replacements, knee replacements nationwide are on the increase yearly,” Lerche said, noting that even amid the economic downturn, the growth didn’t stop.

“They may have delayed them a little longer because they are elective surgeries, but we were still seeing 11 percent-type growth,”  he added.

St. John’s received approval for the orthopedic hospital in mid-2010, and the health system provided statistical analyses to the Missouri Department of Health and Senior Services to obtain a Certificate of Need and proceed with the hospital. Data from several institutions illustrated the need for more orthopedic care.

For example, in 2008, the Advisory Board, a health care think tank, projected 23 percent growth in inpatient orthopedic admissions between 2006 and 2016, and a 1,259 percent increase nationwide in outpatient joint replacement volume.

According to 2009 Missouri Hospital Association Health Industry Data Institute census data, nearly 48 percent of the population in St. John’s Springfield community service area was 40 years old or older, and by 2014, age groups 55 to 64 and 65 and older are expected to grow by 15 percent and 14 percent, respectively. In addition to an aging population, obesity also is driving the increase in orthopedic joint disease because it stresses the skeletal system.

According to the Centers for Disease Control, Missouri ranks No. 13 in state obesity rates, with 63.9 percent of adults in the state overweight and 27.4 percent as obese.

“One thing you can look at when deciding whether you need additional surgical capacity is how busy are the current (operating rooms),” St. John’s spokeswoman Cora Scott said. “If you go over to the orthopedic surgery office right now, you’ll see a waiting room full of people.”

Lerche said consolidating orthopedic services into a specialty center improves hospital efficiency as well as patient satisfaction and recovery times.

A 2010 report by researchers at the University of Iowa found that hospitals specializing in orthopedic surgical care had fewer post-surgery complications such as blood clots, infections and heart problems.

The study, published in the British Medical Journal, was based on data for 1.3 million Medicare patients who underwent knee and hip replacement surgeries between 2001 and 2005 at 3,818 U.S. hospitals.

“We did learn that if we focused on one area, such as orthopedics, you tend to get better and better with that,” Lerche said.

St. John’s orthopedic specialist Richard Seagrave said a sole focus on orthopedics will enable smoother transitions between surgeries and cut down patients’ wait times.

“It’s really like any other business in that when you have these very high volume services, if every so often the operating room has to change to alter equipment around to accommodate a trauma that comes in, it throws you off,” said Richard Seagrave, an orthopedic specialist at St. John’s. “But if you’re doing a total knee after a total knee after a total knee, it markedly improves your ability to pass those people through.”

Lerche said improving efficiency and care also fits well with changes expected from health reform.

“One of the things we can be certain about … is that we’re going to have to do things more effectively, more efficiently,” Lerche said. “We’re going to have to increase our outcomes.”

Lerche said since the Meyer Orthopedic Center opened, the average patient stay dropped to 3.4 days from 3.6 days, while 80 percent of patients were able to recover at home.

Stuart Strangeland, senior vice president and chief operating officer of St. John’s Clinic, said decreasing the length of stay for patients was a major factor in St. John’s decision to move forward with the orthopedic hospital, which he calls a significant step toward adapting to health care reform and an increasingly tight budget.

“The level of spending in the country on health care is not sustainable,” Strangeland said. “Medicare reimbursement is a challenge for most hospitals right now. So in order for us to be strong, we need to be able to provide care more cost-effectively and we really believe this facility will help us to do that.”

The architect of record for St. John’s 149,000-square-foot orthopedic hospital – designed by Dallas-based HKS Architects Inc. and being built by St. Louis-based McCarthy Building Cos. Inc. – is set to open in summer 2013.[[In-content Ad]]

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