After critics of the University of Iowa Health Care’s initial application to build a hospital in North Liberty slammed its focus on orthopedics, UI officials stripped the word from a do-over application.
Now that the hospital has state approval and is advancing to the exterior phase of construction, UIHC officials again are airing plans to move orthopedics to the site — even calling the project an “orthopedic hospital.”
Orthopedics deals with bones or muscles and is among the most lucrative for hospitals, given the high number of surgeries. Behind salaries for UI’s head football and basketball coaches, the top-earning UI employee in 2022 was an orthopedic surgeon — with two making between $1.4 and $1.7 million on the year, more than UI Vice President for Medical Affairs and Carver College of Medicine Dean Brooks Jackson.
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“Orthopedic surgery would account for a significant portion of the initial service mix,” according to the first UIHC application, which reported plans for 36 inpatient beds, with up to 32 tied to orthopedics.
But after competing hospitals spoke against the UIHC project for veering outside its lane to take away business from community providers — including those focused on orthopedics — UIHC distanced itself from orthopedics and highlighted the growing need for complex care, which nearby hospitals can’t provide.
Now, officials are back to where they started.
“In 2025, we will move the department to a new musculoskeletal hospital in North Liberty,” according to a 2022 year-in-review email from Larry Marsh, who’s been chair and executive officer of the UI Department of Orthopedics and Rehabilitation for nearly a decade.
In a section labeled, “Orthopedic Hospital Under Construction,” Marsh described the emerging hospital on 60 acres of land between Highway 965 and Interstate 380 as having a “floor devoted to education, an administrative floor for our offices, skills lab, gait lab, research focused weight bearing CT and our biomechanics lab.”
A gait lab can assess how someone walks or runs; a biomechanics lab involves the study of structure, function and motion; and CT scans can be used in orthopedic research and care involving joints and other alignment issues.
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“It will be a remarkable near one-of-a-kind facility and will be a 50-plus year future for the department,” according to Marsh’s departmental message, announcing, “The orthopedic world at the University of Iowa will be changing.”
The genesis of UIHC’s North Liberty hospital — now budgeted to cost $525.6 million — involved a 2016 proposal to spend $100 million expanding its Iowa River Landing property in Coralville so UIHC’s orthopedic services could relocate there from the main hospital in Iowa City.
“Since the relocation of the Department of Orthopedics & Rehabilitation to the lower level of the John Pappajohn Pavilion 20 years ago, the department’s volume has increased by over 57 percent,” according to UIHC’s Board of Regents project proposal in 2016. “This remarkable growth in outpatient activity has far surpassed the projected capacity of the department’s current clinical and imaging space.”
UIHC at the time noted a “significant strain on clinical operations within the physical space,” creating a weekslong scheduling backlog to get into clinical rooms that are “undersized in comparison to contemporary standards and do not meet the needs of many orthopedic patients.”
The regents gave UIHC permission to proceed with that project in Coralville. But four years later in early 2020, UIHC returned seeking permission to revise plans and instead build a new medical facility in North Liberty.
“Based upon thoughtful consideration of a host of variables, including the heightened patient demand experienced across all UIHC services, it was determined that undertaking this construction at a more expansive location would offer the opportunity to increase the scope of services, and better meet the needs of Iowans in a timely manner,” according to that 2020 request.
“While orthopedics is still a component of this medical facility, the first phase would also include a level 4 emergency treatment center, urgent care services, outpatient clinics, diagnostic services, surgical suites, acute inpatient beds and associated support services, all aimed at improving patient access and decompressing the congested main UIHC complex,” the request said.
When UIHC first brought the proposal to the State Health Facilities Council in February 2021, UIHC orthopedics chair Marsh led presentations on why the region needs a new hospital in North Liberty. Marsh said the department had 100-plus providers — including about 50 faculty members and 30 residents — operating in “outdated, cramped, cluttered, small facilities.”
“Being able to be in a better environment, with better space, and modern space for our education, of course, would be just fantastic,” he said.
But opponents referenced UIHC’s orthopedic intentions in disputing the community’s need for the new medical campus — reporting ample resources at other local care providers, including Mercy Iowa City and the Iowa City Ambulatory Surgical Center, which work with Steindler Orthopedic Clinic, based in Iowa City.
“It’s a big ortho hospital,” Mercy Iowa City ICU medical director and pulmonary critical care doctor Andrew Ashby said during the first state hearing, arguing approval could drive his hospital out of business. “That is not what this community needs.”
Noting UIHC offers unique services to the sickest patients, UnityPoint Health-Cedar Rapids President Michelle Niermann criticized its use of a new facility for orthopedics.
“Rather than proposing a project that clearly and first focuses on expanding their capacity for those patient care services they uniquely offer, they are instead proposing to offer primarily orthopedic, urology and GI procedures — procedures that are outpatient in nature and that are core offerings of our community hospitals,” Niermann said. “These procedures are high volume, they're driven by demographics, and they yield some of the strongest margins in health care.”
The State Health Facilities Council cited those arguments in denying the first application. “The council notes that the local hospitals and outpatient service providers report being at 50 percent capacity and that they could handle many of the procedures, especially orthopedic and other outpatient procedures, being proposed by the UIHC at the North Liberty Campus,” the council wrote.
In returning to the board months later with a revised application focused on UIHC’s care of Iowa’s sickest and most complex patients, orthopedics weren’t mentioned this time.
When the state responded with a list of questions — requesting a list of specific services the North Liberty location will provide — UIHC gave examples of potential services, listing orthopedics fifth of six mentioned.
After the state approved UIHC’s revised application, The Gazette asked UIHC whether orthopedics would remain central to its North Liberty plans. Officials said “maybe.”
“Our plans for this facility remain flexible as we continue to evaluate and determine which clinical specialties will be offered on the new campus based on patient demand,” according to a UIHC statement provided in October 2021. “Based on this patient demand, orthopedic subspecialties may be included at the new location.”
In response to The Gazette’s follow-up questions in December, UIHC officials said they weren’t yet able to say how much of the space at the hospital would be allocated to various services. “However, we do know one of the initial services upon opening in 2025 will be orthopedics and sports medicine, largely due to an increasing demand for these services and the need for a more convenient and accessible drive-up location for patients with mobility challenges.”
Months after the state approved UIHC’s North Liberty project, it also approved construction of a $19.2 million Steindler North Liberty Ambulatory Surgery Center on 36 acres off I-380, about 1.5 miles east of the new UIHC hospital campus — making that a soon-to-be hub for orthopedic care.
www.thegazette.com
Now that the hospital has state approval and is advancing to the exterior phase of construction, UIHC officials again are airing plans to move orthopedics to the site — even calling the project an “orthopedic hospital.”
Orthopedics deals with bones or muscles and is among the most lucrative for hospitals, given the high number of surgeries. Behind salaries for UI’s head football and basketball coaches, the top-earning UI employee in 2022 was an orthopedic surgeon — with two making between $1.4 and $1.7 million on the year, more than UI Vice President for Medical Affairs and Carver College of Medicine Dean Brooks Jackson.
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“Orthopedic surgery would account for a significant portion of the initial service mix,” according to the first UIHC application, which reported plans for 36 inpatient beds, with up to 32 tied to orthopedics.
But after competing hospitals spoke against the UIHC project for veering outside its lane to take away business from community providers — including those focused on orthopedics — UIHC distanced itself from orthopedics and highlighted the growing need for complex care, which nearby hospitals can’t provide.
Now, officials are back to where they started.
“In 2025, we will move the department to a new musculoskeletal hospital in North Liberty,” according to a 2022 year-in-review email from Larry Marsh, who’s been chair and executive officer of the UI Department of Orthopedics and Rehabilitation for nearly a decade.
In a section labeled, “Orthopedic Hospital Under Construction,” Marsh described the emerging hospital on 60 acres of land between Highway 965 and Interstate 380 as having a “floor devoted to education, an administrative floor for our offices, skills lab, gait lab, research focused weight bearing CT and our biomechanics lab.”
A gait lab can assess how someone walks or runs; a biomechanics lab involves the study of structure, function and motion; and CT scans can be used in orthopedic research and care involving joints and other alignment issues.
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“It will be a remarkable near one-of-a-kind facility and will be a 50-plus year future for the department,” according to Marsh’s departmental message, announcing, “The orthopedic world at the University of Iowa will be changing.”
How we got here
The genesis of UIHC’s North Liberty hospital — now budgeted to cost $525.6 million — involved a 2016 proposal to spend $100 million expanding its Iowa River Landing property in Coralville so UIHC’s orthopedic services could relocate there from the main hospital in Iowa City.
“Since the relocation of the Department of Orthopedics & Rehabilitation to the lower level of the John Pappajohn Pavilion 20 years ago, the department’s volume has increased by over 57 percent,” according to UIHC’s Board of Regents project proposal in 2016. “This remarkable growth in outpatient activity has far surpassed the projected capacity of the department’s current clinical and imaging space.”
UIHC at the time noted a “significant strain on clinical operations within the physical space,” creating a weekslong scheduling backlog to get into clinical rooms that are “undersized in comparison to contemporary standards and do not meet the needs of many orthopedic patients.”
The regents gave UIHC permission to proceed with that project in Coralville. But four years later in early 2020, UIHC returned seeking permission to revise plans and instead build a new medical facility in North Liberty.
“Based upon thoughtful consideration of a host of variables, including the heightened patient demand experienced across all UIHC services, it was determined that undertaking this construction at a more expansive location would offer the opportunity to increase the scope of services, and better meet the needs of Iowans in a timely manner,” according to that 2020 request.
“While orthopedics is still a component of this medical facility, the first phase would also include a level 4 emergency treatment center, urgent care services, outpatient clinics, diagnostic services, surgical suites, acute inpatient beds and associated support services, all aimed at improving patient access and decompressing the congested main UIHC complex,” the request said.
Opposition
When UIHC first brought the proposal to the State Health Facilities Council in February 2021, UIHC orthopedics chair Marsh led presentations on why the region needs a new hospital in North Liberty. Marsh said the department had 100-plus providers — including about 50 faculty members and 30 residents — operating in “outdated, cramped, cluttered, small facilities.”
“Being able to be in a better environment, with better space, and modern space for our education, of course, would be just fantastic,” he said.
But opponents referenced UIHC’s orthopedic intentions in disputing the community’s need for the new medical campus — reporting ample resources at other local care providers, including Mercy Iowa City and the Iowa City Ambulatory Surgical Center, which work with Steindler Orthopedic Clinic, based in Iowa City.
“It’s a big ortho hospital,” Mercy Iowa City ICU medical director and pulmonary critical care doctor Andrew Ashby said during the first state hearing, arguing approval could drive his hospital out of business. “That is not what this community needs.”
Noting UIHC offers unique services to the sickest patients, UnityPoint Health-Cedar Rapids President Michelle Niermann criticized its use of a new facility for orthopedics.
“Rather than proposing a project that clearly and first focuses on expanding their capacity for those patient care services they uniquely offer, they are instead proposing to offer primarily orthopedic, urology and GI procedures — procedures that are outpatient in nature and that are core offerings of our community hospitals,” Niermann said. “These procedures are high volume, they're driven by demographics, and they yield some of the strongest margins in health care.”
The State Health Facilities Council cited those arguments in denying the first application. “The council notes that the local hospitals and outpatient service providers report being at 50 percent capacity and that they could handle many of the procedures, especially orthopedic and other outpatient procedures, being proposed by the UIHC at the North Liberty Campus,” the council wrote.
Orthopedics ‘may be included’
In returning to the board months later with a revised application focused on UIHC’s care of Iowa’s sickest and most complex patients, orthopedics weren’t mentioned this time.
When the state responded with a list of questions — requesting a list of specific services the North Liberty location will provide — UIHC gave examples of potential services, listing orthopedics fifth of six mentioned.
After the state approved UIHC’s revised application, The Gazette asked UIHC whether orthopedics would remain central to its North Liberty plans. Officials said “maybe.”
“Our plans for this facility remain flexible as we continue to evaluate and determine which clinical specialties will be offered on the new campus based on patient demand,” according to a UIHC statement provided in October 2021. “Based on this patient demand, orthopedic subspecialties may be included at the new location.”
In response to The Gazette’s follow-up questions in December, UIHC officials said they weren’t yet able to say how much of the space at the hospital would be allocated to various services. “However, we do know one of the initial services upon opening in 2025 will be orthopedics and sports medicine, largely due to an increasing demand for these services and the need for a more convenient and accessible drive-up location for patients with mobility challenges.”
Months after the state approved UIHC’s North Liberty project, it also approved construction of a $19.2 million Steindler North Liberty Ambulatory Surgery Center on 36 acres off I-380, about 1.5 miles east of the new UIHC hospital campus — making that a soon-to-be hub for orthopedic care.
UI reports ‘orthopedic hospital under construction’ in North Liberty
Although the University of Iowa stripped orthopedics from its second application to build a new hospital in North Liberty – after critics of the first, denied application slammed its focus on orthopedics and state officials cited the heavy orthopedics bent in its rejection – UI Health Care...
www.thegazette.com
