by James C. SherlockBeckers j

ust published a list of the 14 largest orthopedic projects in America in 2021. None of them are located in Virginia. Virginia’s COPN law and its administration make such projects highly unlikely here.

Every Virginia hospital that did not propose such a project would oppose it. And in the monopolized metro areas, why spend the money? They have a captive audience.

For reference, not one hospital in Virginia is rated among the 50 in orthopedics by U.S. News and World Report using its methodology. Only three of the 14 orthopedics projects listed by Beckers are in states that regulate such projects, two in New York and one in Alabama.

One of those New York hospitals, Hospital for Special Surgery, is the top-rated orthopedics hospital in America and the world. I am going to go out on a limb and suggest they did not have a problem getting a CON for their new 12-story tower that will specialize in spine surgery and joint replacement.

We must ask ourselves: Why would the best orthopedics hospitals and the biggest orthopedic investments locate in Virginia, where the state clearly does not welcome them?

Lesson here: medical facility investment, like all investment, goes where it is welcome and free to plan and execute a project without regulatory risk.

Virginia has some excellent orthopedic surgeons. I was just operated on by one. But they can practice more freely and create businesses elsewhere that they are denied in Virginia. Some of the best orthopedic surgeons in Northern Virginia own ASCs in Maryland and take their patients across the bridges to operate.

Anyway, here is the Becker’s list. The parenthetical assessments are mine.

1. In April, the Spine Institute of Louisiana broke ground on a $20 million multidisciplinary spine hospital in Bossier City, La. The Spine Center of Excellence, a 34,000-square-foot facility, will include an ASC with four operating rooms. It is expected to be open in the fall of 2022. (LOUISIANA DOES NOT REGULATE HOSPITALS OR ASCs)
2. The University of Arkansas for Medical Sciences broke ground on an $85 million surgical facility in Little Rock in April. The building will include 12 operating rooms and 12 exam rooms dedicated to orthopedics and physical medicine and rehabilitation. It is expected to open by spring 2023. (ARKANSAS DOES NOT REGULATE HOSPITALS OR ASCs)
3. Construction is underway for the Orlando Health Jewett Orthopedic Institute, which will feature a 75-bed orthopedic specialty hospital, a medical pavilion and an ASC. The hospital will open in summer 2023, but the ASC could open in late 2022. (FLORIDA DOES NOT REGULATE HOSPITALS OR ASCs)
4. New York City-based Hospital for Special Surgery is planning a 12-story tower that will specialize in spine surgery and joint replacement, for which it recently received a $35 million donation. Construction of the 100,000-square-foot facility is set to begin this year. (NY CON REQUIRED)
5. Rochester, N.Y.-based UR Medicine is developing a $240 million orthopedic campus. The 330,000-square-foot campus will be one of the country’s largest for orthopedics. The campus’s ASC is expected to be open by 2022, with the patient tower targeted for 2023. (NY CON REQUIRED).
6. In February, Altamonte Springs, Fla.-based AdventHealth broke ground on a $100 million facility that will be Rothman Orthopaedic Institute’s Florida headquarters. The 12-story, 300,000-square-foot medical office building in Orlando, Fla., will be at AdventHealth’s Health Village campus in Orlando, Fla. (FLORIDA DOES NOT REGULATE HOSPITALS OR ASCs)
7. Akron, Ohio-based Crystal Clinic Orthopaedic Center plans to open a $100 million hospital for orthopedic, reconstructive and plastic surgery in the fall. The 165,000-square-foot facility in Fairlawn, Ohio, will include 60 private patient rooms and 12 operating rooms equipped with Stryker’s Mako system and the ExactechGPS system for joint replacement procedures. (OHIO DOES NOT REGULATE HOSPITALS OR ASCs)
8. Phoenix-based Banner Health is developing a $54 million orthopedic sports medicine center in Scottsdale, Ariz. The center, expected to open in late 2022, will include a surgery center and a physical therapy, imaging and a concussion center. (ARIZONA HAS NO CON LAW)
9. Penrose-St. Francis Health Services in Colorado Springs, Colo., plans to begin construction of a $150 million spine and orthopedic hospital. The 72-bed hospital will have 10 operating rooms and include a medical office building and a surgery center. The facility is expected to open in January 2023. (COLORADO REGULATES ONLY GROUND AMBULANCE SERVICES.)
10. Parkview Medical Center broke ground on a $58 million orthopedic hospital in Pueblo West, Colo., in November. Expected to open in April 2022, the hospital will have 30 beds and free up to 20 beds at the main campus in Pueblo, Colo. (COLORADO REGULATES ONLY GROUND AMBULANCE SERVICES.)
11. Appleton, Wis.-based ThedaCare broke ground on its $144 million Orthopedic, Spine and Pain Center in August. The facility will feature medical offices, a specialty surgery center and an orthopedic and spine hospital. Construction is set for completion in summer 2022. (WISCONSIN HAS NO CON LAW ON HOSPITALS OR ASCs.) (Wisconsin’s hospital bed cap is set at a sufficiently high level that it is not binding and is not expected to bind for several decades)
12. The $250 million Orthopedic & Spine Tower at Huntsville (Ala.) Hospital is on course to open this summer. The facility will feature 24 operating rooms, 72 patient rooms and house the hospital’s program for joint replacement patients. (ALABAMA CON LAW REGULATES SUCH FACILITIES.)
13. Sioux Falls, S.D.-based Sanford Health is developing a 12-operating room orthopedic hospital and two clinics as part of a $209.5 million expansion. Construction will begin this summer, with the hospital’s opening expected by 2023.  (SD HAS NO CON LAW)
14. Covenant Medical Center in Lubbock, Texas, is building a six-story spine and orthopedic tower that will cost $120 million. The center will treat spine, cranial neurosurgery and complex orthopedic trauma patients and will open by the first quarter of 2022. (TEXAS HAS NO CON LAW)

Next time you need an orthopedic procedure in Virginia, thank COPN and specifically the Democrats and a few Republicans in Richmond who are controlled by the hospital lobby for your limited choices.

I wonder if they stay in-state for spine surgery. Actually, I wonder if the hospital lobbyists do.