Critical Access Hospitals & Rural Business Strategies

“Brains Before Bricks and Mortar”

1

Presentation Team and Introductions

• The Owner’s Perspective: Jeff Prochazka, Director of Strategic Planning, Methodist Health System

“Listening to The Customer”

• The Architect’s Perspective: Patrick Leahy, Director of Planning, Research and Innovation for Holland Basham Architects

“Asking the Right Questions, To The Right People”

• The Planner’s Perspective: Jim Easter, Principal, Easter Healthcare Consulting

“Why Do We Need Business Focused Leadership”

2

Important Video Linkshttp://time.com/3833111/inside-hospital-room-

future/?xid=emailshare

Planetree Story

Patient RoomOf the Future

3

The Planetree Concept Illustration

01. Human Interaction

02. Architectural Design + Healing

03. Nutrition + Diet

04. Patient Empowerment

05. Family, Friends, Social Support

06. Spiritual and Emotional Support

07. Human Touch

08. Healing Arts and Sensory Factors

09. Complementary Therapies

10. Healthy Communities (Youth + Aged) 4

Learning Objectives• O1: The Community Is a Key Partner in The Future of CAH Success. This presentation will discuss

how the “service linkages” and “community health needs analysis” can work most effectively as a win/win effort.

• O2: The involvement and orientation of the Board of Directors, provider staff, physicians and informed consumers continue as a key part of the success factors; case studies will exhibit comparative ideas and winning products for the attendees to consider and offer the opportunity to “share and compare” ideas with attendees.

• 03: The “how and why” of strategic and facility master planning will be discussed to illustrate the winning business strategies evolving from these management approaches. Selection of the “best advisors” is key to effective results…lowest bidder isn’t always cost effective!

• 04: The session will share “innovative ideas and trends” that will be helpful to facilitate discussions and compare/contract ideas with attendees. The future is ours to create and demographic forces are running just ahead of our planning and design…we must understand those factors to design appropriately.

5

Summary of Program Discussion

It has clearly been the CAH program that set in motion better healthcare delivery in America. We believe this because so many communities have re-visited their mission, vision, goals and objectives in the context of an “improved service delivery model” (linked to CAH licensure status).

The evolution of this program has; opened the door to “needs based efforts”, automatically reduced bed capacity, severed physically linked adjacencies to nursing homes, and expanded into broader based community efforts for senior care, extended care, memory care, hospice and greenhouse design nationwide.

Improved Service Delivery(Access, Quality, Cost, Outcomes)

A Needs Based Perspective On Facility and Service Developments

(What, Where, When, Why, How Much)

6

Summary of Program Discussion

Facilities that were previously located in the “wrong part of town” have been re-developed to offer better access, more efficient service delivery, and overall more efficient infrastructure and design quality that meets and exceeds consumer expectations. Yes, city/county joint ventures are occurring to permit utility sharing, FQHC partnerships and regional partnerships with secondary and tertiary care partners.

This presentation will EMBRACE THESE WINNING success stories and outline ways to grow farther and faster and more effectively in the future. It is clear to the presentation team that outpatient care and alternative delivery models will evolve for many communities in the future. The next generation of the CAH program is exciting, innovative and cost effective. We hope to illustrate the ADDED VALUE OF CAH efforts and speak to our audience in “creative and positive terms”.

Location and Image(Consumers Are Changing)

Winning Success Stories(Emergency Medicine, Rural Health, Wayfinding)

Process Change7

What is Business Planning In Healthcare?(This Isn’t An Easy Question To Answer)

• Goals and Objectives• Assignments• Fact Gathering • Market Analysis, Strategy and Vision• Budgeting and Aligning Money With Expectations• Taking Risk With Money• Assessing Team Members and Customer Expectations• Measuring Results Carefully• Capital Asset Alignment and Outcomes:

- Human Resources- Facility Assets- Technology- Services

8

Key Elements of a CHNA ProcessIntegrated Strategy and Master Plan(Market Share, Space Needs, Master Plan, Process Change)

Partnership Effort On Strategy and Process

9

How To Build Bridges To Other Community Services For CAH Sustainability?

TheSchool

The Hospital

The WorshipCenter

The Housing

TheRecreation

The Retail

Quality of Life + Economic Development = Our Priorities

Who Are The Players In Your Market?10

Who Are The Stakeholders…Implications?• Consumer

• Provider

• Third Party

• Government

• Physician

• Employer

• Banker

• Business

• Politician

• Community Leadership

• Education

Board Balance and Diverse

Representation Is Key!

11

Policy Making and C Suite Interface

• CAH Board Training and Management:• Value of IT and Technology

• Value of Partnership

• Value of Clinical and Physician Linkages and Partnerships

• Value of CEU, Board Awareness and Regular Awareness Efforts

Discuss Montgomery CountyCass CountyIllustrations

12

TeamworkHow The CAH/CHNA Links Providers With Overlapping Objectives Into the Service Area (Kicking Ours Off Right Now As We Speak):

• FQHC

• Acute Care Partner (Regional Sponsor of The CAH)

• Fulfilling the CAH Mission and Vision Via Partnership With Care Receivers

• County Health Department

• Local Nursing Care Centers

• Mental Health Association

• Pharmacy

• Local Practitioners

• Public School System

• Business Community

CAH Responsibility.

Who Involved? Why?

Where?13

CHNA – An Overview

• New (2010) Requirements for most Tax Exempt

Hospitals (2,894 of total 4,999)

• Dual eligible (federal NFP) not required to provide

• While required, should be viewed as a useful tool to

determine vulnerable populations and health disparities in

the community

• Most hospitals haven’t utilized the information other than

to meet requirements

• Next wave of assessments to be conducted in 2016 (for

2015)14

ACO Timeline

2007

Elliott Fisher of Dartmouth Medical School publishes “Creating Accountable Care Organizations: The Extended Hospital Medical Staff.” He is generally credited with coining the phrase “Accountable Care Organization.”

2011

• 3/31/11: CMS releases its proposed rules for the “Shared Savings Program,” inviting commentary before rules are finalized.

• 6/6/11 Comment period closes.

• Final rule will be released after all comments have been reviewed.

• CMS will accept applications for ACOs and will approve or reject by 12/31/11.

2014

All first year ACOs will have reached the shared risk stage, if they have continued with the Shared Savings Program.

Beyond2010

PPACA signed into

law

• Outlines a “Shared Savings Program.”

• CMS will determine how this program is to be implemented.

32 Around USA But 1/3 Dropped Out15

Keys to Success

Successful Co-

Management Agreement

Transparency

The Necessary

Tools

A Clearly Defined Plan

Service Line Expert

Established Expectations

Physician Leadership

Active Participation

The Future Physician Relationships(Employment, Co-Management, Other)

16

Key Elements of a CHNA Process

1. Data Assessment

- Service Area

Defined

- External and

Internal Sources

- Local Studies

- Community

Inventory

2. Community Input

- Public Health

- Underserved

Populations

- Chronic Disease

Populations

- Others

3. Implementation Strategy

- Summary of Data and

Community Input

- Prioritizing

- Implementation

Strategy for Each

- What is NOT included

and Why?

4. Reporting

- CHNA Summary

Report

- Implementation

Strategy Board

Approval

- Posted on Website

- 990 Reporting

5. Monitoring

- Measurements

- Annual Data

Updates

- Prepare for the

Next CHNA

What do we know? How do we package the

final material?

What are the priorities and

how do we implement?

What are we hearing?

What are we doing to track

results?IRS AuditOf Gaps!

Community Planning – CHNA

Partnership Effort On Finance, Needs and Strategy

Must ShareThe DataTo Work

Effectively!17

Assessing “Common Good” In Society

• Understanding the Basic Business Principles That Have Common Value:

• 2/3rds CAH’s would close if Congress retroactively enforces the 35mile rule.• Nebraska Map of distances between hospitals.

• See Map

• Partners with Federal Delegation

• Partnership With City/County Leadership

• Collaboration With Utility Providers (Water, Sewer, Electrical)

• Collaboration With Real Estate

• Selecting key Consultants to Support CAH

18

Nebraska Impact Considerations

19

Wow!93 Counties.

100 Hospitals.50+/- CAHs_?_ FQHCs

2 Medical Schools

Thinking Prior to Design & Construction

The Most Important Phase!

The Master Plan + Program = Choice/Need

20

What is integration?Combining two or more elements into an integral whole

Systems IntegrationSoftwareHardware

Inter-departmental IntegrationClinicalITFacilitiesAdmin

Interdisciplinary IntegrationClinicalBusinessResearchReporting

21

Why do we integrate? Save time Save money Create efficiencies Better outcomes Regulatory Pressures Staff Expectations Consumer Awareness Precision Benchmarks Transparency Safety and Security Performance Improvement

22

Dictation

Nurse Call

OR Integration

Pharmacy Distribution

PACS and other Imaging

Physiological Monitoring

Wireless Communications Systems

Wireless Computers for Bed Side Order Entry

Patient Entertainment and Education Systems

Patient Admitting/Process Flow and Control of Visitors and Patients

Clinical Systems

23

Visitor Networks

Voice over IP (VoIP)

All media (optical fiber, copper, coax)

Distributed Antenna Systems of Discrete Wireless Systems

Voice/Data/Wireless Networks (including traditional voice systems)

Pathways and Spaces (tray, comm. Rooms, inside and outside plant)

Cell Phone connectivity in-building including dual-band IP/GSM-CDMA

Convergence Systems

24

Simplifying the nurse’s tool belt.

Fundamentals of Design for Totally Integrated IT Systems

Gather Requirements, Goals & Objectives• Plan• Budget• Design• Engineer• Specify• Procure• Install• Interface• Integrate• Test• Train• Turn-over• Manage

DO THIS FIRST!

26

Outside PlantRFID and RTLS CATV/SATV/MATVEmployee TimekeepingMaster Clock/GPS Clock SystemsElectronic Signage and Kiosks SystemsAlarm and Event Management for BAS/BMSOverhead Paging and Local Intercom SystemsAudio/Visual -conference facilities, training, and controlCCTV and Access Control, Visitor Control, Intrusion Detection

All of these technologies can/should be integrated and moving toward one primary goal...

“More With Less, Long Distance and Seamlessly”!

Facility Systems To Carefully Consider

27

Departmental & Service Line Communication

Clarify Performance Expectations,Capacity, ROI,and Cost!

28

Construction Processes Considering Integration

Ideally An IPD Arrangement

Is In Process Using BIM Technology.

“Clash Detection”

Finding ProblemsBefore They Happen

29

The integration of

BIM technology at

HFR has allowed us

to explore design

ideas that were once

impossible. Now,

data from the entire

project can be

coordinated into a

single model, giving

us a thorough

understanding of

design and function.

Design Through IPD With BIM

30

Money Management

• Business, Finance, Funding and Capital Development Comments

• Cash on Hand• Capital Budgeting• Special Projects• Building For Better Cash Flow• USDA Funding As One Example of Support

31

Strategy + Architecture

• Strategic Planning, Facility Master Planning and Programming Comments

• Staffing, Quality and Change Management (Hospitalists, Intensivists, Robots, Scribes, Technology)

• Step-by-Step Process• Part of Business Plan• Road map • Vision

32

Opportunity +

• Innovation and Creative Considerations:• Ambulatory Care Options For Small and Rural Communities• Shifting to Free Standing Emergency Centers, Ambulatory

Surgery Center and Primary / visiting Specialist.• Creative HealthParks• Greenhouse Design for Senior Care• Memory Care and Assisted Living• Nursing Homes

33

Trends & Vision(Focus on Patient + Family 1st)

Why Research?Why Plan?

Motives.Needs.

Value Added.Purpose + Perceptions.

Family.Volunteerism.

34

Key Questions

• How Will Population Based Health and Integrated Delivery Systems Impact Technology?

• Why Would “Needs Based Efforts” Apply In The Technology Arena?

• What Are The Asset Implications Of An Integrated Healthcare Delivery System?

• How Does IPD and ITD Tie Together, Or Should They?

• Will IT Programs For the Future Show An ROI and What Are The Cost Savings (mapped cost accounting)?

35

Shift From Building Master Planning (MP) to Integrated System-wide Master Planning:

Consolidation Efforts (Impact of MD Employment and Extender Efforts)

Demolition (Combined With Preservation In Some Cases)Community Linkages and Continuity of Care (Needs Based and

Population Health)Real Estate (Re-Alignment of Assets Using Technology and Creative

A/E Design plus Energy is Expensive)Process Improvements (Modular Design, Waste Reduction, Efficiency

Metrics – HCA FacilitiGroup and Ascension Medexcel+ Trimedx Biomedical Support Program)

Technology (EMR, Digital, Remote Telemedicine and Robotics)

Why: More Effective Care With Better Access/Consolidate. GPS,

Onuma, Trelligence and Revit for A/E and IPD applications.

1

36

Emergency Medicine (Industry-wide Trends)No Waiting Emergenuity ModelFree Standing EDs (Trend Driven) Free Standing ED + HealthPark Support ServicesProcess Change and Training plus Performance Focused Clinical Pathways (SA, Children, Seniors, Cardiac)Enhancement of Efficiency + IncentivesRural and CAH Partnerships (Impact of FQHC Programs)

Why: Advanced, Less Expensive, Higher Quality Service Delivery Plus ED’s Need To Be BetterTeam Members. Stronger Data Interface.

2

37

Wayfinding Innovations and Advanced PlanningFunctional and Operational Wayfinding MethodsWayfinding Behaviors, Psycho/Social Factors, Time and

PerformanceSignage, Branding and Image EnhancementWayfinding CommunicationsWayfinding Management and Capital Project

Integration of Wayfinding With PlanningLess Consumer and Provider StressContextual Programming + FunctionalityAttitude AdjustmentsPeople + Ambassadors + StaffThe HUMAN WAYFINDING Chain

Why: Better Interior Design and Less Stress for ALL!

3

38

Rural Health and Shifting Service Delivery DynamicsCAH Transition (25 + 10 Utilization Shifts). ADC = 8+/-CAH Move to Free Standing ED and Post Acute ModelHealthPark Applications With Modular and Flexible

Components (Re-Alignments and Re-Purposing for Efficiency Purposes)

Rural Health Linkages to Post Acute, Rehab, Nursing Home, Assisted Living, Memory Care, etc.

CAH Partnerships and FQHCs, Medical Home Models,TeleMedicine, Robotics, Centralized Clinical Support

Centers (Clinical and Asset Implications)Leveraging Regional Partnerships and Economic Development (City, County, State, Public Health,

Industry and Family)

Why: Rural Areas Are Changing, It Is Time To Change.

4

39

Sharing Ideas and Impressions(The Future Is Not Here Yet…Hard To Predict, Trends Are Easier)

• Regulatory Impact (ACA and Private Pay – ACO a little too fast…move toward Co-Management with MDs).

• Mergers, Acquisitions and Network Partnerships.

• Community Health Needs Assessment (CHNA).

• Certificate of Need (CON).

• Guidelines and Standards of Practice.

• Research and Regional Implications.

40

Operations + Assets(Strategy, Buildings, Systems, Access, Process and Economics)

Old Fragmented Obsolete Low Tech Poor Environment Non – Compliant Wrong Location Image Safety

PartnershipsResource Re-Alignment

System UpgradesSmaller

Higher CapacityLess Maintenance Dollars

Shorter StaysFriendlier Staff

Safer + Modular + FlexibleSMARTER ARCHITECTURE

41

• Understanding The Dynamics and The Situation

• Changing Systems, Processes and Methods

• Community Linkages plus Demands

• Cost Reduction, Waste Reduction and Change

• Real Estate Re-Alignment and Savings (Energy, Rent, etc)

Integrated System-wide Master Plan(Full Continuum, Multiple Sites, 30,000 Foot Perspective)

42

Integrated System-wide Master Plan(Full Continuum, Multiple Sites, 30,000 Foot Perspective)

• Situation

• Cultural Work Up + Data Collection

• Asset Work Up, Inventory + Image

• System Work Up, Capacity + Conditions

• User Perspectives

• Consumer Perspectives

• Clinical Perspectives + Needs

• Size, Time, Money and Priorities

• Debt Capacity

• Decisions + Action

43

The ED Is The WindowTo The Community

(Demand, Exchanges, Convenience, Portal of Entry, Poor PC Support)

LastingImpressions!

44

Emergency Department Planning

45

The Free Standing ED, Urgent Care and New Models For

The Future(12 Hr Turn Around, Less Liability, Case Management Team, Follow Up, Network and Family

Friendly Effort)

Geriatric + W/IMedicine

Clinical Pathway(One Illustration)

46

The Rural Health Situation(CAH, Step Down, Post Acute, ED, Free Standing ED orPossibly Innovative HealthPark Model; Less Costly and No Waste)

47

B Model – M odest Reductions

M ASTER ZON IN G (M Z)

Conceptua l Design Our MP studies have illustrated the OPTIMUM HEALTHPARK but not a “precise application” on behalf

of the TRHMG smaller versions that may be more applicable to suburban and rural areas. In order to

prepare the prototype models, one must make some “gross assumptions” . In this case, we will TEST OUR

concepts with staff early in 2013 (scheduled for February briefings at this time).

Prototype M odels Plus Smaller Components

The development of these models is actually a reasonable way to begin a “prescriptive and iterative

process” which provides both CASE STUDIES and illustrative models that may be creatively adapted to the

TRHMG/ TRHMC regional services. Changes will occur as the MP process evolves due to the system-wide

adjustments in staffing, IT system enhancements and process improvements. These models will combine all

the existing services and “ test” as mentioned previously, new linkages that may not be readily apparent at

the onset. Briefly, each model; the A Model -- Full Scope, B Model -- Modest Reductions and C -- smaller

model all move toward the preferred groupings identified at the start of the MP process. (see representation

at left).

Each illustration decreases in size from 82,547 GSF to 49,586 GSF and finally, 33,988 GSF. The Excel

back up programs have been designed to permit a “careful and methodical selection” of rooms and

services that ultimately build the “preferred prototype” project. Smaller versions of these models can drill

down to the very basic services for example, the following:

A 9 E/ T Physician Clinica l Practice (No Diagnostic Support) New Construction:

o 10,070 BGSF (1,119 per MD)

o $2.0 to $3.0 M Total Project Cost Including All New Equipment

A Free Standing 6-Room Urgent Care Center Only:

o 5,710 BGSF for 6 Rooms plus Support

1. $1 - $1.5 M Total Project Cost Including All New Equipment

C Model – smaller model

Scope

A Model – Full Scope

A Model – Full Scope

Scope

A Model – Full Scope

A – C Models Developed By Size, and Proportional

To Need, Scope and Situation

48

Imaging

ASCSurgery

Pre/Post Recovery

Lab

Women’sService

FSED or Urgent

Care

Pharm

PhysicalRehab/Fitne

ssCompMed

InfantCare

Co

nco

urs

e o

r M

all

MO

BC

afet

eria

CommunityEducation

Eng

SleepCenter

“A Clinically drivenAnd ACO FriendlyCenter”

“Outpatient = Instant Referral”

Spa

ALot of

Parking +ADA

spaces

ConvenienceOptimumVision + GrowthDirectionImpressionsHealthPlace FitnessAlready An IssueRegional ImpactClinical Pathways:

-Seniors-Women-Infants-SA/Pain/Addicition-Education -Prevention

Spiritual

WellnessCtr

CommunityOutreach

ALot of

Parking +ADA spaces

An IDS Friendly HealthPark With ED Hub

Retail:

PharmacyDME

CosmeticApparelPodiatricWellness

Other

An Important Rural Opportunity!Less Expensive + More Appropriate.It’s About The Outpatient Package.

49

What is Programming in a Traditional Sense? A PROGRAMMING MATRIX FOR HOSPITAL PLANNING

GOALS FACTS CONCEPTS NEEDS ISSUES

FUNCTIONMission Statistical Data Service Groups Space Requirements Unique and important

Maximum Number Area Parameters Departmental Groups Room By Room Performance standards

Individual Identity Manpower/Workloads People Groups Equipment that will ultimately

People Interaction/Privacy Utilization Trends Special Activities Systems/Services shape/drive function and

Hierarchy Of Values User Characteristics Priority Parking Building design.

Activity Security Community Security Outdoor Spaces

Progression Value of Loss Sequential Flow Building Efficiency

Relationships Segregation Time/Motion Studies Separated Flow Functional Alternatives The existing building is

Encounters Behavioral Patterns Linkages/Networks obsolete...should be

Efficiency Space Adequacy Separated Flow replaced.

Mixed Flow

Relationships Can't recruit physicians

FORMSite Elements Site Analysis Enhancement/QA Quality (Cost/SF) Major considerations that

Site Land Use Climate Conditions Climate Control Environment and Site will ultimately impact

Property Ownership Code Survey New Image/Character Influences On Cost building function and

Environment Neighbors Engineering Survey Safety design quality.

Individuality Soils Analysis Special Foundations

Quality Direction FAR/GAC Density

Access/Egress Surroundings Interdependence The building is in the wrong

Image Physiological/Psychol. Home Base Location

Quality Level Cost/SF Network

Efficiency Orientation/Access No land available nearby.

ECONOMYAmount Of Funds Cost Parameters Cost Controls Project Budget What is the general attitude?

Return on Investment Maximum Budget Allocation Of Resources Operational Costs related to the initial budget

Cost Effectiveness Time-Use Factors Multi-Functional Debt Capacity expectations and real project

Initial Budget Operational Cost Market Analysis Merchandising Life Cycle Costs cost and that relationship

Capital Costs Income/Reimbursement JV/Investment Energy Costs to project quality standards?

Operating Costs Maintenance Energy Source/Costs Energy Conservation Loan Capacity

Capital Expenses Economic Data Cost/Benefit Reserves

Life Cycle Life Cycle Reductions Competition

Equipment Activities/Climate Design Related Groups

Systems/Energy Historical Position Capital Cost Pass Through

Automation Credit Rating

TIME Preservation Significance Adaptability Escalation Implications Of Change, Growth

Master Plan Behind/Ahead Phased/Staged Phasing Plan on the overall long-range

Past Static/Dynamic Space Parameters Tailored/Loose Fit Workplan performance of service

Change Activities Convertibility

Present Growth Projections Expandability

Controls/Limits Linear Schedule Concurrent Schedules Leadership is key

Future Occupancy Date Progress Interchangeability

Revenue Streams Limiting Factors Fast Track Conservative leadership today.

What Is The Statement Of The Problem....Opportunity?

To create a more

efficient hospital

Zoning requires a 50’ set back with

a 5 story max. height

The budget is $50 M total project cost.

Funding?

Use a CM and prepare early

release packages will help us open

quicker

What does LEED gain our

community, building users

and staff?

Doesn’t it Cost more to achieve the LEED status?

We’ve converted

to CAH, now we

must down-size

We prefer the

PlanetreeConcept

Is

GreenhouseDesignMore

Expensive?

56

Integrated ProjectDelivery (IPD)

Is On The Horizon

For The Future.

CAH Concept and Development Options

Diagnostic

and Admin

OP

Clinic

Office +

Admin +

Education

Surgery/Recovery

Imaging Suite

Laboratory

Emergency Department

Inpatient PT/Rehabilitation Services

Cardiopulmonary/RT

Sleep Lab

Pharmacy

Outpatient Clinical Services

Oncology Clinic

Dietary/Dining Fast Foods Variety

Materials Managment

Central Sterile Processing

Plant Operations

Housekeeping Only (Laundry at Nursing Home)

Staff Facilities

123

A

Three Building

Mall Concept…

IP Bed Pod2 – 25+

63

Program + Master Plan = Design

Excellence

The Architectural Program should be a key

aspect of the hospital campus master plan (MP).

The precursors to programming include: Owner and User Orientation to Process

Establish a Planning and Programming Leadership Committee

Completion of a Strategic Plan (Usually by Staff or Consultant)

Completion of a Campus Master Plan (MP) By Healthcare Consultant/Architect

Completion of Building Gross Program (All Departments Sized Using Various

Methods)

Formal Approval of the MP and the First Phase Projects to be Programmed

Ideally, the Departments Are Programmed

Simultaneous With the MP

Process…Better Results! (Often a Fee Issue With Owners) 65

What is Facility Master Planning (MP)?1. A “full service” road map for the hospital system and/or campus.

2. A “building study” based on mission, vision, strategy and actions.

3. A process that addresses all issues and then decides…to “build

or not to build”.

4. A MP reaches closure through “consensus” on objectives.

5. A MP includes more “health and healthcare information” than the

“traditional program”

6. A comprehensive MP includes a program.

Differences between a MP and a Program:1. Master planning is the “road map” and quite often the “visionary strategy”

while the program ties down the details suitable to conduct basic A/E design

services. A MP will also begin “early conceptual design and master zoning of

departmental services”. The MP might reveal strategies other than construction:

• Sell the facility.

• Move to a site.

• Conduct a feasibility study or a fund raising campaign.

• Seek a “systemwide partner” or close due to poor market share.

.66

Beginning Our

Capital Campaign

67

An Illustrative Budget Summary

Category of Cost Area/Unit Cost per SF Sub-Total RemarksA. Raw Const Light

0 $0 $0.00

0 $0 $0.00

0 $0 $0.00

71,636 $250 $17,908,897.00 Need Estimator Review

71,636 Hospital Only W/O MOB

B. (Allowance All New ) N/A None Required

C. (Allowance) N/A $1,500,000.00 12 - 15 Acres Range of Development (TBD)

(Allowance) N/A $0.00 (Parking, Sewers, Landscape, Misc)

D. $19,408,897.00 Requires Architect Verification

E.

$1,164,533.82 For Budgeting Purposes Only

$194,088.97 Assume 1% for Discussions

$0.00

CM Fee/Costs $0.00

F. (Assume 6% x D) $1,164,533.82 Early Estimate For Budgeting Only

G. $5,822,669.10 Some Credit for Existing Items

$388,177.94

H. $194,088.97 Permits, Legal and Admin. Support

I. Contingency $1,164,533.82 Assumes No Complications At Site

J. $0.00 By Owner

K. W/Line A Above Assume 4 Years (2 Yrs. Inflation)

$29,501,523.44 Budget For DiscussionTOTAL ESTIMATED BUDGET

(Line "D" plus "E" - "K")

(Assume 6% x D)

Debt. Service On Loan (Separate Budget)

Inflation To Mid Point (Separate Budget)

(6% Over 2 Years to Mid Construction)

Moveable/Fixed Equipment (Assume 30% x D)

Communications Equip. (Assume 2% x D)

Administrative Costs (Assume 1% x D)

Interior Designer (Assume 1% xD))

CM Cost Allowance (Assume Fixed Fee)

(Assume 03% x D)

Furnishings & Furniture

CONSTRUCTION COST (SUM of A-C)

Professional Fees

Architect/Engineer (Assume 6% x D)

New Const MOB

New Construction

Structured Parking

Fixed HVAC/El Equip

Site Development/Preparation

Site Development/Signage

Replacement Project Budget Illustration

Preliminary Order of Magnitude

P R O J E C T B U D G E T A N A L Y S I S

First Test for Discussion

Demolition

New Const Service

Size Linked to Cost Key Factor

70

Other Site Plan

Studies For

Campus Plan…

Location

Access

Growth

Image

Value

ROI

71

Other Site Plan Studies For Campus Plan

72

73

Thank YouQuestions, Thoughts and Suggestions

75