Endoscopy Center Data Analysis
About Healthcare Analytics Planning for the future is more complicated than ever for healthcare organizations. Exploring the impact upon the physical plant due to demand fluctuations, mergers and acquisitions, market conditions and consumer demands requires skillful vetting and interpretation of pertinent data. The understanding of the population demographics, utilization factors, catchment characteristics, trends within specific modalities and migration opportunities are critical to right sizing so that accurate translation to program needs and capital outlays can be evaluated.
Example Study - Endoscopy Center Community Hospital’s Growth Strategy In this hypothetical study a community based hospital has been experiencing a drop in Endoscopic Procedures due to a series of physician owned practices establishing freestanding Endoscopy Centers within the hospital’s catchment area. The hospital currently only performs endoscopic procedures within the hospital campus. 95% of those procedures are outpatient diagnostic cases. Patient satisfaction surveys have indicated concerns regarding the dated facility that currently houses this service line as well as the challenges of navigating the campus to the procedure suite. A migration of cases to the physician owned practices has been recognized by the hospital administration and they have asked IKM’s Healthcare Analytics group to explore options to regain and increase market share to remain competitive.
Case Load Projection Scenarios The study began by determining the current and projected caseloads of the hospital as well as two physician owned practices that compete for market share within the hospital’s catchment area. Using the data from the Healthcare Advisory Board it was determined that the hospital’s market share is 5.5%. Growing this service by acquiring practice A increases that market share to 27% (Scenario 1), adding practice B increases that to 20% (Scenario 2) and acquiring both practices would increase the market share to 32.7% (Scenario 3) at the end of 5 years. These numbers also include the assumption that there would be a migration of 10% of the remaining market share to a new freestanding facility that would provide consumer based efficient service and ample readily adjacent parking. Each of those scenarios would place the hospital in a better competitive position with the Academic Medical Center that dominates the market. Scenario 1: Acquiring Practice A (Market Share 27%) Scenario 2: Adding Practice B (Market Share 20%) Scenario 3: Acquiring both Practices (Market Share 32.7%)
Base Info
Information based on General Community Hospital Scenario FY
Catchment
Hospital
Market
Potential Acquisition
Potential Acquisition
Area Cases
Cases
Share
“A” Cases
“B” Cases
2019
24,020
1,321
5.5%
3,412
1,287
2024
24,767
1,362
5.5%
3,518
1,327
2029
24,572
1,351
5.5%
3,489
1,314
SCEN ARIO SCEN ARIO SCEN ARIO
1 2 3
FY
Total Cases
Migration of 10% of
Total
Hospital + “A”
Catchment Balance
Scenario 1
2019
4,733
1,929
6,662
2024
4,880
1,989
6,869
2029
4,840
1,973
6,814
FY
Total Cases
Migration of 10% of
Total
Hospital + “B”
Catchment Balance
Scenario 2
2019
2,608
2,141
4,749
2024
2,689
2,208
4,897
2029
2,665
2,191
4,856
FY
Total Cases
Migration of 10% of
Total
Hospital + “A & B”
Catchment Balance
Scenario 3
2019
6,020
1,800
7,820
2024
6,207
1,856
8,063
2029
6,154
1,842
7,996
Converting Volumes to Space Needs Utilizing the volume projections the development of a program was initiated. This process began by converting the volumes to the number of primary activity space to support that volume, the procedure room. Using average procedure and room turnover times and an 80% utilization as the factors in the equation, the number of procedure rooms was calculated. The number of procedure rooms was established by rounding the results to the next whole number.
Primary Activity Space Calculation
480 250 Operational Days
40 Average Procedure Time (Incl. Turnover)
Procedure Room Minutes Available Daily
80% Utilization *Graphics Apply to all 3 Scenarios
Scenario 1
Scenario 2
Scenario 3
Designed Case Load:
Designed Case Load:
Designed Case Load:
6,869
4,897
8,063
*One Dot Per 200 Cases
*One Dot Per 200 Cases
*One Dot Per 200 Cases
Cases Per Day:
Cases Per Day:
Cases Per Day:
34
24
40
*One Dot Per 5 Days
Procedure Rooms Needed: 2.86 *One Dot Per Room
*One Dot Per 5 Days
*One Dot Per 5 Days
Procedure Rooms Needed:
Procedure Rooms Needed:
2.04
3.36
*One Dot Per Room
*One Dot Per Room
An analysis of pre/post procedure was the next step in program development. This analysis included inputting some outliers to make sure the number of bays would be able to accommodate these natural variants. With those two primary components of a building program determined the balance of a space program was developed that resulted in an overall building size that needed to be constructed to support each of the scenarios.
Pre/Post Room Analysis: Scenario 1 Daily Work Hours Time in Pre/Post Rooms
Case # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34
1
2
3
4
5
6
7
8
9
10
Repeating Pattern of 9 Pre/Post Rooms
Outlier 1 With one outlier the need remains at 9 Pre/Post
Outlier 2
With one outlier the need expands to 10 Pre/Post
Pre/Post Room Analysis: Scenario 2 Daily Work Hours Time in Pre/Post Rooms
Case # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
1
2
3
4
Outlier 1
5
6
7
8
9
10
With one outlier the need remains at 6 Pre/Post
Outlier 2
With two outliers the need becomes 8 Pre/Post
Pre/Post Room Analysis: Scenario 3 Daily Work Hours Time in Pre/Post Rooms
Case # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
1
2
3
4
5
6
7
8
9
Repeating Pattern of 12 Pre/Post Rooms
Outlier 1
With one outlier the need remains at 12 Pre/Post
Outlier 2
With two outliers the need remains at 12 Pre/Post
10
The overall space program was formulated around the primary activity spaces It includes all the required spaces identified by FGI (Facility Guideline Institute) and various life safety codes. Departmental Net square footage is converted to Departmental Gross Square Footage which accounts for wall thickness, corridors, shaftways, stairs, and elevators. A final factor of exterior wall thickness is applied to determine building gross square footage which determines final size.
Program Statement: Scenario 1 Program Element
Number
Net SQ/FT
Program Element Total
Notes
Clinical Staff Support
Seating for 20
Unisex Locker Room Scrub Ex Changing Rooms Staff Toilet Breakroom Subtotal NSF
Public Areas Entry/Lobby Waiting Reception / Check In Interview Areas Check Out Front Desk Family Consult Center Administrator Misc Center Offices Meeting Room Center Administration Storage Public Toilet Rooms Subtotal NSF
1 1 1 2 1 1 2 1 3 1 1 1
300 500 120 60 40 200 120 120 100 180 60 160
300 500 120 120 40 200 240 120 300 180 60 320 2,200
10 2 1 1 1 1 1 1 1 3 20
110 100 60 80 150 100 120 200 60 60 2
1,100 200 60 80 150 100 120 200 60 180 40 2,290
Pre/Post Procedure Holding Bays Nurse Work Area Nourishment Med Room Clean Utility / Linens Soiled Utility Recliner / Stretcher Storage Storage Housekeeping Patient Toilet Rooms Patient Lockers Subtotal NSF Endoscopy Procedure Room Scope Cleaning Scope Storage Exam Room Medical Gas Manifold Room Storage Subtotal NSF
3 1 1 1 1 1
350 160 100 100 120 100
1,050 160 100 100 120 100 1,630
Number
Net SQ/FT
Total
1 1 2 2 1
200 60 40 60 150
200 60 80 120 150 610
1 1 1 1 1 1 1 1 1 1
150 80 400 120 120 100 80 80 120 60
150 80 400 120 120 100 80 80 120 60 1,310
1 1 1 1
200 200 150 120
200 200 150 120 670
1 1 1 1 1 1 1
80 120 150 200 0 300 0
80 120 150 200 0 300 0 850
Notes
Material Management Receiving Area Receiving Clerk Bulk Storage Clean Linen Storage Soiled Linen Holding Trash Holding Hazardous Holding Recycle Holding Office Staff Toilets Subtotal NSF
Share with EVS
Environmental Serv. Bulk Storage Equipment Storage Employee Breakroom Lockers Office Subtotal NSF Utility Support Water Service Entry Hot Water Heaters / Pumps IT Servers Electrical Transformers Emergency Generator Electrical Switchgear Air Handling Units Subtotal NSF Subtotal Net Square Footage
9,560
Departmental Grossing Factor
0.4
3,824
Building Grossing Factor
0.1
1,338
Total Gross Square Footage
14,722
On Roof
Program Statement: Scenario 2 Program Element
Number
Net SQ/FT
Program Element Total
Notes
Clinical Staff Support
Seating for 15
Unisex Locker Room Scrub Ex Changing Rooms Staff Toilet Breakroom Subtotal NSF
Public Areas Entry/Lobby Waiting Reception / Check In Interview Areas Check Out Front Desk Family Consult Center Administrator Misc Center Offices Meeting Room Center Administration Storage Public Toilet Rooms Subtotal NSF
1 1 1 2 1 1 1 1 2 1 1 2
200 400 120 60 40 150 120 120 100 150 60 160
200 400 120 120 40 150 120 120 200 150 60 320 1,800
8 2 1 1 1 1 1 1 1 3 15
110 100 60 80 120 100 100 150 60 60 2
880 200 60 80 120 100 100 150 60 180 30 1,960
Pre/Post Procedure Holding Bays Nurse Work Area Nourishment Med Room Clean Utility / Linens Soiled Utility Recliner / Stretcher Storage Storage Housekeeping Patient Toilet Rooms Patient Lockers Subtotal NSF Endoscopy Procedure Room Scope Cleaning Scope Storage Exam Room Medical Gas Manifold Room Storage Subtotal NSF
2 1 1 1 1 1
350 160 80 100 100 100
700 160 80 100 100 100 1,240
Number
Net SQ/FT
Total
1 1 2 2 1
160 60 40 60 150
160 60 80 120 150 570
1 1 1 1 1 1 1 1 1 1
150 80 300 120 120 100 80 80 120 60
150 80 300 120 120 100 80 80 120 60 1,210
1 1 1 1
150 150 150 120
150 150 150 120 570
1 1 1 1 1 1 1
80 120 150 200 0 300 0
80 120 150 200 0 300 0 850
Notes
Material Management Receiving Area Receiving Clerk Bulk Storage Clean Linen Storage Soiled Linen Holding Trash Holding Hazardous Holding Recycle Holding Office Staff Toilets Subtotal NSF
Share with EVS
Environmental Serv. Bulk Storage Equipment Storage Employee Breakroom Lockers Office Subtotal NSF Utility Support Water Service Entry Hot Water Heaters / Pumps IT Servers Electrical Transformers Emergency Generator Electrical Switchgear Air Handling Units Subtotal NSF Subtotal Net Square Footage
8,200
Departmental Grossing Factor
0.4
3,280
Building Grossing Factor
0.1
1,148
Total Gross Square Footage
12,628
On Roof
Program Statement: Scenario 3 Program Element
Number
Net SQ/FT
Program Element Total
Notes
Clinical Staff Support
Seating for 25
Unisex Locker Room Scrub Ex Changing Rooms Staff Toilet Breakroom Subtotal NSF
Public Areas Entry/Lobby Waiting Reception / Check In Interview Areas Check Out Front Desk Family Consult Center Administrator Misc Center Offices Meeting Room Center Administration Storage Public Toilet Rooms Subtotal NSF
1 1 1 2 1 1 2 1 3 1 1 2
300 600 120 60 40 200 120 120 100 180 60 180
300 600 120 120 40 200 240 120 300 180 60 360 2,340
12 3 1 1 1 1 1 1 1 3 25
110 100 80 100 180 120 120 250 60 60 2
1,320 300 80 100 180 120 120 250 60 180 50 2,760
Pre/Post Procedure Holding Bays Nurse Work Area Nourishment Med Room Clean Utility / Linens Soiled Utility Recliner / Stretcher Storage Storage Housekeeping Patient Toilet Rooms Patient Lockers Subtotal NSF Endoscopy Procedure Room Scope Cleaning Scope Storage Exam Room Medical Gas Manifold Room Storage Subtotal NSF
4 1 1 1 1 1
350 200 120 100 120 120
1,400 200 120 100 120 120 2,060
Number
Net SQ/FT
Total
1 1 3 2 1
240 60 40 60 180
240 60 120 120 180 720
1 1 1 1 1 1 1 1 1 2
150 80 500 160 160 120 80 80 120 60
150 80 500 160 160 120 80 80 120 120 1,570
1 1 1 1
250 250 150 120
250 250 150 120 770
1 1 1 1 1 1 1
80 120 150 200 0 300 0
80 120 150 200 0 300 0 850
Notes
Material Management Receiving Area Receiving Clerk Bulk Storage Clean Linen Storage Soiled Linen Holding Trash Holding Hazardous Holding Recycle Holding Office Staff Toilets Subtotal NSF
Share with EVS
Environmental Serv. Bulk Storage Equipment Storage Employee Breakroom Lockers Office Subtotal NSF Utility Support Water Service Entry Hot Water Heaters / Pumps IT Servers Electrical Transformers Emergency Generator Electrical Switchgear Air Handling Units Subtotal NSF Subtotal Net Square Footage
11,070
Departmental Grossing Factor
0.4
4,428
Building Grossing Factor
0.1
1,550
Total Gross Square Footage
17,048
On Roof
Converting Space Needs to Capital Investment The final step in this study engagement was to provide a probable cost to the hospital for constructing an outpatient Endoscopy Center for each of the three scenarios. This probable cost model included soft costs of professional fees as well as FFE costs in addition to the hard construction costs. Scenario 1 would require the hospital to invest approximately $9.6M, Scenario 2 $8.3M and Scenario 3 $11.1M. These do not include the land acquisition costs or the practice acquisition costs. With these numbers the hospital would be able to complete their overall financial analysis to determine the Return on Investment and the Board of Directors could make an informed decision regarding the future of this service line.
Opinion of Probable Project Costs (Scenario 1) Project
Description
SF Size
Construction
New
Unit Price SF
Construction
Site Work Shell Construction
14,722
$190
Design
FFE
Category
Total with Fees
10%
Total Project
and FFE
Contingency
Costs
Category
Cost
Cost
$200,00
L
$13,000
$213,000
$21,300
$234,300
$2,797,180
L
$181,817
$2,978,997
$297,900
$3,276,896
Major Departmental Fit Outs 1
Public/Staff Areas
4,327
$150
$649,050
M
$51,924
M
$146,036
$847,010
$84,701
$931,711
2
Clinical Areas
6,468
$425
$2,748,900
H
$261,146
H
$962,115
$3,972,161
$397,216
$4,369,377
3
Mechanical & Building
3,927
$100
$392,700
L
$25,526
L
$39,270
$457,496
$45,750
$503,245
Support Miscellaneous Contingency
$325,000
(Other Potential Owner Costs) Total Cost Per SF Excludes Costs Associated with: Land Acquisition Hazardous Material Financing
$6,787,830
$533,412
$1,147,421
$8,468,663
$846,866
$9,640,529
$461
$36
$78
$575
$58
$655
Estimated Percentages of Construction Design Fees FFE H 0.095 0.35 L 0.065 0.1 M
0.08
0.225
Opinion of Probable Project Costs (Scenario 2) Project
Description
SF Size
Construction
New
Unit Price SF
Construction
Design
Category Site Work Shell Construction
12,628
Major Departmental Fit Outs
$200
Cost
FFE
Category
Total with Fees
10%
Total Project
and FFE
Contingency
Costs
Cost
$175,000
L
$11,375
$186,375
$18,638
$205,013
$2,525,600
L
$164,164
$2,689,764
$268,976
$2,958,740
$150
1
Public/Staff Areas
3,650
$425
$547,500
M
$43,800
M
$123,188
$714,488
$71,449
$785,936
2
Clinical Areas
5,280
$100
$2,244,000
H
$213,180
H
$785,400
$3,242,580
$324,258
$3,566,838
3
Mechanical & Building
3,698
$369,800
L
$24,037
L
$36,980
$430,817
$43,082
$473,899
Support Miscellaneous Contingency
$300,000
(Other Potential Owner Costs) Total Cost Per SF
$5,861,900
$456,556
$945,568
$7,264,024
$726,402
$8,290,426
$464
$36
$75
$575
$58
$657
Total with Fees
10%
Total Project
and FFE
Contingency
Costs
Opinion of Probable Project Costs (Scenario 3) Project
Description
SF Size
Construction
New
Unit Price SF
Construction
Design
Category Site Work Shell Construction
Cost
FFE
Category
Cost
$225,000
L
$14,625
$239,625
$23,963
$263,588
17,048
$175
$2,983,400
L
$193,921
$3,177,321
$317,732
$3,495,053
Major Departmental Fit Outs 1
Public/Staff Areas
4,712
$150
$706,800
M
$56,544
M
$159,030
$922,374
$92,237
$1,014,611
2
Clinical Areas
7,953
$425
$3,380,025
H
$321,102
H
$1,183,009
$4,884,136
$488,414
$5,372,550
3
Mechanical & Building
4,383
$100
$438,300
L
$28,490
L
$43,830
$510,620
$51,062
$561,681
Support Miscellaneous Contingency
$350,000
(Other Potential Owner Costs) Total Cost Per SF
$7,733,525
$614,682
$1,385,869
$9,734,076
$973,408
$11,057,483
$454
$36
$81
$571
$57
$649
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