Obstetric Service Line Facility Feasibility 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 - Obstetric Care Hospital Expansion vs. Free Standing Birth Center The IKM Healthcare Analytics group has developed a process to assist facilities in assessing, determining, and understanding their needs in the context of volume projections and market influences. In this example we have analyzed the Denver market and one of the hospitals, hospital A, which is evaluating increasing their market share by either acquiring an existing OB/GYN practice and building an obstetric addition, or by acquiring a midwifery practice and constructing a freestanding birthing center.
Market Share Analysis
46,453 2019 TOTAL CATCHMENT AREA Deliveries
1,906 2019 TOTAL DELIVERIES Hospital A
4.1% 2019 HOSPITAL A MARKET SHARE Total Deliveries
The initial step is collecting the appropriate data for the current conditions. In this case it was the number of deliveries in the entire catchment area, the share for the client ‘Hospital A’ as well as the other market focus impacting this client.
Volume Projections with OB Practice Acquisition 8000 6000
2019
2024 Total Deliveries
2097
4105
6202
2074
4054
6132
2164
0
4274
2000
6439
4000
2029
Vaginal
C-Section
1877
1901
2000 1980 1960 1940 1920 1900 1880 1860 1840 1820
1983
Volume Projections with Midwifery Acquisition
2019
2024
2029
Vaginal
*Included is a projection of cases from the remaining catchment that would migrate. Given that this facility has a low percentage of the overall market, we projected 2% of remaining cases in the catchment area would migrate.
Community Hospital Obstetric Service Line Study The next step is to calculate the number of LDRP’s as they are the primary activity space upon which the balance of the space program is built around. The total annual caseload is divided by the operational days and then a utilization factor applied which will determine the designed loading of vaginal cases per day. The utilization factor for this modality is 65% as the seasonal fluctuation of deliveries is accounted for along with the normal nuances of unpredictable timing associated with care delivery. These cases have an average length of stay (LOS) applied that includes room turnover. The LOS is an industry tested metric and potential modified by the particular institution history and standard. The result is the number of LDRP’s that would accommodate the projected demand except on outlier days.
Primary Activity Space Calculation - LDRP for Vaginal Births Scenario
Designed Case Load
Operational Days
Utilization Ratio
Cases vaginal Per Day
Average LOS
LDRP Rooms Needed
Scenario 1
4105
365
65%
17.3
2
34.60
Scenario 2
1901
365
65%
8.0
1.75
14.02
Programming for Growth Looking at the projected volumes for 2029 we are able to determine the primary activity spaces for the addition that would be C-Section operations, post-partum rooms and LDR’s. For the hospital addition option, it is the birthing rooms (see appendix) once the primary activity spaces are determined a complete building program can be formulated. The primary activity spaces are the building blocks off of which a detailed space program of net square footage can be developed. This includes each space then applies industry standards net to gross factors to accommodate circulation and wall thickness to establish a departmental gross program. Then finally, a building grossing factor is approved. To account for exterior wall thickness and all vertical penetrating elements: stairs, elevators and shafts. This results in a final program. This then results in a building square footage to support the program.
Labor & Delivery
# of Rooms
NSF
Total
Ante / Post Partum
# of Rooms
NSF
Total
Admin / Public Areas
# of Rooms
NSF
Total
LDRP
35
400
14.00
Patient Rooms
36
240
8,640
Entry / Lobby
1
500
500
Patient Toilet Rooms
35
60
2,100
Patient Toilet Rooms
36
60
2,160
Waiting
1
875
875
Triage Rooms
6
160
960
Reception
1
120
120
Reception / Check In
3
120
360
Triage Toilet Rooms
6
60
360
C-Section
3
500
1,500
Nurse Station
3
240
720
Interview Areas
3
60
180
Equipment Alcove
18
10
100
Front Office
1
200
200
Sub Sterile
3
120
360
Nursery
1
600
600
Family Consult
3
120
360
Scrub Alcove
3
20
60
Nursery Work Room
1
120
120
Administrator
1
120
120
C-Section Control Desk
1
120
120
Formula Prep
1
120
120
Misc. Center Offices
4
100
400
C-Section Equipment Storage
1
300
300
Med Prep
3
100
300
Classroom Room
2
300
600
C-Section Infant Evaluation Room
3
120
360
Clean Utility
3
120
360
Center Admin Storage
1
150
150
Staff Changing Room
2
160
320
Equipment Storage
3
300
900
Public Toilet Rooms
2
240
Nurses Station
3
180
540
Wheelchair Storage
1
50
50
Subtotal NSF
Nurses Work Area
18
20
360
Soiled Utility
3
160
480
Multidisciplinary Work Area
3
240
720
Nourishment
3
100
300
Equipment Alcoves
18
10
180
Nurse Manager
1
120
120
Med Prep
3
100
300
Office Misc.
2
160
320
Clean Utility
3
120
360
Data Closet
2
120
240
Equipment Storage
1
300
300
Electrical Closet
2
120
240
Wheelchair Storage
1
50
50
Housekeeping
3
60
Soiled Utility
3
100
300
Subtotal NSF
Nourishment
3
100
300
Nurse Manager
1
120
120
Office Misc.
2
160
320
Visitor Toilet Room
4
60
240
Patient / Family Lounge
1
500
500
Data Closet
2
120
240
Electrical Closet
2
120
240
Housekeeping
3
60
Subtotal NSF
180 25,690
180 15,970
480 4,225
Determining Probable Cost Utilizing the detailed program cost categories based on complexities and local market conditions can be established to develop a thorough opinion of project cost. This includes an overlay of expected expenses associated with FFE and design services. Additionally, a 10% contingency is applied to develop an overall project budget estimate for facility development. The client can then analyze that with respect to operating expenses and revenue projections to develop an ROI to determine the viability of a project.
Project
Description
SF Size Construction
New
Design
FFE
Unit Price SF Construction
Site Work Shell Construction
Category
Total with Fees
10%
Total Project
and FFE
Contingency
Costs
Category
Cost
Cost
$500,000
L
$30,000
$530,000
$53,000
$583,000
$13,501,844
L
$810,111
$14,311,954
$1,431,195
$15,743,150
81,043
$167
1
Public / Staff Areas 12,990
$132
$1,708,524
M
$128,139
M
$384,418
$2,221,081
$222,108
$2,443,189
2
Clinical Areas
59,552
$373
$22,192,766
H
$1,886,385
H
$7,767,468
$31,846,619
$3,184,662
$35,031,281
3
Mechanical /
8,501
$88
$745,390
L
$44,723
L
$74,539
$864,653
$86,465
$951,118
Major Departmental Fit Outs
Building Support Allowance
$400,000
(Other Potential Owner Costs) Total Cost Per SF Excludes Costs Associated with: Land Acquisition Hazardous Material Financing
$38,648,524
$2,899,358
$8,226,425
$49,774,307
$4,977,431
$55,151,738
$477
$36
$102
$614
$61
$681
Estimated Percentages of Construction Design Fees FFE H 0.085 0.35 L 0.06 0.1 M
0.075
0.225
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