Big Plans for Big Boxes
Pros and Cons of
Retail-To-Healthcare Conversions
Session Description
In the progressively challenging financial
environment facing the delivery of healthcare,
institutions are increasingly considering
repurposing existing “big box” facilities for
healthcare functions. Opportunities exist in this
approach, but challenges also lurk.
Session Objectives
• Identify potential benefits of repurposing an
existing facility and assess likelihood of fruition
• Assess appropriateness of potential investment
• Assemble a list of potential pitfalls
• Explain examples of pros and cons that might
not be readily evident
Introduction
1
2
3
4
- Drive for more with less cost, yet higher quality
- Disruptive innovation & digital transformation
- Ambulatory settings to reduce costs / provide access
- Industry trends in facility conversion
Presentation Format
1
- Original Drivers / Strategy
- Guiding Principles
2
- Selection of Neighborhood / Search For Facility
- Experience of Conversion Process
3
- Lessons Learned
-
Suitability for purpose
Economics: planned cost vs. actual
Challenges / restrictions / surprises
ORIGINAL DRIVERS / STRATEGY
GUIDING PRINCIPLES
JPS Health Network
System Facilities
2
49
INPATIENT LOCATIONS
UNIQUE LOCATIONS
Patient Care Pavilion and John Peter Smith Hospital Fort Worth Campus
$1.7B
ECONOMIC IMPACT – CREATING MORE
THAN 12.5K JOBS IN TARRANT COUNTY
ACADEMIC PARTNERS:
UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL
BAYLOR MEDICAL CENTER
UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER
TEXAS A&M HEALTH SCIENCE CENTER
20 schoolbased
health
centers
1.1 million
patient
encounters
annually
nation’s
largest
hospital-based
family
medicine
residency
30 primary
care
and specialty
clinics
JPS Project Strategy
- Moving from fee-for-service to medical
-
home model
Improve the patient experience
Increased access with design
Community education
Locate services near our patients
Provide services at one location
Proximity to other services
Reduce operational costs
Design and build a prototype for the
patient-centered medical home
JPS Clinical Access
6 JPS Sites
located within a
3.5-mile Radius
3.5 Mile
Radius
Source: Data Bank CHC Revised January 2010.pdf + JPS Contacts.
9
JPS Project Guiding Principles
1
2
3
4
5
Promote Patient and Family-
Centered Principles
6
7
8
9
10
- Welcoming, Patient Friendly, Easy To Access
And Navigate
- Child Friendly, Respite Spaces, Reduced Stress
Encourage Partnerships Between
Providers, Staff & Patients
Promote Active Patient Engagement
With Dignity And Respect, Including Use Of
Remote Health Management
- Access To Internet, Family Resource Area
Protect Patient Privacy, Both
Visual And Auditory
Practice At The
“Top Of License”
11
12
13
14
15
Integrate Ancillary Services To
Support The Medical Home
Computer Access Outside Exam
Rooms To Facilitate Work Flow
Meet The Diverse Needs Of Our
Population
Establish The New JPS Health
Network Brand
Promote Provider Fulfillment,
Effectiveness and Satisfaction
Pursue LEED Certification If
Practical and Affordable
Leverage Technology To
Optimize Work Of Our People
Exam Room Layout To
Facilitate Interaction &
Documentation
Support Education Needs For
Patients and Community
Provide “Alternative Hour”
Access To Designated Areas
JPS Secondary Guiding Principles
1
2
3
4
5
6
7
Promote Flexibility
Standardize Room Sizes For Future Alternative Uses
Optimize Efficiency
Limit Travel Distances To Frequently Used Spaces
Seek To Share Spaces, Staff and Functions
Provide Family “Self-Testing” Room For
Unscheduled Use
Include Quiet/Meditative Space Option For
Patients
Be Mother Friendly
Support “On-stage” and “Off-stage”
Circulation and Functions
TCH Background
System Facilities
2
10
8
INPATIENT CAMPUSES
MAJOR BUILDINGS
MILLION SF
(3RD UNDER CONST.)
Texas Medical Center
West Campus
The Woodlands
7 CORPORATIONS
OVER
Health Centers
TCHP – The Center for
Children & Women
Texas Children’s Pediatrics
And Community Cares
Urgent Care
10,000 EMPLOYEES
ACADEMIC PARTNER:
BAYLOR COLLEGE OF MEDICINE
MFM/Therapy Center/
Imaging
Greater Houston Area
TCH Project Guiding Principles
1
2
3
4
5
Change “sick engine model” to “well engine
model” delivered by a health care team
Leverage medical home concept within existing
expenditures by downstream savings – ED &
NICU
Patient and Family-Centered Medical Home
New model of delivery: personal physician
leads team of individual who collectively take
responsibility for the ongoing care of patients
8 year implementation trajectory for a positive
ROI
Lower cost physical setting
6
7
8
9
10
Target population: children and pregnant women
Ultimate size: 359,000 members
Center 1, Year 1: 16, 408 members; Year 2: grow by 40%; and Year 3:
grow by 26% (ultimately serving 28,884 members at this location)
Enhanced afterhours and weekend access to care
Equip healthcare team with timely data to identify
how to best serve patients and families
Physically dispersed into community that is served
Multiple Center locations anticipated (2
created to date)
J P S H E ALT H N E T W O R K
JPS Patient Demographic Study
Note: Driving times are
averages used in Microsoft
Areasand
of Poverty
MapPoint,
may not include Central Tarrant County,
Northern
partrush
of Arlington,
South Central Tarrant
adequately
reflect
times
and County
other non-controllable
traffic factors.
The zip codes with the largest populations < 250% FPL
and uninsured are within 20 minutes of JPS’ main
campus, with the exception of North Arlington’s 76010,
which is inside of 30 minutes.
*Because this is a service area analysis, there are pockets of wealth, but
overall the average HH income is below $35,000 for these areas
15
JPS
Patient
Origin
Current
State
– Study
Patient Origin
Patient Origin: All Zip Codes
76010
76014
76018
76017
76011
76013
75052
76002
76063
76001
76012
76015
76006
76016
76040
76112
76039
76119
76180
76120
75051
76140
All Others
Grand Total
JPS Arlington
% of patient
Family Practice visits from each
& Urgent Care
zip code
3,291
12.9%
2,486
9.7%
1,679
6.6%
1,491
5.8%
1,388
5.4%
1,269
5.0%
1,232
4.8%
1,184
4.6%
1,147
4.5%
1,063
4.2%
915
3.6%
805
3.2%
759
3.0%
650
2.5%
497
1.9%
355
1.4%
326
1.3%
295
1.2%
246
1.0%
276
1.1%
281
1.1%
259
1.0%
3,618
14.2%
25,512
100.0%
Cumulative % of
patient visits from
each Zip Code
12.9%
22.6%
29.2%
35.1%
40.5%
45.5%
50.3%
55.0%
59.5%
63.6%
67.2%
70.4%
73.3%
75.9%
77.8%
79.2%
80.5%
81.7%
82.6%
83.7%
84.8%
85.8%
100.0%
Connection membership 2/28/11 = 12,400
Operational Parameters: Workload Volumes
Future Scenario Projections
JPS Site Selection
JPS
Campus
Arlington
Medical Home
JPS Conversion
$7.2M Original Construction Budget
$6.1M Final Construction Cost
2 Bidders After 16 Pre-Bidders (Complexity, Building Access,
Unknowns From Limited Investigation, Aggressive Schedule)
Different Footprint From When Project Started
Approvals Required By Neighboring Tenants – Couldn’t Add Coffee
Shop
Cooper Commons
Arlington, TX
Medical Home – Space Program Summary
Total Area
Admin / Public Area
Diagnostics
50,400 sf Quantity of Rooms
11,045 sf
7,770 sf 2 Gen Rad, 2 US, 2 Mammo, 1 Bone
Exam Modules
16,560 sf 40 Exam Rooms, 8 Consult Room
Women’s Clinic
5,785 sf 12 Exams, 2 Consult, 2 Centering
Dental Clinic
1,730 sf 5 Operatories
Behavioral Health
1,170 sf 5 Exam Rooms
Support Services
4,170 sf
Education
2,170 sf