After you estimate your square footage, re-run the pro-forma and subtract 500 or 1,000 feet from the building program and re-run the numbers. The cost to construct the shell and interior of an ASC can be between 5 per square foot to as much as 0 per square foot. The reduction of 1,000 square feet from your construction estimate could save you as much as 5,000 to 0,000 in construction costs, and ,000 or more in annual operating costs. If the center is properly designed, the reduction in square footage may not cause any change in the function of the building.
New vs. Existing Facilities
There are nonetheless some disadvantages to a completely new construction site. If you select a previously constructed building, the architect will have existing structures which may somewhat limit the facility design, but, conversely, all site development work will have been done and paid for, and construction time can possibly be substantially reduced.
Construction Standards
Those who have not previously developed Ambulatory Surgery Centers often believe that ASC construction is the same as medical office building construction, when, in fact, the two types of structures are different. Because of the obvious life-safety concerns, a single city inspection is now replaced by multiple inspections at the city, state, and federal levels.
Federal Level Regulation
On the federal level, some limited construction information can be found in the Code of Federal Regulations-Title 42, Volume 2, Chapter IV, Part 416-Ambulatory Surgical Services. Some consider the "Guidelines for Design and Construction of Hospital and Health Care Facilities," published by the American Institute of Architects, as the bible for construction of Ambulatory Surgery Centers.
State Level Regulation
When you research the construction standards for Ambulatory Surgery Centers, you will find, unfortunately, that there is little uniformity among the states. Some states have no regulations regarding Ambulatory Surgery Centers, while other states have quite lengthy regulations which include many facility standards. For example, Florida has adopted many national construction codes and includes a listing of those codes in their ambulatory surgery state regulation.
Local Regulation
Often the city or local entity will require that your construction documents be approved by the city construction office before you can receive a construction license.
The Construction Team: You Can't Afford Rookies
Often we tend to think of the construction team as simply the general contractor, when in fact the team has many members. The construction team consists of the architect, the engineer, and on occasion structural and civil engineers. The cost for each of these team members should be reviewed as a part of the overall construction costs. An ASC is a complex facility, which requires special knowledge and experience on the part of the entire design team.
Selecting a General Contractor
When selecting a contractor, always look for one who has done medical projects, preferably Ambulatory Surgery Centers. Check not only the references of your general contractor, but the references of the proposed sub-contractors as well to ensure they have had experience meeting healthcare requirements. The construction process can be an adversarial process, and at times confrontational, so be careful when selecting a friend as your contractor. If there is a very important person (VIP) on your project, it is the construction superintendent.
The Construction Contract
Once your construction contract has been either bid or negotiated, the general contractor will ask you to sign a construction contract. Look for changes to the standard form which were made by your contractor, and don't hesitate to have your attorney review the contract. You should always specify a time of completion for the project, and in some states you can even include special penalty clauses to charge the contractor, in the event the work is not finished on time.
The Process
Once the construction contract has been signed, a representative of the ASC gives the contractor a notice to proceed, and the contractor will obtain building permits from the local building authority. Thereafter, monthly progress meetings should be held with the contractor, architect and ASC representative (consultant) to resolve outstanding issues, ensure that the facility is being constructed based on the architect's plans, and ensure that the timeline for construction is being met.
Change Orders
If the contractor finds a problem with the architectural drawings or if a change is requested by the ASC, then a change order may be requested by the general contractor. Change orders can increase contract costs significantly and must be closely monitored. It is quite common to experience change orders that increase building costs as much as 10 to 20 percent of the total construction cost.
Inspections
During the construction process, the construction will be monitored on a daily basis by the superintendent, and the city or county having jurisdiction will make numerous inspections to ensure all city codes are being met. In addition, some states will make periodic inspections, as well as full inspections at the completion of the project.
Boiler inspection if you have boilers on your sterilizers
Emergency power system
Nurse call system
Fire sprinkler system
Depending on the state, the following inspectors may be sent to evaluate the ASC: fire marshal, sanitarian, boiler inspector, construction department, pharmacy board, and licensure office. Construction of an ASC is a complex and heavily regulated process, which requires knowledgeable and experienced participants at every step in the process.
