When it opens in the spring of 2010, Huggins Hospital in Wolfeboro, N.H., will have completed its largest building project in more than a century with a facility that is considerably larger than most critical-access hospitals.
Its an ambitious project for a small hospital and comes at a time when some executives, given the flagging economy, are reconsidering their construction plans.
Located in the central part of the state, in the eastern section of whats known as the Lakes region, Huggins serves a population of about 30,000 during most of the year, and anywhere from three to five times that amount in the tourist season of mid-May through mid-September. Originally built in 1907 about a block and a half from its current location, Huggins relocated to its current site in 1923, according to Christine Strong, vice president of marketing and development at the hospital. Huggins, which was designated as a critical-access hospital in June 2005, reported operating revenue of just under $809,000 in fiscal 2007.
The existing facility is an aging, outdated infrastructure, Strong says. It did not accommodate modern technology and what patients were looking for in a hospital setting. The board went through a cost analysis to determine if they should renovate or build in another community or build on the current spot. The most prudent and cost-effective measure would be to stay on this existing campus and rebuild the hospital on the existing site.
According to Strong, it has taken about five years for this project to evolve, and there are three reasons why it is happening now: the age of the facility, a shift in area demographics and changes in healthcare. For example, when the old hospital was built, patients stayed in the hospital for treatment for a longer period of time.
Now there are shorter inpatient stays and more is done on an outpatient basis, Strong says. That is one change that is driving the configuration of the facility.
Other changes in healthcare led to the need for private treatment for patients that developed from the Health Insurance Portability and Accountability Act of 1996. Another driver has been rapid growth in research and technology.
We have a facility that is not conducive to accommodating new technologies, Strong says. We have state-of-the-art equipment, but not adjacent to each other. In the new facility, neither patients nor equipment will have to be transferred to different ends of the hospital, as they do today.
In addition, Strong says 57% of the hospitals patient population is Medicare and that growth projections estimate that one in three patients will be eligible for Medicare within five years in Carroll County, where Huggins is located. They have needs for different kinds of healthcare services. We want a hospital to address the needs of young families and a retiring population.
Several factors have made this project possible for Huggins in the current economic environment, according to Daniel ONeill, vice president of finance at the hospital. To begin, the hospital has not had any major construction in the past 20 to 30 years.
The board of trustees, being good stewards, has put money aside in investments, ONeill says. We built a pretty good reserve, or nest egg, if you will, with the anticipation that the hospital would need to do this to provide good quality care to the community. In those monies, we had most of what wed need to do the project.
Huggins did not think it prudent to spend all of its reserves, however, so it also relied on two bond issues. The first, for $10 million, came in November 2007, and a second, for $15 million, is yet to come. Also, trustees liquidated a large portion of the hospitals funds from the equity market in September 2007, which was equivalent to about half of what the facility needed for the $52 million project, ONeill says.
The only other piece of the equationand its not in the financing upfront, but more long-term servicing the debtis the fact that were a critical-access hospital and cost reimbursement will be favorable, ONeill says.
After an analysis of the hospital site, Huggins applied for a certificate of need in late 2006, which was approved in March 2007, according to John Weaver, chief executive officer and founder of Bostons DiGiorgio Associates, the architecture firm Huggins chose to design the facility. Huggins selected Providence, R.I.-based Gilbane, a family owned construction and real estate development company since 1873, to build the replacement hospital that will add 101,100 square feet. Currently, the hospital spans 147,400 square feet, of which 53,600 will be demolished. Accounting for about 38,000 square feet that will remain unoccupied for now, the new hospitals size will be roughly 158,000 square feet when it opens in 2010.
Also, the new hospital will be built to accommodate 55 beds for emergency situations, even though the standard bed count for critical-access hospitals is 25. But the new hospital will accommodate a larger patient population if Huggins opts out of the critical-access designation, ONeill says.
That size for a critical-access hospital is on the larger side, Weaver says. Five to 10 years ago, it would be about 65,000 square feet and found not to work well, he says, adding that the current size of the average critical-access hospital is now about 85,000 square feet. Both Weaver and Doug Butler, senior project executive at Gilbanes district office in Manchester, N.H., say the project has faced considerable challenges, such as building a new hospital while keeping an existing one open.
While the firm could not design to accommodate space for those peak months of May through September, it did rely on what Weaver termed cross-utilization, in which a specific space can be used for multiple services. In the case of Huggins, that will be the emergency and day-surgery departments.
The other component was a mix of soft space with technical space, Weaver says, describing soft space as areas used for office or administrative purposes. If you redesign a lab or a (patient room), its harder than redesigning office space or a storage room, he says. On the patient room floor, we included administrative functions but in a way that the mechanical systems could be converted to (accommodate) higher utilization of beds. It can only become common if you can afford the flexibility.
Construction for Huggins began just before the hospitals official groundbreaking ceremony on July 8, and the facility is expected to be completed in May 2010. There will be duplicate services at both facilities until all of the services are transferred to the new hospital, Strong says. The current facility will be torn down, and the space will be filled with landscaping and a new parking lot by November 2011.
A news release about the project from Gilbane says the new Huggins will have an expanded emergency department, a new womens health and obstetrics unit, a womens imaging suite with private waiting and diagnostic imaging rooms, larger outpatient treatment rooms, and a centrally located cardiopulmonary department. Also, the new hospital will have a helicopter landing pad that is adjacent to the emergency department. As it exists now, the pad is in the hospital parking lot, which poses a challenge each time a helicopter lands because cars must be moved. That wont be a problem when the new facility is completed.
For many, having an ED with a helicopter landing pad is a lifesaving feature, Strong says. Were obviously the primary-care provider for all residents and visitors in the region.