On-Campus Outpatient Center

Thomson Reuters Healthcare has named Silver Cross one of the nation’s 100 Top Hospitals for 8 years in a row—something only 4 other hospitals in the country can claim. In February 2012, Silver Cross opened its 76-acre replacement hospital campus in the southwest Chicago suburb of New Lenox. The campus offers conveniently located services, advanced medical technologies, and an integrated model of care to the 800,000 residents of Will County—one of the fastest growing counties in the nation. Just one year after the new campus opened, the hospital experienced a 25% increase in admissions, a 27% increase in deliveries, and a 6.5% increase in outpatient services. 

NexCore Group collaborated with Silver Cross to develop Pavilion A, the largest outpatient facility on the campus and the only facility directly connected to the hospital. NexCore successfully delivered the facility in December 2011, two months before the opening of the new hospital.
 

Moving Forward Together

Following a competitive nationwide selection process, Silver Cross chose NexCore to develop, own, lease and manage Pavilion A—a 6-level, 182,000 SF outpatient center that plays a crucial role in the hospital's strategic plan. Objectives for the project included:

• Implement an integrated facility design.
• Reduce costs through efficient design and construction.
• Recruit physician specialties that had been identified as lacking.
• Increase access to care in an underserved market.

Confronting Key Challenges

Silver Cross and NexCore faced some key challenges leading up to the development of Pavilion A. Silver Cross was closing its existing hospital, constructing a $400 million replacement hospital, and moving its entire operation to a new campus—as a result, any accessible capital was stretched thin. Silver Cross needed to leverage NexCore’s healthcare real estate expertise to:

• Access competitive capital.
• Mitigate financial and delivery risk.
• Develop an integrated outpatient facility to fulfill its business plan.

Silver Cross also asked NexCore to recruit a group of complementary physicians to the campus, targeting specialties identified as deficits by the Medical Staff Development Plan.

Timing was also a challenge. NexCore needed to complete an 182,000 SF facility in 12 to 13 months, instead of the typical 16 to 18 months for a building of this size. Also, after the construction of Pavilion A had already begun, the hospital asked NexCore to house its primary data center on the Lower Level of Pavilion A and to complete the data center space earlier than the rest of the building. Silver Cross needed to install, test, and launch its primary data center well before the opening of the new hospital in February 2012.
 

Innovative Solutions

Patient-Centered Design
NexCore worked closely with the hospital staff, program managers, planners, designers and engineers to design and implement an integrated, coordinated model of care on the replacement hospital campus.

Outpatient services were separated from inpatient services and located on the first two levels of Pavilion A (68,000 RSF), with physician offices housed on the four levels above (106,000 RSF). This single location for outpatient services in Pavilion A, with its own entrance and parking, provides a more convenient and efficient experience for patients. Pavilion A is also directly connected to the hospital on three floors. This results in direct, convenient interaction between the hospital’s inpatient and outpatient services. 

Effective Leasing Strategies
To aid the hospital with its campus transition, NexCore devised a pre-leasing incentive for physicians at the existing campus. Physicians who committed early in the pre-leasing phase were offered an investment opportunity with a higher preferred return. NexCore also presented an aggressive economic offer that included a tiered rent structure and creative tenant improvement packages.

Building design and connectivity created a few areas with compromised views, which provided an opportunity for differentiated rents. NexCore’s strategy appealed to specialists seeking prime space and willing to pay top dollar while accommodating physicians seeking more affordable space.
 
NexCore proactively contacted 350 physician practices throughout Will County and was able to demonstrate the quality of the new building along with the benefits of joining a winning hospital in a strong location. NexCore also used 2 timeshare suites, which it owned and managed, as a recruitment tool. The suites give practices an opportunity to test the market on a part-time basis and capture new patients in a new market.

Cost-Saving Construction Methods
During development of Pavilion A, NexCore employed various design and construction measures to manage and reduce the cost of the project, including a design/build process for the mechanical, electrical, and plumbing (MEP) disciplines. This produced an approximate saving of 50% in the MEP design services, reduced exposure, and potential change order costs, and allowed early identification of equipment manufacturers and lock-in of pricing. 

The design phase also included using Revit software that allowed the design documents to be converted for use in Building Information Modeling (BIM) and direct conversion to shop drawings by the sub-trades. Direct conversion reduces the chance of error in the translation of information and the potential of cost-incurring mistakes. The use of BIM allows for clash detection, primarily for structural components occupying the same space as utility and communication runs, including duct work, piping, cable trays, and pneumatic tube systems. The detection of interferences in the design phase significantly reduces costly changes post-fabrication and in the field.

Sparking Extraordinary Results

• The 182,000 SF Pavilion A was delivered in only 12 ½ months.
• Accelerated delivery of Pavilion A saved $2/SF in construction costs and significantly more in construction period interest.
• By consolidating multiple tenant construction projects (designed, built and completed concurrently), NexCore saved 14% in construction costs, reduced interest carry cost, shortened overall construction durations, and allowed tenants to open for business faster.
• NexCore completed the Silver Cross primary data center space 2 months before the rest of Pavilion A to meet hospital objectives.
• Eliminating the specialists deficit, NexCore recruited 178 physicians to Pavilion A—102 of whom were new to the Silver Cross campus.
• Using developer-owned timeshare suites, NexCore recruited 3 physician groups to Pavilion A on a full-time basis.
• NexCore convinced Dr. Volker Bertrand, a neurologist, to streamline his operations and consolidate his multiple locations into one office on the Silver Cross campus. Dr. Bertrand reported an increase in 50% in his patient base only 18 months after moving to Pavilion A.