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Introduction/Frequently Asked Questions

Ashland Health Center Proposed Building Project

 

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Contents

If you have any questions, we encourage you to submit them to questions@ashlandhc.org.

Do not overbuild. Right size the facility. Ensure all services provided are sustainable for what our community can support and afford. Those are the directives provided to us by the Ashland community. And that is precisely what we have done by minimizing areas of loss, expanding revenue generators and when possible, transferring the local tax payers cost to the state and federal levels. Below we have provided information to address the frequently asked questions. These efforts are providing materials for an informed community. The decision to build a new Ashland Health Center will not be upon our Board of Directors, Administration or staff – only the voters. We can provide you with cost – only you can determine the value of future healthcare services within our shared community.

The Ashland Health Center is committed to being your community health provider. As one of the area’s largest employers, Ashland Health Center’s payroll of more than $3 million annually is a huge part of our local economy.  Of equal importance, the health center’s acute patient care, emergency room, senior services, and outpatient clinic are all vital in maintaining our quality of life within Clark County.

In 1955, more than 60 years ago, residents of Hospital District #3 approved a bond issue to construct a new facility in Ashland.  A year later in 1956, the Ashland Health Center was up and running as the primary medical center for our area.  The building has served the area well for six decades, but time, much use, and changes in modern healthcare require improvements to continue to serve our community. 

Changing regulations in healthcare, advancements in medicine, services, and technology mandate necessary changes.  Parts of our facility are the same as they were when originally designed and constructed in 1955, placing Ashland Health Center behind the times compared to other facilities.  In order to compete and continue to serve Ashland residents with quality care and service, an investment is required.  The proposed improvements would modernize and optimize health care services.

As with any building that is aging, the primary difficulty is meeting the physical needs of the facility and the community. These expectations require a hospital to be more mechanically efficient, environmentally friendly and a safe place for patient care. In 2009, Ashland Health was presented with a facility planning study, completed by independent construction and architect groups. After closely scrutinizing the facility infrastructure, it was determined that building a new health system would provide significant savings, as the design/build of our current facility does not lend itself to cost effective renovations.

In 2014, the hospital issued a request for qualifications from architects interested in providing a master plan for the present medical facilities. A committee comprised of medical staff and the hospital Board of Director’s reviewed proposals and recommended the design firm ACI Boland. 

Following this recommendation, the Board of Director’s decided that it will utilize construction management in the planning process. Construction managers get involved in the process much earlier and provide detailed feedback that can aid in the decision making about what to include in a project or leave out to stay within a budget. Ashland Health Center has enlisted the help of Hutton Construction, a construction management firm with an office in Garden City.

After completing a full assessment with much study, thought, and input from the design firm, construction manager, medical staff, a community building committee and other patrons of the Health Center, a list of questions and concerns has been documented below to address the needs and expectations in our medical community.  The Ashland Health Center looks forward to answering any additional questions and sharing more information with you throughout the process.

What's wrong with our existing facility and why can't we continue with it? 

Infrastructure:

Major portions of the existing infrastructure within Ashland Health Center are at the end of useful life. We are utilizing an outdated boiler, with no back-up fuel or heating source. Majority of piping is original to 1956, the temperature controls are pneumatic, able to only be on or off, unable to provide heat or cooling simultaneously. Patient rooms are served by unit ventilators that lack required outside fresh air requirements. Repairing and replacing these problems will cost approximately $2,925,000 dollars, extending the life of an already inefficient facility by only a few years.

 

Interior:

Above Ceiling Space

·             Currently Ranging from 0 to 2'.

·             Requirements are 4’ to 6’ to accommodate ductwork, piping, conduit, and cabling.

 

Patient Corridor

·             Currently are 7’ wide

·             Codes require a minimum of 8’

o   Column spacing prohibits the widening of our corridors

 

Semi-Private (two beds per room) Patient Rooms

·             Currently measure 11’ x 14’ = 154 square feet total

·             Requirements are 300 to 350 square feet

·             State guidelines require a minimum of 100 square feet of clear floor space per bed in semi-private rooms.  This adds 200 square feet

·             Our current rooms are half the size required to meet regulations

·             Current regulations encourage private rooms doubling the current number of patient rooms

 

Patient Toilets

·             Currently 4' x 2'-7" for 10.33 square feet, too small to assist patient or accommodate a wheel chair.  ADA minimum of 5' X 4'-8" for 23.35 square feet.

·             Doors are only 24" wide, too narrow to accommodate a wheelchair.  ADA minimum is 36"

·             Patient toilets are now required to serve one room only and have hand washing facilities.

o       Regulations now encourage a shower in each patient toilet room.  Ours serves two rooms and has no provision for hand washing or bathing.

 

 

 

 

Crawl Space Below Floor Slab: 


The existing crawl space below the uninsulated floor slab of the facility frequently floods and is not ventilated. This provides an atmosphere that fosters mold and mildew. The air from the crawl space migrates into the building itself, creating poor air quality. Current building codes require the ventilating of crawl spaces for this reason.  Bringing this condition up to code will expose the floor slab to outside air temperatures without benefit of insulation, another code violation. Insulating the slab from underneath is simply not practical due to the many layers of utilities secured to the slab and the severe space constraints.  

 

Exterior Walls:

 

 

 

 

 

Exterior curtain wall system consisting of single glazed windows, metal framing and thin metal panels with virtually no insulating value, and must be replaced to gain acceptable insulating efficiency. 

 

Where did we get this information? 

In addition to our own Maintenance staff, we have had multiple architectural and engineering firms complete assessments that verified significant systems are at risk of failing at any time.  A master facility plan was completed from 2009-2010 from independent architect and construction firms, at which time a full replacement facility was determined as the most cost effective option to address the failing infrastructure and numerous systems that have outlived their usefulness. Again in 2013-2014, additional construction and architect firms were brought in, confirming the findings from the original study. 

 

How old is the current facility? 

The original hospital was constructed in 1956. In 1969, the long term care unit was added with Independent Living after that.  A majority of the existing infrastructure is original, including all the piping, ductwork, and heating and cooling systems. 

 

Why is it so expensive to repair our current facility? 

The facility needs assessments, performed in 2009-2010 from independent construction/architects firms indicated that the current facility has many expensive problems to address.  For example, the current piping system which runs throughout the hospital needs replaced.  The cast iron pipes are set in concrete and would require the floor to be jack hammered up to be removed.  The mechanical, electrical, and plumbing systems were compliant with the codes when originally installed in 1959.  If renovations were to occur, all systems would have to be brought up to current 2015 codes. This would be a costly project – more so than building a new facility – and it would force closure of portions of the facility during construction.

 

Why can we not renovate our current facility? 

The existing hospital building was constructed in 1956.  Program requirements for the various departments have changed dramatically over the years leading to greater space needs and in some cases different functional relationships between them.   The ability of this structure to meet these needs is compromised both in terms of lack of space available and the resulting inability to accommodate an efficient work flow.  A replacement facility gives us the ability to right size each department, allow for its future growth and establish work patterns and department locations that maximize efficiency.

Since 1956, space required above ceiling for mechanical and electrical systems has grown from virtually no minimum requirements to 4’ to 6’. Regulations determining the size of patient rooms and toilets have caused their floor area to nearly double in size. Patient corridors are now required to be a minimum of 8’ wide, existing corridors are 7’ wide.  All of this required growth is restricted by a concrete roof slab that is 8’ above the floor in most cases.  A column grid layout prevents patient rooms and corridors from being expanded as required.
 
The exterior walls for much of the building consist of the original uninsulated metal framing system, infilled with thin metal panels below and single pane glass windows above.  Today’s energy codes will require that this system be either upgraded or replaced at considerable expense with materials meeting enhanced, specified insulating values.
 
Faced with the reality that much of the building lies over an unhealthy and problematic crawl space, the likelihood that the concrete roof will have to be raised, many structural columns will have to be removed and/or relocated, and a good portion of the exterior walls replaced, very little of the existing structure would remain.  Add to this the complete replacement of the Heating, Ventilating, Air Conditioning, Plumbing and Electrical Systems.  Keeping in mind that this all has to be done while maintaining Ashland Health Center in operation, it becomes readily apparent that renovating the existing facility is just not a viable option. 

 

Can I tour the current facility to see the problems for myself?

Of course a tour can be arranged.  However, out of respect for patient care and privacy, we would prefer to schedule those by appointment.  We developed a video tour of the facility that will be shown at public meetings and will be online that shows most of the issues without inconveniencing our patients.

 

 What other problems need to be addressed at Ashland Health Center?

The current inpatient acute care model is antiquated. The Centers for Medicaid and Medicare (CMS) – our primary payer sources – are moving towards a pay for performance model. Their directive, and our funding will be in keeping our community well and out of the hospital through outpatient services of clinics, therapies, and preventative health, rather than simply caring for them after they are sick.  Our facility does not provide adequate space – and cannot be renovated – to meet the healthcare expectations in the future. There are privacy issues with emergency department, outpatient clinic and patient rooms all opening up off of public hallways. The patient rooms are small, with shared bathrooms.  The facility is not energy efficient and has high maintenance and utility costs. Moreover, the overseers/surveyors are beginning to look at ADA and various code compliances. Though we have been “grandfathered” for the last 25 years, as a way to ensure facilities are kept updated, other states are now enforcing these regulations, and have begun forced compliance – at much greater cost – with only a few months’ notice to avoid closure. 

 

Why do we have to decide on this now?

The infrastructure of the facility has truly reached the end of useful life. In recent years, our maintenance staff has diligently repaired portions as able, but they have been temporary fixes at best. And now, in many cases that is no longer an option. The latest facilities assessment completed in November 2014, identified several mechanical, electrical and plumbing code deficiencies that need urgent attention. Some of these items would cause significant interruption to the operation of the facility and still wouldn’t address the majority of the code issues within the building. These priority items could be deferred as long as we are moving forward with a new build, and the funds could be better used towards the bond payments.

    

How do we know the correct size for a new facility?

The architects and engineers worked with an internal group of Ashland Health Center employees from each area of the facility for a process called “right sizing”. This helped us to determine what our community healthcare needs will be for the future.  They reviewed the growth statistics for the past 10 years to help determine the best size for a new facility.  The new facility design will allow the hospital to expand high growth areas like therapy, outpatient clinics and inpatient short-term rehabilitation. The new hospital design has been fully drawn to confirm the cost. Though the right sizing of the facility has actually decreased the number of beds, the square footage has expanded, due to increased regulations for patient rooms, corridors and restrooms.

 

What is the cost of a new facility?

Project Build Cost: $15.1 Million

Federal Contribution: 80 percent through the Medicare Cost Report

Actual Community Cost: Remaining 20 percent

 

The Project Cost includes new land purchase, preparation, demolition of existing facility and new build.

 

How will the Public Building Commission bond (PBC) be paid for?

Ashland Health Center is a district facility. As such, the City of Ashland will sponsor the PBC. By going to a straight acute care/swing bed facility, we will be 80+ percent reimbursed on the Medicare cost report. So the majority of expense has been transferred to federal dollars instead of exclusively local dollars. Ongoing operations will continue to be supplemented through tax appropriations for the district.

 

Will it cost more to receive services at the new facility?  

No, the cost of services at Ashland Health Center is primarily impacted by the 24/7 nature of running a health system. With ever increasing regulations and government mandates, the cost of providing care increases each year. The additional services provided by the new facility could actually slow future increase in prices by offsetting what has become incredibly overwhelming inefficiencies, maintenance and regulatory issues.

  

How will a new health system improve health care for our community?

Following the CMS directives of focusing on outpatient services, our therapies will more than triple in square footage, enabling a much greater focus on getting patients rehabilitated and back to full function at home and active in the community. For those inpatients, meeting regulations will provide far greater services and space for their stay.

 

What are the other benefits of having a new facility?

A new hospital will take us into the future and allow us to provide expanded services for our patients.  A new facility will allow us to attract and retain health care professionals to our community.  Historical data shows an expected growth from a new facility is estimated 10 percent additional patients per year for the first two years, according to reports sponsored by the National Rural Health Association. A new facility will enhance our county’s stability by ensuring health care jobs to continue providing high quality health care locally. 

  

What is the economic impact of Ashland Health Center (AHC) to the community?    

Employee Salaries/Economic Contribution

Average Number of employees on payroll: 85 - 90

Annual Salaries: $3,149,829.32

 

AHC Fees Paid to Community Vendors

Including maintenance, pharmacy, office supplies, insurance, grocery, general operations and other expenses: $851,595

 

AHC Employees/School District Population

Total USD Population: 211 (PK-12)

USD 220 Children of AHC Employees: 52.2 Full-Time Equivalent

AHC Percentage: 25 percent

Economic Contribution of AHC Employee’s Children: $427,000 annually for USD 220

 

AHC Employee Age Distribution

Age 18-30: <30

Age 31-50: <40

Age 51+: <15

Average Age: 37.5 

 

According to the Kansas Rural Health Options Report from Kansas State University, for every three healthcare jobs in rural communities, one additional job is created in the private sector.

 

 

 

 

What is to become of the current facility?

The Project’s Cost includes tearing down the current facility and returning the property to grass land, enabling future development. However, if the community wanted to retain the current facility for other uses, that would lower overall project cost. Additional options for use are being explored.

 

Where would the new facility be located? (Updated 3/23/15)

The new Ashland Health Center will be built on the land directly west of the new COOP gas station along the river road.  The new Health Center will be constructed in an 18 month time period. Moving to a new location would allow for a new facility to be built without any interruption in current hospital services, at a reduced rate over phased construction on our current property. 

        

 

What would the new facility look like? (Updated 3/23/2015)

 

Floor Plan:

        

 

Images:

        

 

Room Comparison, Present and Future

Room Comparison:

        Inserted Image

Room Comparison Current:

        Inserted Image

Room Comparison Future:

        Inserted Image

Room Comparison Combined:

        Inserted Image

 

What are the additional cost in phased construction?

There are significant additional costs that are going to be incurred by the project if the decision is made to build a new hospital facility on the existing site. The main reason for these additional costs is that building on the existing site would require a phased project. The time extension for a project of this size and type could be between 8-12 months at a cost of $55,000 per month.

 

Breakdown of potential costs due to phase construction:

Additional General Conditions for added time = $440,000 - $660,000

Additional Demolition costs = $80,000 - $90,000

Multiple Subcontractor Mobilizations= $200,000 - $250,000

Additional Mechanical and Electrical Provisions= $200,000 - $300,000

Total Additional Costs= $920,000 - $1,300,000

 

The second contributing factor is the higher costs of building demolition. Having to demo a building wing that is connected to an occupied space is slower, and carries much more risk. The cost of this type of demolition could be 30 percent higher than demoing a fully unoccupied building.

 

The third contributing factor with a phased project is that it would require multiple mobilizations from every subcontractor. Things like earthwork equipment, heavy demolition equipment, cranes, concrete pump trucks, excavation equipment, etc. would have to be brought out to site and pulled from site multiple times in order to build the building in phases.

 

Another factor to consider are the provisions that would be required to keep the building’s mechanical and electrical systems operational as we take old areas of the hospital off line and re-feed new areas with these mechanical systems. A lot of temporary provisions could be required in order to keep all of the occupied parts of the facility online.

 

What happens if we don't build a new facility?

Condition of the hospital will continue to deteriorate and the cost of maintenance will continue to rise. The cost of repairs to address ongoing problems will be increasing, until such time in the near future that the majority of services will no longer be provided within Ashland Health Center.

 

What does a "No" vote mean?  

A “no” vote on the upcoming PBC bond issue means that District voters will be declining an opportunity for a new Ashland Health Center.

   

What have we been paying in taxes, and how much will they go up?

As an example, we have included historical data for the last five years of expenses versus tax appropriations. To be noted, in an effort to be good stewards of the community’s money, the tax appropriations (amount request and paid into by the community) has actually gone down, even as healthcare cost continued to increase.

Operations Cost/Community Tax Appropriations for Ashland’s Hospital District

Year                                       Operations Cost           

             

 

Tax Levied  

2010                                       $4,532,220                    

             

 

$1,183,743 

2011                                       $5,057,119                    

             

 

$1,045,743 

2012                                       $5,995,240                    

             

 

$999,995 

2013                                       $6,323,320                    

             

 

$990,052   

 

2014                                       $7,000,000 (projected)  

 

Tax Appropriations Comparison for Region

             

 

$990,052 

                                                Meade             Coldwater 

Minneola 

 

Ashland  

General budget                        $588,666         $498,854 

$1,424,524 

 

$537,918 

Debt Service                            $514,043         $367,734  

             

 

 

Employee Benefits                  $341,504                       

             

 

$452,134 

Total Community Support:    $1,444,213      $866,588* 

$1,424,524**

 

$990,052***  

 

* Coldwater: Post $4 million renovation – with no associated long-term care unit  

** Minneola: Subsidies contributed from both Clark and Ford County 

*** Ashland: Including cost (>$500,000 annually) with operating long-term care

 

How much will my taxes increase?

 

80 percent Medicare Reimbursement Rate for a $15.1 Million Facility (20 Years)

 

Cost to Homeowner of Projected Mill Levy Increase

Home Value                           Annual Property Tax

$50,000                                   $109.25

$75,000                                   $163.88

$100,000                                 $218.50

$150,000                                 $327.75

$200,000                                 $437.00

 

Cost to Commercial Businesses of Projected Mill Levy Increase

Property Value                      Annual Property Tax

$50,000                                   $237.50

$75,000                                   $356.25

$100,000                                 $475.00

$150,000                                 $712.50

$200,000                                 $950.00

 

Cost to Agricultural Property Owners of Projected Mill Levy Increase

Acreage Usage                       Annual Cost per Acre

Dry Crop Land                       $0.35

Irrigated Land                                     $0.93

Grass Land                              $0.12

 

 

Above numbers based on 80% Medicare Reimbursement Rate for a $15.1 Million Facility over a 20 years

 

What about absentee owners?

Of particular interest is how the tax appropriations/payments are not limited strictly to those living within the district. Below is a breakdown of ownership for both residential and agricultural land.

 

Agricultural Property Assessment

 

 

 

 

 

Agricultural Acres

Acre % of Total

Assessed Value

Assessed Value %

Property Owners Within District

169,170.30

39 percent

$3,842,523

59 percent

Absentee Owners/Outside District

267,236.25

61 percent

$2,626,814

41 percent

Total

436,406.55

 

$6,469,337.00

 

 

 

Residential Property Assessment

 

 

 

Residential Assessed Valuation

Assessed Valuation % of Total

Property Owners Within District

$2,180,298

43 percent

Absentee Owners/Outside District

$2,942,650

57 percent

Total

$5,122,948

 

 

 

 

 

  

 

 

 

 

 

 

 

 

 

Timeline:

 

DATE

EVENT

January 27, 2015

Hospital Board Meeting

Hospital Board adopts resolution seeking authority to increase the levy authority

February 4, 2015

Publication for Levy Authority (Hospital)

Begin 30 day protest period (30 days)

March 6, 2015

Protest period expires

April 8, 2015

First Publication of Notice of Special Election

April 15, 2015

Second Publication of Notice of Special Election

May 12, 2015

Anticipated Ashland Hospital District Special Election – Levy Authority, PBC Authority

 

 

 

 

 

 

 

 

 

 

 

 

 

Hospital Districts' Boundaries

View the map of the Ashland Health Center (District #3) District

 

 

 

Current Project Expenses Paid

ACI/Boland-Architect Fees $14,842.78*
Option to Buy Land Deposit $2,500.00*
Goodell, Stratton, Edmonds-Legal Fees

$24,066.09

Contractual Obligation - Unbilled

Hutton Pre-Bond Election Preconstruction Fees 

$15,000.00*

ACI/Boland                         Total charges not to exceed $16,000 
  Plus reimbursable expenses.

 

Total Project Cost:     $15,100,484

This cost includes allowances for all subcontractors, utilities, architectural, Construction Manager at Risk and land cost.  The ACI/Boland architect fees, Hutton Pre-Bond Election Fees, and the Option to Buy

Land deposit already paid or owed will be included in the total project cost if bond election is approved.

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Ashland Health Center625 S. Kentucky St.Ashland, KS  67831

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