New York Methodist Hospital Center for Community Health New York State Certificate of Need Application

New York Methodist Hospital Center for Community Health New York State Certificate of Need Application: 292 page complete document (30mb)

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New York State Department of Health Certificate of Need Application
New York Methodist Hospital

Executive Summary

New York Methodist Hospital (NYM), a 591-bed not-for-profit teaching hospital, requests approval for the construction of a new ambulatory care center to be located at 515 5th Street, Brooklyn, NY. Founded in 1881, NYM is affiliated with the Weill Cornell Medical College and is a member of the NewYork-Presbyterian Regional Hospital Network. NYM’s active parent is NYHB, Inc. The Hospital consists of five connected buildings that have undergone extensive renovation and modernization over the years to accommodate the changing healthcare environment.

The proposed facility, the NYM Center for Community Health (CCH), will be an extension clinic located across the street from the Hospital. The proposed building has two levels of below ground parking and six levels of above ground clinical space. The proposed CCH will include the following services: Multispecialty Ambulatory Surgery; Special Procedures Suite for endoscopy, bronchoscopy, and pain management; Pre-admission testing; Imaging Center with digital X-ray, Magnetic Resonance Imaging, Ultrasound, and PET-CT; Orthopedics; Cardiology; GI; and a Cancer Center that includes an infusion center.

The purpose of building the CCH is to relocate certain existing programs in a more patient­ centered environment that will help improve patient experience, operational efficiencies and care coordination. Currently, ambulatory surgery and special procedures are done in the same space as the inpatients. With the CCH, the Hospital will no longer comingle inpatients and lower acuity outpatients, which will improve the patient experience and free up procedure capacity so that inpatients can receive their treatments in a timelier manner. The other clinical programs in the building are being relocated into the CCH because their current spaces are overcrowded and cannot accommodate the existing volume in a patient centered environment.

The total project cost with fees is $445,013,869. The project will be funded through a combination of Hospital funds and issuance of new debt.


New York State Department of Health Certificate of Need Application
New York Methodist Hospital

Introduction

New York Methodist Hospital (NYM), a 591-bed not-for-profit teaching hospital located at 506 6th Street, Brooklyn (Kings County), NY 11215, requests approval for the construction of a new ambulatory care center to be located at 515 6th Street, Brooklyn (Kings County), NY 11215. Founded in 1881, NYM is affiliated with the Weill Cornell Medical College and is a member of the NewYork­ Presbyterian Regional Hospital Network. NYM’s active parent is NYHB, Inc. Please refer to the Organizational Chart for NYHB, Inc., appearing as a Schedule 1 Attachment. The Hospital consists of five connected buildings that have undergone extensive renovation and modernization over the years to accommodate the changing healthcare environment. The proposed facility, the NYM Center for Community Health (CCH), will be an extension clinic located across the street from the Hospital.

The proposed building has two levels of below ground parking and six levels of above ground clinical space, totaling 395,976 square feet. The proposed CCH will include the following services: Multispecialty Ambulatory Surgery; Special Procedures Suite for endoscopy, bronchoscopy, and pain management; Pre-admission testing; Imaging Center with digital X-ray, Magnetic Resonance Imaging, Ultrasound, and PET-CT; Orthopedics; Cardiology; GI; and a Cancer Center that includes an infusion center. Additionally, in response to the changing healthcare environment, approximately 53,600 square feet will be reserved for future programmatic needs.

Overview of Need

The purpose of building the CCH is to accommodate the increased demand for outpatient services and to relocate existing programs in a more patient-centered environment that will help improve the patient experience, improve efficiencies to lower the cost of care, and increase care coordination and patient-centered care.

Growth in Outpatient Services

The shift toward outpatient care is being experienced throughout the healthcare industry, resulting in a faster growth of outpatient services than inpatient services. Between 1993 and 2013, outpatient utilization in the U.S. increased from 1,422 visits per 1,000 people to 2,144 visits per 1,000 people. This increase is a result of healthcare reform initiatives, advancements in clinical care treatments, and the rise in chronic conditions that require ongoing management in the outpatient setting. Demand for outpatient services is expected to grow further with the increased number of patients newly insured by the ACA, shifting reimbursement that rewards care in low-cost settings, and initiatives such as DSRIP, which encourage restructuring the healthcare system to provide coordinated care in the outpatient setting.

NYM has experienced significant outpatient growth for the reasons identified above, but also because of its unique position in the Brooklyn healthcare market. According to the U.S. Census Bureau, Brooklyn is the fastest growing borough in New York City, and one of the fastest growing counties in New York State (New York City Department of Planning, 2014). Physicians want to continue practicing in the borough and are looking to do so at a modern, up-to-date, financially stable facility. Brooklyn residents also prefer to stay in the borough for outpatient care, and are choosing to come to NYM because of the high quality physicians, programs, and facilities.

From 2012 – 2014, ambulatory surgery at NYM grew an average of 10.4% per year. In that same period special procedures (including endoscopy, bronchoscopy and pain management) grew an average of 10.9% per year. Similarly, outpatient faculty practice visits grew by 19% and the number of pre­ admission testing visits grew by 7%. These high growth rates have continued through 2015, and the Hospital anticipates that demand will continue to increase as the Brooklyn population grows and as more services shift to the outpatient setting.

Improve the Patient Experience

Such significant growth has already put pressure on both the inpatient and outpatient space and operations, which in turn have limited access to care and the ability to maintain a patient-centered environment. Currently at NYM, many outpatient services are fragmentally located throughout the inpatient facility, retrofitted into spaces designed for inpatients and inconveniently located from parking and street access areas. Additionally, inpatients and lower acuity outpatients are comingled in the same treatment space, which contributes to a sub-optimal patient experience and operational inefficiencies.

While the Hospital does have an outpatient medical arts building across the street, the practices in the building are overcrowded due to continuous growth and expansion of clinical programs. The clinical programs being relocated into the CCH are in spaces that are overcrowded and cannot accommodate the existing volume in a patient centered environment. NYM seeks to address these issues by constructing the CCH and relocating certain outpatient programs from both the main campus and the medical arts building to a single location that will facilitate coordinated, efficient, patient­ friendly care. CONs, as required, will be filed for the future use of any space that is vacated as a result of this project.

Improve Operational Efficiencies

Currently, ambulatory surgery and special procedures are done in the same space as the inpatients. With the CCH, the Hospital will no longer comingle inpatients and outpatients, which will free up procedure capacity so that inpatients can receive their treatments in a timelier manner. In addition, the growing number of surgeries and procedures has forced cases to be scheduled late into evening hours, a tactic that diminishes our patient-centered approach and leads to inefficiencies that can impact the patient experience and add to the overall cost of care. The Center will lower the cost of care by supporting length of stay reduction initiatives and providing the infrastructure to decrease overall inpatient admissions.

Increase Care Coordination

The CCH’s location, design, and programs have been strategically planned to maximize the Hospital’s ability to provide coordinated care based on each patient’s unique set of needs. Moreover, by building a Center that supports all patient care modalities in one location, NYM expects to see improvements in patient compliance with follow-up care, waiting and treatment times, physician and caregiver collaboration, patient access, operational efficiencies, and economies of scale.

Volume Growth Assumptions

The Hospital is relocating existing programs into the CCH and anticipates that any future growth of these programs will be a result of the reasons listed above. NYM does not anticipate increasing growth rates nor growing market share in the borough. The following table of growth and volume projections for key programs in the CCH demonstrates that the Hospital anticipates modest growth rates:

nym-con-chart

Support of NYSDOH Initiatives

The CCH will provide key infrastructure that is aligned with the State’s initiatives to create a healthcare system that provides high quality, integrated, patient-centered care in a low-cost environment. NYM is dedicated to providing convenient, accessible primary care throughout the borough where people work, live, and have existing relationships with PCPs. The CCH is intended to supplement this model by connecting patients and caregivers with a state-of-the-art outpatient facility. Additionally, the NYM outpatient care model provides the infrastructure to support the DSRIP program goals. NYM is actively participating in the Community Care of Brooklyn PPS, led by Maimonides Medical Center, with 477,612 covered lives. Furthermore, the Hospital’s complete electronic medical record across the continuum of care gives both patients and providers access to health information in any location.


1 Assumed that in 2018, volume is maxed out due to space limitations. Limited growth comes from efficiencies and/or expanded hours of operation
2 Approximately 13,936 total ambulatory cases performed in 2015. The above table includes only the volume of
procedures that will be performed in the CCH.

Project Financing

The total project cost with fees is $445,013,869. The Hospital will fund the project with
$117,495,510 cash and financing of $327,518,359 through a bond issuance.

See also: CON floorplans . And: CON space allocation chart. Also: Project Narrative


Documents for the May 19, 2016 Public Health and Health Planning Council Meeting