Floyd County Medical Center plans $25.8 million hospital addition, including clinic relocation

By Bob Steenson, bsteenson@charlescitypress.com

The Floyd County Medical Center’s Board of Trustees gave the go-ahead to begin designing and arranging financing for a new Medical Center Clinic to be built onto the existing hospital, also expanding hospital space and dramatically changing the look of the building.

Dawnett Willis, the Floyd County Medical Center (FCMC) chief executive officer, told the Press she has been looking at the clinic and what it needs since taking the CEO job in September 2021. What it needs, she said, is more space and a better flow within the building.

Scott Blum, president of Accord Architecture of Ames, gave a presentation to the Board of Trustees at its monthly meeting last week, covering four areas – why consider remodeling and adding on to the hospital for a new clinic, what the new space might look like, what it would cost, and how long it would take.

Blum said it became clear pretty quickly in their evaluation of the existing clinic across the street south of the medical center that it has too many limitations.

“There’s a lot of load-bearing walls in this clinic. It is carved up a lot. Small rooms with load-bearing walls, and that’s troublesome when you try to use a structure and you have to create the flexibility you need to make proper exam rooms, related to proper nurse stations and so on,” he said.

The idea of doing something with the current clinic location quickly took a back seat to doing something on the hospital property, he said, adding that the idea has benefits in addition to just more and better space for the clinic.

“We can share registration. We can share a front door, with a canopy. We can share parking,” he said. “There’s a lot of synergy there with being attached to the hospital — which is happening in a lot of hospitals we work at around the north Iowa area here. Osage. Cresco. Britt. Emmetsburg, and the list goes on.”

In addition to space for the clinic, they also wanted to address space needs for the hospital itself, Blum said.

“Can we place the clinic in a spot here that would allow it to be really close to radiology and lab, and still allow the future vision of the hospital, which we have been working with Dawnett on, which is to say that, could there be a new surgery center some day, and could there be the cancer center some day?” he said.

Blum presented possible floor plans of the new combined clinic and hospital in an addition that would involve removing the current circular entryway, then building on to the east from there and wrapping south around the existing hospital.

Then he showed computer renderings of the exterior view of a combined three-story and two-story addition, with the potential of the third floor being a shell for future expansion, and with the option of a full basement.

On the cost part of the presentation, initial construction costs, including the third floor shell and the basement, was estimated at $19 million. The third floor shell made up about $2 million of that cost, and the basement added about $1.75 million to that cost total.

Blum said if they started right away, the design work would be done about the end of the year and they could go out for bids in January or February 2024. Adding in 2.5% inflation from now until then, along with a 10% contingency for changes and items not yet identified, the total construction part of the project was estimated at $21.5 million if bid the first of next year.

With architectural and engineering fees; fixtures, furnishings and equipment; and other costs, and including another 7.5% contingency for changes during construction, the total projected price for the project is $25,848,698.

Willis said the project will be funded through cash on hand, grants, donations and a U.S. Department of Agriculture low-interest loan.

Craig Carstens, FCMC chief financial officer, said even if they don’t get any grants, he’s already checked and they have more than enough borrowing capacity to finance the entire project through a USDA loan.

Blum said that if they got the go-ahead soon, construction could begin in the spring of 2024, with an estimated two years to completion, looking at April 2026.

The Board of Trustees discussed the presentation with Blum while he was still there, then moved on to other matters on the agenda, but later in the meeting the trustees came back to the clinic proposal and agreed to tell Blum to go ahead – to begin the more formal design phase, including the third floor shell and the basement.

Willis told the Press that building a new clinic onto the hospital makes the most sense.

“Looking at the cost to rebuild the building, trying to make sure that patients are having a better experience and looking at patient satisfaction, proximity to lab, ER, radiology, allowing room for growth and/or expansion of services, having one main entrance for all of our patients and visitors, all coming in one door whether you’re a clinic patient or hospital patient or outpatient patient,” she said.

During the board discussion, Trustee Cheryl Erb asked Blum if the numbers he presented were realistic, and whether other projects they have been working on have come in where they projected.

Blum said that from before the COVID-19 pandemic to “post pandemic,” there has been about a 38% increase in constructions costs.

“Imagine that,” he said. “On a million dollars now you’ve got $380,000 added to the job.”

He said that increase is built into these numbers, and they have been adjusted even further than that, with allowances for inflation until bidding time and contingency factors.

The numbers will change as they get further into the design and engineering processes, he said, but the goal is for the final estimate to be as realistic as possible.

Willis said the trustees thought it was a good idea to add the third floor and basement for future growth.

“The cost of construction will be cheaper today than it is tomorrow, so to go ahead and finish that out and have it shelled where we can decide later what we need, or if we need more providers or more specialists or whatever, we’ll have a place to put them,” Willis said. “As well, they were very, very positive with wanting to move forward with the basement.”

She said the timing is also important. The clinic is currently designated as an HPSA (Health Professional Shortage Area) rural clinic, which means the county is designated as being underserved by medical professionals.

There was some concern that moving the address of the clinic would jeopardize that rating for the clinic by requiring a new survey, Willis said.

“Why’s that important? It really drives how we’re reimbursed for our clinic, so that is a really big factor for us to consider,” she said.

They checked more deeply into the rating and found out they are grandfathered in for four years, until July 2026.

“Now that the HPSA status is what it is and we have it for four years, it seemed like a really good time to make that move without having to risk our reimbursement for the services provided there by mainly Medicare and Medicaid,” she said.

The construction of the new clinic will need to be “substantially complete” by July 2026 to avoid a new survey, Blum said.

The addition will help in other ways, too, Willis said.

“It helps us attract new talent with providers and nurses and clinicians all alike. And an opportunity to refresh the exterior and give us a fresh new modern look, and as well, we all know we need more parking, so a lot of factors went into deciding this,” she said.

“We are very excited. I shared it with leadership Wednesday when we had our leadership meeting. They were just thrilled, moving in the direction that everybody wants to go, and having a new front to Floyd County Medical Center. It’s time. It’s time to move into the future and have a fresh new look,” Willis said.

“Even though construction is never fun, we’re thrilled about the opportunity and what that will bring for us in the future to better provide for our patients and our community,” she said.