Capital scenarios for an existing hospital

How the numbers are made

Cost. Every intervention is priced by sampling from 405 project cost points (73 psychiatric hospital projects from state budgets and project records, 362 hospital filings), not one figure. Each point is brought to September 2026 dollars with the Bureau of Labor Statistics producer price index for new health care building construction, divided by its own county’s Department of Defense area cost factor and multiplied by the facility’s. Psychiatric projects are used where there are at least eight of the right kind; otherwise general hospital filings take a behavioral health premium. Points that give construction cost alone get site work, equipment, design and owner costs and contingency added; total project points get none. Each run then escalates to the midpoint of construction at a rate drawn once per run, so every intervention in it moves together. Results are the 10th, 50th and 90th percentiles: an order-of-magnitude range for a strategic plan, not an estimate.

Condition. Each asset in the inventory is matched to one of 257 standard components and takes its consensus service life (230 have one, from public facility condition assessments, engineering handbooks and agency tables; residential sources are left out). Its due year is the install year plus that life. The Facility Condition Index (FCI) is work past due and not done, over the current replacement value. A renovation that covers an asset’s wing and system absorbs it if it lands within the grace period of its due year; a replacement building retires the old plant at move-in.

Beds and approvals. Beds available each month are licensed beds, less those offline in active work, plus swing beds and new beds, checked against the average daily census from the Medicare cost report plus a surge margin. Approval rules are encoded for 6 states (New Jersey, New York, Pennsylvania, Connecticut, Maryland and Massachusetts); the other 45 show their Certificate of Need (CON) threshold and review clock from the data, flagged to check. In New Jersey, renovations need no CON whatever they cost, and psychiatric beds can be added only through a Department of Health call.

What is assumed, not sourced

• How a system’s share of the replacement value splits across its assets (the shares themselves are the RSMeans hospital model’s). The unit replacement costs in the data need each asset’s size, which the inventory does not give.
• Renovation durations and the licensing plan review clock. New-building months are the medians of psychiatric hospital projects.
• Demolition cost per square foot from Department of Defense rates per cubic foot, at the RSMeans model’s 12 ft story height.
• Operating cost change: a 2008 hospital median per square foot of facility operations, as a rough proxy.
• The example scenarios’ wings, beds offline and timing are illustrative, not from the request for proposal (RFP).

The Essex County Hospital Center inventory (126 assets) is the risk assessment appendix of Essex County’s public RFP; its beds, census and area are from the Medicare cost report. 162 sources are cited on this page. For the building program and 3D test fit, use the planner. Methods for the underlying data: methods.