Miller to build hospital in Los Lunas
It looks like a hospital is more than a mere possibility in Valencia County.
According to Darin Miller, the president of Oklahoma City based Miller Architects, LLC, after six months of study and analysis, “We have the ability and funding to build an 80,000- to 90,000-square foot hospital.”
Since April, Miller Architects has been in an exclusive and confidential relationship with the village of Los Lunas to study a hospital and medical campus in the village. In that time, village officials agreed to not enter into an agreement with a competing agency for a similar project.
Now that the study is complete, Miller is presenting the company’s findings to the village councilors in a two-hour work session, starting at 5 p.m., Wednesday, Sept. 12.
In a preliminary interview with the News-Bulletin, Miller said some of the major services the hospital will provide are surgical capabilities, between 30 and 40 inpatient beds, an obstetrics unit and a 24-hour hospital based emergency facility with all the support services necessary — MRI, CT, X-ray, laboratory and pharmacy.
Also in the plans are a full range of women’s services, including mammography and ultrasound, and a outpatient surgical rehabilitation unit for patients coming out of surgery either at the Valencia County center or from an Albuquerque hospital, Miller said.
“The final number of beds is an area that will be determined by the support from others,” Miller said. “Having an obstetrics, birthing unit is something I think will be great for the community.”
In the same building will be about 25,000 square feet of medical office space to house physicians and other outpatient services, he said, for a total square footage somewhere in the neighborhood of 115,000.
Miller didn’t pinpoint an exact location, but did say the facility would be built west of Interstate 25 immediately off N.M. 6. He said the company has targeted two to three locations, both north and south of the highway.
“A hospital needs about 10 acres, but we typically target 15 to 25 acres to account for expansion in the future and to have a parcel size that will support related health facilities,” he said.
Miller reported that he had commitment from private equity investors for the $50 to $55 million needed to take the project from construction to opening.
He said the company was also looking at getting funding from the federal EB-5 program. The program was created by Congress in 1990 to stimulate the U.S. economy through job creation and capital investment by foreign investors.
Investors must invest in a new commercial enterprise that will create or preserve at least 10 full-time jobs for qualifying U.S. workers within two years of the immigrant investor’s admission to the United States as a conditional permanent resident.
In general, investors must invest a minimum of $1 million in a project, or $500,000 in a business in a high-unemployment area or rural area.
“We have these commitments in writing,” Miller said. “In addition to that, we have had discussions with the state about other funding programs.”
Right now the company is finalizing the presentation for the council, Miller said. After that presentation, taking into account any comments and suggestions, Miller Architects will finalize its business plan.
“Over the next six to seven months, we will be engaged in the final funding, design and land acquisition processes,” Miller said. “This is just the beginning of the state licensing process.”
Miller said the project will ultimately go out to bid to find a general contractor, putting the project at a May 1 construction start date. The construction period is slated to 18 months, followed by a two month move-in period.
“So we’re talking about basically 20 months before we’re open — January 2015,” Miller said. “It sounds like a long way away, but these are the steps necessary to get a project of this complexity done. If we could build it faster, we would.”
Looking at short term goals for the facility, Miller said improvement to emergency and ambulance services was something this hospital would be able to resolve.
“That is a major issue,” he said. “Long term, we are looking at providing outreach clinics and more emergency services outside of Los Lunas. We are not about ‘One and done and out.’ This is a county-wide solution.”
The company’s final determination that a hospital is viable in Valencia County was driven by several factors, Miller said.
“That’s really going to be the meat of our presentation to the council,” he said.
The population of the county was a major driver he said, with the market share the company estimates it can comfortably capture in a particular location being the ultimate driver.
Looking at data compiled by zip code, Miller said he and his team could extrapolate the number of services provided to county residents.
“They are being provided mainly in Albuquerque,” he said. “Let’s say there were 1,000 surgeries done in a year in this market. We can comfortably capture 50 percent, so that’s what is going to drive size. And that’s a conservative estimate.
“In this market, we are being conservative and at the same time, the facility is designed to expand. There are future services we are not even anticipating now just due to technology advancement.”
Miller said he and his team felt if the company built a hospital in this community, it could capture a good part of the market.
“It will offer convenience and quality care close to home,” he said. “We’re not talking about heart surgery or major orthopedic work. That will continue to go to Albuquerque, which makes sense because they have the expertise and the doctors. But those patients can come back to their community for rehab and not have to travel to Albuquerque.”
When asked about President and CEO of Presbyterian Healthcare Services Jim Hinton’s contention that most health care delivery has transitioned to an outpatient setting, thus voiding the traditional “hospital” model, Miller said he agreed with the CEO’s assessment.
“Whenever there is a discussion on beds, the future of beds, we talk about needing less and less,” Miller said. “The services hospitals provide now are predominately more outpatient procedures. There are treatments we can do without shoving people in a bed and warehousing them for a week.”
Miller said past analysis of a community such as Valencia County would yield the conclusion that based on a population of nearly 80,000, 80 beds would be needed.
“That’s not the case now, but you still have people who get the flu, elderly we still need to bring in and watch and observe, so we still need some capacity,” he said. “I agree the number of beds in these facilities needs to be minimized. It’s one of the most expensive aspect of a hospital because it takes a lot of trained staff to operate in that bed environment.”
A critical component to the hospital is the emergency room, staffed round the clock, day in and day out by an emergency room doctor. An ER allows for three possible outcomes, Miller said. Patients are treated and sent home, admitted to the local hospital or sent on to an Albuquerque hospital.
Miller said having an ER and beds available for inpatient procedures were the two things he considered “hospital services.”
“The rest — imaging, the lab, rehab services — are outpatient services that serve both the inpatient and outpatient sides,” he said. “Technology is growing our capabilities.
“I see the bulk of our surgery patients being mostly diagnostic endoscopies, scoping knees. Things where you come in in the morning and are gone by the afternoon.
“I don’t disagree at all with (Hinton’s) assessment, except with his statement that the community doesn’t need a hospital. I understand why he’s saying that, from the position he’s in. It’s silly of them to come in and pay $50 million to serve the market they’re already serving.”
Miller said while staffing a local hospital will be a challenge, it is less of a challenge in a market such as Los Lunas that is close to a major metro area. He said he isn’t at liberty to say who the project’s provider partner is, but he and his team have had numerous discussions with the provider about staffing challenges.
“We are confident, because of the way the market has been left, and we are seeing an increase in physician services, that this is a great opportunity,” he said. “We need to be at a certain level to get specialists interested. If they can do a certain number of procedures in a new facility with quality support, that is going to attract them to come down. It’s smarter for a physician to drive to the source than have 100 patients go the other direction.”
Miller said he envisioned specialists, such as surgeons, coming to the hospital twice a week for procedures and once a week for follow-up visits.
The final choice of provider is based on how it and Miller fit together, and a sharing of common goals, Miller said.
“It’s not to the exclusion of other health systems who want to participate to make this hospital better,” he said. “As this facility opens, progresses, grows, and people utilize it, that will bring a lot of pressure on other systems to cover services at this facility.”
He said that like any emergency room, patients will be treated at a Valencia County ER, regardless of ability to pay or type of insurance.
Looking at the existing local physicians, Miller said independent doctors would be able to affiliate themselves with the hospital, if they chose to.
“If they have a staff position with another system that is not part of the system we partner with, they probably wouldn’t affiliate with us,” he said. “But if we don’t go out there with open arms, and talk to them and try to bring them on board, we’re not doing our job. If we exclude them because of a current affiliation, that’s not the right approach.
“I think we’ve established there is a need for more physicians in this community, not less.”
At the work session with the councilors, Miller said his main purpose is to convey the company’s plan and what steps are needed to move forward.
“We’re not going to show them our plan, and say we need another six months,” he said. “At this point, we are into the implementation part of project. Unfortunately that doesn’t start with construction. People will see progression, but they won’t see building. The whole process is very complex. It’s like herding cats really.”
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