Space Action PlanApproved Recommendations

June 2007

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Major Objectives Improve the appearance of practice space Improve workflow and efficiencies of practice space Recommendations should address:

• Strategic objectives – where do we want to be, how do we want to be organized• Tactical objectives – what can we do to improve current space

Considerations Costs and Budget constraints Interim (“swing”) space issues Implementation of EMR Short term (Tactical) Strategies

• Main Campus• East 60th Street

Long term (Strategic) Strategies • Main Campus• East 60th Street• Off site

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Current State

FPO Goals: Grow young practitioners in all areas of medicine and surgery Create additional Multi-specialty Centers of Excellence Acquire additional practice groups not necessarily on this campus

Current State: Washington Heights campus “maxed out” as currently configured Renovation of NYPH owned space is somewhat more costly related to Article 28 designation No space available for temporary relocations (“swing space” No standard space policies addressing all issues dealing with space Decentralized practice support functions (check in, cash collection, check out)

East 60th Street Physical space is adequate but rent makes it cost prohibitive for many physicians/groups to

be successful Practices need to be designed to fit the East 60th street model

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Funding Streams

Current Funding Available: Refurbishment Account:

Assessed on a square footage basis Collect approximately $877,000 per year Current balance in account = $3,849,000

Funds to be used for: Routine replacement needs includes replacement of furnishings, wall & floor treatments, minor equipment

replacement due to normal wear and tear Major projects :

Upgrades to current space Minor renovation needs

Current annual dollars not enough to do full practice renovation or redesign

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Space Assessment – Upgrade/Renovation Needs

• Comprehensive Space Assessment conducted by Guenther 5 June 2005

• Identified practice areas and common space & ranked them according to condition

• Provided Cost estimates to address categories of renovation/refurbishment

• Categories Estimated cost**

• A – Gut Renovation – 35,629 SF $12,756,717

• B – Full Renovation – 57,744 SF: $12,671,025

• C – Extensive Cosmetic Upgrade - 30,176 SF: $ 2,359,985

• D – Extensive Touch-up – 41,864 SF: $ 1,724,596

• E – Minor Touch up – 97,146 SF $ 2,357,270

Total all categories $31,869,593

• **NOTE: Cost estimates have been updated to reflect 2007 pricing using NYPH cost estimators.

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Proposed Use of Refurbishment Dollars

Routine replacement needs will run approximately $500k for the next 2 years, then drop to $300k per year for next 2 years

Major projects assumes upgrade/renovation of common/public space only

Assumptions for year 5 and thereafter has to assume zero sum budgeting

 Proposed 5 year Budget 2007-2008  2008-2009  2009-2010  2010-2011  2010-2011 

Total Fund Balance $3,849,000 $1,726,000 $603,000 $180,000 $7,000

Income $877,000 $877,000 $877,000 $877,000 $877,000

Routine Replacement $500,000 $500,000 $300,000 $300,000 $250,000

Major Projects $2,500,000 $1,500,000 $1,000,000 $750,000 $634,000

Balance $1,726,000 $603,000 $180,000 $7,000 $0

Concerns and Issues: No ability to do major renovation without financing or additional funding stream No ability to secure additional space for new practices or swing space for renovation work

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Short Term Strategy (1-3 years)

1. Improve look of most “egregious” space in practices by upgrading common areas

2. Improve signage

3. Achieve synergies by domino moves

4. Work closely with EMR implementation team to identify “take back” space and improve workflow

5. Secure additional space to create “generic practice” space so that existing practices can temporarily relocate there during renovation and upgrade.

6. Create standard policies for handling of space issues

7. Identify strategies to standardize operational plans

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Recommended Priorities for Upgrade of Common Space

Priority Area Recommendation Estimated Cost1 Timeline

1 Herbert Irving Pavilion–4th Floor Common Space Full Renovation $1,426,784 Sep 2007- Jan 2007

*2 Herbert Irving Pavilion–5th Floor Common Space Full Renovation $1,647,421 Jan 2008-June 2008

*3 Herbert Irving Pavilion–2, 3 & 6th Floor Common Space

Full Renovation $4,724,885 July 2008-

*4 Herbert Irving Pavilion–7-11th Floor Cosmetic Upgrade/Repairs

TBD TBD

HIGH Signage for Irving Pavilion floors including Directory in lobby.

Floors 2-6 full

Floors 7-12 as needed

$8,020 per floor

Lobby $2,830

Jul 2007 – Sep 2007

*Further study of the impact of the Heart Hospital on these floors in Irving Pavilion is necessary to coordinate the changes with the strategy for the Irving Pavilion.

1Estimated costs using updated cost estimator includes a 20% contingency

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Long Term Strategies (3-5 years)

Main Campus Strategy Maximize existing space

• Exam room utilization analysis• Practice work flow analysis• Common functions should utilize shared services (reception, arrival and check in, appt scheduling, check out functions)

Explore options to decant practices into the community Explore expansion options in the community

Identify and secure areas to decant and expand: Off campus locations

• West Side of Manhattan• Outer Boros• New Jersey

On Campus• New Practice Building (timeline)

Identify practices on main campus that can relocate off campus Maximize E60th St location

Establish generic practice space for “swing space”

Recapture space from EMR, reconfigure current practices

Partner with NYPH for Major renovation to space