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Michael Patterson of the Mississippi Valley Surgery Center and COVID-19

We had the pleasure of speaking with Michael Patterson, President and CEO of Mississippi Valley Surgery Center (MVSC), in a recent podcast. Our conversation with Michael uncovered so many new discoveries, including COVID-19 procedures MVSC has implemented to ensure the health, safety and well-being of its patients and staff, how software has sped the intake process and the rise in popularity of ambulatory surgery centers.

MVSC’s Response to COVID-19

MVSC’s Medical Plaza encompasses two surgery centers – an endoscopy center and a surgery center. MVSC’s initial response to COVID-19 was to close the endoscopy center for two months and only perform urgent surgeries at the surgery center. Like most healthcare providers, gaining access to personal protective equipment (PPE) and responding to staff concerns about treating patients in a COVID environment were top priorities.

In addition, MVSC immediately adopted new screening and surgical procedures to increase the safety of its patients and staff, including:

  • testing all patients for COVID prior to surgery. If a patient tests positive, they wait 30 days from when they were first tested before undergoing surgery.
  • scheduling urgent surgeries at the end of the day. This happens when a patient requires surgery without delay, but there isn’t enough time to test the patient and receive results before surgery.
  • modifying their waiting room to reduce the number of people standing in line to check-in. All patients, staff, providers, and reps now enter through a dedicated room where they are screened for temperature, complete a questionnaire, and a patients’ pulse ox is taken.
  • restricting visitors unless the patient is a minor. If the patient is a minor, only one visitor can accompany the patient in the facility.

Turning Challenges into Opportunities

MVSC is physician-driven, which means patients must consult their doctor before scheduling their procedure. While MVSC is operating five days a week, patients have been choosing to wait longer to make an appointment with their provider as they are more cautious about scheduling elective surgeries. As a result, MVSC has experienced a downturn in the volume of surgeries performed.

On the upside, MVSC’s patient satisfaction scores are rising. MVSC staff believe this increase is due to their ability to spend more time on their patients and less time accommodating family members. However, to ensure a patient’s loved ones are informed of their progress through surgery, MVSC launched an application that allows approved individuals to receive a consistent stream of updates.

Technology has also changed the pre-op process. Before COVID, patients would typically visit MVSC’s facility before the day of surgery. The patient would then have the option to either complete a pre-op health history form online or with a nurse in-person.  Most preferred to answer questions in-person. Now, utilization of the online form is over 60% (up from 20%). As a result, MVSC is spending more time on the phone educating patients about what they can expect leading up to their surgery, how the day of their procedure will go and all the COVID safety measures the facility has implemented.

The Rise of Ambulatory Surgery Centers

Advancements in both surgical and pharmacological technology have allowed ambulatory surgery centers (ASCs) like MVSC to perform advanced procedures in an outpatient setting. For example, total joint surgeries that were once done in a hospital and required a multiple-day stay can now be performed in an ASC, and the patient can go home within a 24-hour period. Another industry trend has been to transition cardiology from the traditional hospital setting to an ASC. With a complete cath lab onsite, MVSC can perform these procedures at their complex.

Convenience and cost savings are additional benefits to patients. At the MVSC, patients can park and be just steps away from the front door without having to navigate through a complex hospital facility. And while hospitals are vital to the nation’s healthcare, Medicare reimburses ASCs 50% of the amount a hospital receives for performing the same procedure. A study conducted by the Ambulatory Surgery Center Association found that ASCs save employers and consumers tens of billions of dollars a year.

Preparing for the Future

To accommodate for innovations in healthcare, MVSC has made significant transformations to its complex. For example, bay areas that were once wide open are now private recovery rooms. MVSC also modernized the flow of its buildings to maximize the efficiency of its staff and the patient flow. Bush Construction has had the honor of being involved in several of these projects.

About Mississippi Valley Surgery Center

Mississippi Valley Surgery Center was founded in 1996 by a group of physicians and has grown exponentially into one of the preeminent surgery centers in the Midwest. Currently, MVSC is the only advanced certified AAAHC Orthopedic and Spine ambulatory surgery center in the state of Iowa. MVSC specialties include orthopedics, ENT, gastroenterology, pain, ophthalmology, cataract surgeries, plastic surgery, general surgery and more.

The Pros and Cons of the Construction Manager as Constructor Delivery Method

Continuing our journey of defining the four most common construction delivery methods, today we’re talking about all things Construction Manager as Constructor (CMc). This method is also referred to as Construction Manager at Risk (CMAR).  This delivery method could be defined as “the silver bullet” delivery method because it’s incredibly versatile and can be used by almost any owner. There is one exception. CMc is not allowed as a delivery method for public works projects – think public schools, police stations, etc. – in 3 of the 50 US states.

The Pros of Construction Manager as Constructor

This delivery method provides an array of benefits to an owner, including:

  • The freedom to select the contractor with whom they want to work.
  • The perspective of both the designer (architect) and contractor during the preconstruction phase.
  • The advantage of receiving accurate cost opinions and project timelines based on current market conditions.
  • The ability to fast-track their project.

It’s sometimes advantageous for an owner to fast-track their project when their construction timeline is very tight. While their building’s design may not yet be fully completed, some aspects of construction can begin. For example, an owner and designer may still be selecting windows; however, since the foundation has already been designed, the contractor can break ground and start work.

Another benefit of this delivery method is that, as the design process progresses, the CM can offer constructability reviews. Let’s take a medical center for example. An MRI machine needs to be placed in the basement; however, the building’s existing doors aren’t wide enough for the equipment to safely fit through them. After speaking with the equipment provider and understanding how many pieces the machine can be broken down into, the contractor will offer several options to get the equipment into the space, from opening a wall, to going through a window, or even leaving open an entire face of the building in order to install the machine before completing the facade. If each of these scenarios aren’t considered when developing the drawings, the cost to install the machine could result in a significant increase to the owner and could delay the project.

The Cons of Construction Manager as Constructor

Some owners may be uncomfortable selecting a contractor before the design is complete because they don’t yet have a firm understanding of the total cost of their project.

Typically, an owner who is considering hiring a construction manager (CM) at the same time as their designer will ask the CM to identify their construction management fee. This fee is often a percentage of the overall cost of the work. What’s important for the owner to understand is that the CM will deliver this cost of work in an open book accounting format. For example, once the design is complete, the CM will obtain quotes from trade contractors like electricians, carpenters, etc. Then, the CM will present these quotes to the owner and they will then work collaboratively to select the best team for the project.  The CM fee is then applied to the cost of the work and the total project costs are known.  So, while the total cost of the project may not be known when the contractor is selected, the owner has the early expertise of the CM to ensure the project’s costs are competitive and help achieve the desired project budget.

Timing is Critical When Selecting a Construction Manager as Constructor

The sooner an owner selects a designer and CM, the better. The most significant benefit of this delivery method is the ability to have a clearly defined scope of work created collaboratively during the design process with the owner, designer, and CM.

If an owner waits to hire a CM until the drawings are partially complete, the owner loses the benefit of the contractor’s expertise during the early design phases.  These early design phases are when the CM has the greatest ability to ensure the owner’s budget is aligned with the intended design.  When the budget and design are aligned, costly redesign and design phase schedule delays can be avoided.

How NOT to select a Construction Manager as Constructor

In some cases, the owner may want to select a CM based on a firm fixed price for a project that is only partially designed.  We have witnessed several cases where this approach was not in the owner’s long-term best interest.  One of these cases was an automobile dealership. We were one of three CMs being considered and were the only one with past dealership experience. Because the drawings were incomplete, our proposal listed all the aspects of the project we knew would be needed but weren’t specifically identified in the drawings.  These additional scope items increased our overall cost of the project and we were not selected.   Ultimately, the owner selected a contractor without dealership experience who “didn’t know what they didn’t know.” At the end of the project, the selected contractor provided all features the owner needed, but at a significantly greater cost to the owner and with a longer design and construction timeline.

The fee-based approach mentioned above has proven to be the best way for an owner to select a CM.

Owners Best Suited for this Delivery Method

Owners that tend to favor the CMc delivery method are those with complex projects, need to meet a demanding construction schedule or are adding onto or renovating their occupied facility. We recently finished a CMc delivery method project for a private higher education client that included renovating their existing 38,000 SF building and constructing a 16,000 SF new addition. Another project currently underway is a church renovation and addition. While the facility isn’t fully occupied during the weekdays, by Sunday mornings we must ensure the building is clean and the flow of traffic is safe for Sunday parishioners.

Learn More

We recently published a podcast on the CMc delivery method. To hear more real-world use cases, tune into the episode here. In addition, follow our blog series on the construction delivery methods:

 

Construction Delivery Methods: 4 Paths for Business Owners

For business owners, proceeding with a construction project is a major decision, and to ensure a great construction experience, they must select the right team. Once an owner proves the project’s financial model makes sense for their business, they can either hire a design firm (architect) or a commercial general contractor. Who the owner contacts first largely depends on the owner’s preference or a pre-established relationship. However, the most successful projects have the perspectives of both the architect and contractor during the early phases of the project.

The next important decision an owner needs to make is selecting the construction delivery method for their project. “Delivery method” is a fancy term for describing who holds the legal agreement (contract) with whom. There are four typical paths or delivery methods an owner can take.

  1. Design-Bid-Build or Hard Bid – The owner first engages and holds an agreement with a designer. The designer designs the project to 100% completion, at which point the owner hires a contractor under a separate agreement.
  2. Construction Manager as Constructor or Construction Manager at Risk (CMAR) – The owner holds agreements with both the designer and the contractor. The critical difference is that the owner brings on the contractor early in the design process. Thus, the owner has the perspective of the contractor and designer as they are going through the design process.
  3. Construction Manager as Agent (CMa) – This delivery method is the exact same as CMAR with one major difference. The owner also holds agreements with each individual trade contractor such as a plumber, electrician, carpenter, etc. While the direct contractual flow is from the trade contractor to the owner, the CMa does all the work of administering those contractors.
  4. Design-Build – The owner holds an agreement with a single entity responsible for both design and construction risk. Most often, this agreement is held between the owner and the contractor who either hires an outside architect or who has the design capabilities in-house.

In our Delivery Methods: Four Paths A Business Owner Can Take to Complete Their Next Project podcast, we dive into the pros and cons of each delivery method. Listen and learn why selecting the right delivery method may be one of the most critical factors in determining a project’s success.

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Because we could have spent hours on this topic, we decided to break each delivery method into its own podcast.

COVID-19 & Higher Education: Our Conversation with Mike Poster of St. Ambrose University

For college students across the country, March 2020 will forever be imprinted in their memories. Classrooms shifted from in-person to online overnight, dormitories went from bustling to vacant, and fine arts and athletic schedules were postponed indefinitely. The Coronavirus outbreak caused seismic disruptions to student life and higher education operations.

When St. Ambrose University, a private institution grounded in the liberal arts, committed to academic excellence, social justice, and service transitioned to distance learning halfway through the second semester, they fully refunded students for their room and board even though it meant losing approximately $3.3 million in revenue.

We had the privilege of sitting down with Mike Poster, Vice President of Finance at St. Ambrose, to discuss how the university has handled COVID-19 challenges. In this podcast episode, we talk to Mike about how classrooms have been configured to meet social distancing guidelines while also safely supporting personal, in-class interactions. And why, amid a global pandemic, St. Ambrose experienced a peak in recruitment and enrollment.

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Tune in to our conversation and learn:

  • What student life looks like this fall.
  • How St. Ambrose has been able to differentiate themselves through COVID-19.
  • Tips for high school students evaluating higher education institutions.

For more information on St. Ambrose’s Fall 2020 plans, visit https://www.sau.edu/.

The Spaces, Built by Bush Construction Podcast is Live!

We are so excited to launch a podcast that brings genuine conversations to all things construction, design, and development. We have a great line up of episodes planned for you, ranging from our own stories as an experienced commercial contractor and design firm to interviews with community leaders on an array of construction topics.

Our podcast team – AJ Loss, President and CEO, Amy Simler Vice President of Strategic Markets, Michael Johnson, Director of Integrated Design and Technology, and Ali Bolin, Marketing Manager – kick off the first episode with a discussion on the impact COVID-19 has had on the construction industry.

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Learn about the biggest adaptation Bush Construction has had to make during the pandemic and how we have continued to ensure the safety of both field operations and office personnel. In addition, you’ll hear our thoughts on:

  1. how COVID-19 catapulted our business years ahead and has presented new growth opportunities.
  2. why video conferencing will play a larger role in future meetings and provide additional time savings.
  3. the importance of hiring a diverse workforce that can perform at a high-level in the office and remotely.

And a bonus! The team shares the names of books and podcasts they’re currently listening to or reading.

Rate, Review and Subscribe!

If you like what you hear, be sure to rate, review, and subscribe to our podcast on Apple or Google Play.

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