In 2019, more than 21 million square feet of outpatient care facilities were built across the United States. Construction of these facilities will continue to be a trend as a cost-effective way to provide quality care to patients.

While outpatient care is a more economical way to care for patients outside of traditional hospitals, there are important factors to keep in mind before designing and beginning construction of a facility to ensure that a provider stays on budget.

Here are three insights from the construction industry that will help offer the best value and return on investment for an outpatient facility.

  1. Establish project budget

In the early stages of a project, construction managers should discuss potential variables and unexpected challenges with clients to help solidify the budget as part of Target Value Design (TVD), which is between the owner, designers, and construction managers to determine scope, budget, and cost allocation for building elements. Understanding an owner’s budget allows early collaboration with the design team and will help drive design and deliver the best building and value within that budget. During this stage, it’s helpful to know that most construction costs for outpatient facilities follow a 30/30/40 rule. That is 30 percent on the core/shell, 30 percent on fit-up, and 40 percent on mechanical, electrical, plumbing, and fire protection (M/E/P/FP) systems. This can help guide the design team and owner on how much of the budget can be spent on a specific area of a project.

  1. Leveraging buying power

Standardizing building systems and finishes over a multifacility rollout will result in cost savings and long-term ease of maintenance. Having consistent design and building features, such as HVAC systems, elevators, flooring, etc., for every structure also streamlines the project delivery. There are three strategies that will help lower costs: designing for prefabrication (prefab), being open to new vendors to receive competitive rates, and buying in bulk.

With prefab, portions of the building are constructed off-site in a controlled environment and, once completed, brought to the project site and fit into place. Prefab should be considered as cost certainty and speed are typically the driving factors in a project—particularly ones that features repetitive elements like exam rooms and bathrooms—and prefab can help accelerate schedules and reduce costs.

Many times, hospitals have relationships with a limited number of equipment suppliers to help manage costs on maintenance and limit the quantity of spare parts. In an outpatient facility, the equipment needs are different because the facilities are smaller than the main hospital and may not operate 24/7. This means different approaches to HVAC can be used rather than equipment that would need to be used to service a massive building. Because the equipment types may be different, owners may open the specification to new suppliers, which can lower costs through competitive bidding.

Lastly, purchasing materials in greater quantities creates inherent cost savings, streamlines the project, and makes the project more predictable. For example, attic stock bulk purchases are possible when the design and building materials are standardized for a multifacility rollout.

  1. Choosing a site strategically

There are pros and cons to developing outpatient facilities as either new construction or a renovation of an existing building. New construction can offer unlimited design opportunities but can also come with higher acquisition, development, and construction costs.

Renovating existing buildings, like the trend of converting vacant shopping plazas into healthcare facilities, can come with existing conditions risks and potential unforeseen site conditions. Renovations can also require months of enabling work, which can cost up to $50 per square foot before a building is ready to receive the fit-up. Therefore, when deciding which type of project to undertake, it’s important to keep in mind below-grade conditions and condition of the envelope, which can affect the end costs.

For example, below-grade conditions can pose potentially significant earthwork requirements, ranging from hazardous soil abatement to ledge removal to the introduction of new infrastructure. Additionally, patient confidentiality and experience are crucial in the healthcare setting, making sound transmission, such as between the corridors and exam rooms, a major design concern in a space. It’s possible to mitigate sound through structural elements and building systems, such as demountable partitions, ducted returns, sound masking, and deck-to-deck construction.

New strategies

There are tangible and effective ways to build a quality outpatient care site while also keeping construction costs low. Strategies should start with early collaboration between the client, designers, and construction manager to increase the likelihood of success. From there, leveraging buying power by standardizing building elements and strategically choosing a site will ensure the best value for owners.

Brian Hamilton is project executive and director of healthcare and life sciences at Consigli Construction Co., Inc. (Milford, Mass.). He can be reached at