Home Case Studies

“Why are we building two free-standing emergency rooms so close to our acute care campus? This is crazy!” While cannibalization is certainly a consideration when evaluating new locations, it is only one data point that should be evaluated when selecting a site. This was especially true on the east side of a large Southwestern U.S. metropolitan area, where a large regional health system had two acute care campuses serving the market, comprised of multiple suburbs.

To understand the “why” on proximity location, one must first understand the competitive landscape. Commercial real estate brokers typically provide their clients with available real estate, traffic count, and other demographic data. In our experience, healthcare clients require a more thoughtful and focused approach to determine the optimal site for new locations. This deeper analysis revealed that potential patients living as close as two miles from one side of their hospital, and three miles from another side, were all actively avoiding traveling to their facility. These patients were actually choosing to drive longer distances to go to a competing health system. This was simply due to traffic patterns and traffic congestion. In other words, it was more convenient to go further due to accessibility.

This created a tremendous opportunity to pinpoint two ambulatory service locations designed to take advantage of the situation. The benefit for patients was new access points conveniently located along their existing commutes. The benefit for the health system was a greater capture rate for those patients they were previously losing. These highly visible locations are also another opportunity to extend the brand of the health system creating further awareness of their potential patient population. Collectively, once both locations opened, despite experiencing a slight decrease in emergency medicine cases at the primary campus, meaningful increases were seen in the service lines referred from emergency medicine including inpatient census, general surgery, and orthopedics to name a few.


An Academic Medical Center located in the Mountain West had a very limited ambulatory care presence in their primary markets when they sought assistance in increasing their patient access footprint and market share relative to their competition. And while the system is one of the premier academic medical centers in the country, they had never focused on leveraging their brand equity. A joint venture was crafted, combining ten existing FSED locations in those primary markets as well as mapping out a patient access point expansion strategy in other underserved communities.

In addition to urgent care and FSEDs, this expansion included the design and development of two community hospitals with the intent to serve specific needs. In one market, a 22-bed acute care hospital with 2 operating rooms was developed. And while licensed as a general hospital, the facility design and operating strategy focused on the community need for an orthopedic/sports medicine destination. In another market, a 50 bed, 3 OR campus was custom designed to accommodate expansion given the rapid growth of the surrounding community. After a rebranding effort, marketing, and negotiating innetwork contracts with the major payors, it was a tremendous win for the health system. They effectively increased their acute care locations by 40% and had 12 more front doors for prospective patients to enter. Six months after all the facilities had been rebranded with the academic medical center name and implementation was complete, the system recognized a 5% lift in their market share.


Each organization that looks to deploy a satellite service model is also looking to be able to provide care at a lower cost of service. Yet we often see the “hospitalization” of these remote facilities while leaders try to implement standard hospital staffing and efficiency modeling. In our deployment to a market in the Southern U.S., we advised and refined the health system’s proposed staffing plan, resulting in a reduction of the overall labor model by over 18%.

Incorporating cross-training, facility layout design, and technology, our efficiency models allow for the utilization of resources typically left wasted in other models. Ensuring the staff feels supported, equipped to handle emergencies, and have the tools to do their job, all contribute to a highly effective model that saves on the cost of care.

Teams that work within our modeled facilities find the experience extremely fulfilling, and the opposite of larger institutional models. Our team members come together to support one another in ways that leave them referring to their colleagues as a family as they partner together in unique and innovative ways.


Until recently, the term “micro-hospital” was not widely used or adopted. In 2014, a campus in large Southwestern U.S. metropolitan area was built with the intent of bringing access to an underserved population. It is important to understand that this hospital was designed from scratch by ambulatory care operators and a very experienced architectural healthcare firm, without using any preconceived notions of existing hospital design conventions. When finished, the facility encompassed 38,900 square feet. Services included an emergency room, radiology, pharmacy, high-complex laboratory, 16 inpatient beds, and surgical services.

Shortly after opening, the facility was contributed to a joint venture with a large regional health system. During tours of the facility, the hospital executives were astonished by not only the operational design of the facility but how rapidly and cost-effectively such a premium hospital was built. One of the comments: “You built a much better facility and did it 30% faster and 30% cheaper than we ever could.” Another admiration was shared around the forethought given to allow for service line growth that would not require additional capital and expansion. Examples of this are surgical services being architecturally and operationally designed to replicate a two OR ambulatory surgery center. This allows for both lower operating costs and increased throughput while maintaining the option of serving patients in the inpatient setting. Another area of differentiation is the design of the inpatient setting. With only 16 inpatient beds, four of these beds were designed to a higher acuity setting. The intent was for growth in potential surgical cases whereby surgeons could book their surgical day, and perform cases at one facility for both routine and higher complexity patients with comorbidities.

When designing a new project, it is critical to think through its intent. Micro-hospitals can serve multiple needs for a health system, and more importantly the patients that they serve. Considerations include medical staff, service lines, patient population, accountable care, and just as importantly, how the new facility is perceived by the payers. Some existing micro-hospitals are no more than free-standing ERs with inpatient beds attached, and payers are starting to see through this facade. Our advice continues to be that micro-hospitals must be true community hospitals tailored to specific needs of each geography in order to successfully engage all stakeholders.


Providing complementary care throughout an entire network offers patients the greatest service possible and allows for the best outcome. A challenge with many systems in the deployment of satellite campuses is the inconsistent connection to resources needed for a continuum of care.

In the Southwestern U.S., we advised our partner on the conception, development, and successful implementation of a network of collaborative and seamless facilities that spanned over 140 square miles and incorporated over 20 unique access points of urgent cares, hospital-satellite emergency centers, and acute care hospitals. Streamlining the flow of patients through a ‘Command Center’ operation provided a single point of communication between each satellite location, and patients were moved not necessarily to the closest location, but the most appropriate for the treatment that was needed. This continuum of care model allowed for the highest utilization of appropriate resources and reduced the overall cost of care in each setting.

We have helped develop, design, and strengthen healthcare locations across the country. Let us see how we can help yours.