Outpatient Plans

Fletcher Allen’s goal is to create outpatient facilities that are more accessible and have the potential to expand to meet future patient needs – something our current outpatient space on the medical center campus cannot do. We are therefore looking to optimize our outpatient campus in South Burlington to support outpatient and ambulatory programs that can be offered at locations other than the busy medical center campus in Burlington. This will allow us to meet growing demand for outpatient services, invest in a smart buy-vs-lease strategy, and preserve space on the medical center campus for the most acute care needs. We remain committed to utilizing our medical center campus for inpatient care and closely related outpatient services.  

new outpatient facility

Outpatient Plans FAQs 

Background

The focus of Fletcher Allen’s Master Facilities Planning efforts have been twofold: how to rejuvenate aging inpatient facilities and how to provide outpatient services in the context of growing demand and limited space on our medical center campus, all while making certain that we are doing this in the most financially prudent way.  Our planning has been based on several underlying principles:

  • Burlington will remain the inpatient hub for the sickest, most complex patients in our four-hospital health network.
  • All of our plans must support the goals of health care reform to promote greater access to high-quality, cost-effective care.
  • Patients must be able to access our services.

As a result, we are looking to expand our existing outpatient campus in South Burlington located on Tilley Drive off of Hinesburg Road, which already includes Orthopedics, Cardiology, Cardiac Rehab, Endocrinology and Pain Management services.  We currently lease space in two buildings on Tilley Drive, which we would like to purchase in order to reduce our costs, and we are proposing to purchase two adjacent parcels of land at this site.

What land are you proposing to acquire?

We are looking at two adjacent sites that are well-suited for ambulatory care purposes – Mountain View Park (on Tilley Drive) and an adjacent parcel to its north, both in South Burlington. These properties are located off of Hinesburg Road:

  • Mountain View Park on Tilley Drive includes almost 92 acres and several undeveloped lots and occupied buildings, and is suitable for near-term development. Our outpatient cardiology and orthopedics specialty centers are already located here in buildings that we lease, as well as our pain management clinic, cardiac rehab and endocrinology services.  
  • The adjacent parcel, owned by the O’Brien family, includes 38 undeveloped acres and provides a unique opportunity to develop a seamless campus plan approach, consolidating specialty outpatient services in one area that fits in the regional land use plan outlined by the Chittenden County Regional Planning Commission.
  • 

 Why aren’t you expanding on the Medical Center Campus? 

There are many constraints and factors that limit our ability to expand further on our Medical Center Campus in Burlington, which led us to the conclusion that this was not the right site for this type of development.  These constraints include the potential negative impacts of additional traffic congestion on the surrounding neighborhood and the Williston Road/East Avenue “jug handle” intersection; our desire to honor our commitments to our Ward I neighbors and the City of Burlington that limit how much of our property we can cover with buildings or pavement and where we can build on our property, and how high; and the inability to site additional facilities for outpatient services on the main campus without compromising our long term needs for space for renovating and replacing our inpatient units.  Regarding parking and traffic impacts, it is important to note that outpatient care services create more traffic than inpatient care because patients come and go frequently for appointments, creating more trips and congestion.  Also, we estimate we would need to build approximately 200 additional parking spaces for each 100,000 additional square feet of outpatient facility space. Based on past traffic studies completed about the volume of cars and trips that the surrounding grid can sustain, we do not believe it would be prudent to add further traffic congestion in the area of East Avenue and Williston Road. 

How could you have outgrown the Ambulatory Care Center (ACC) already when it opened in 2005, less than a decade ago?

It is important to note that the Ambulatory Care Center was never large enough to accommodate all of our specialty outpatient care when it opened in 2005.  Orthopedics, Neurology and Cardiology are some of the outpatient specialty services that never moved into the ACC because of space constraints in 2005.  Beyond that, the pace of change in health care – including advancements in technology and a continued shift toward more outpatient care – has outstripped many of our previous projections, and in the last decade or more, Fletcher Allen has had to move many of its outpatient specialty services to other locations due to space constraints in Burlington.  The clinics we’ve moved as a result of all of this include Plastic Surgery, which is located in leased space at Water Tower Hill in Colchester; Orthopedics, Cardiology, Endocrinology and Pain Management, which are located in leased space at Tilley Drive.  Also, we recently moved our Dental Clinic to leased space on Hinesburg Road, and soon, we will move a portion of our Ophthalmology Clinic out of the ACC into leased space in the community.   In the long run, we must move additional outpatient services out of the ACC, to preserve space in the ACC for those outpatient services with the greatest affinities with our inpatient services.

What other sites did you review before choosing the South Burlington Tilley Drive location?

We looked at many options and sites throughout the community, including in Burlington, before we selected the South Burlington site for long-term development:   

  • We began with a review of our patient population, including demographics, where our patients come from, and their predominant health conditions, and forecasted that with assessments of changing trends in health care delivery practices.  Through this review, we learned that slightly more than half of the patients who come to us for outpatient specialty clinical services live in Chittenden County, while the other half live throughout Vermont, Northern New York, and beyond.  Specifically for Chittenden County, 11% come from Burlington, while 7% come from South Burlington, 6.6% come from Essex Junction, 5.6% come from Colchester, 4.3% come from Milton, and 3.5% come from Williston. 
  • Using this data, we reviewed our existing facilities to determine our physical challenges and opportunities, and then reviewed sites throughout the community where patient needs could best be met.  We considered acquiring real estate at a single location, proximate to the Main Campus, for the future relocation of certain of our outpatient services on a consolidated outpatient campus.  This approach was ultimately selected because we believe it will result in greater efficiencies, more coordinated outpatient care, improved patient access, and lower costs. To pursue this option, it was necessary for Fletcher Allen to identify an appropriate real estate site. Fletcher Allen engaged real estate advisors, White + Burke Real Estate Investment Advisors (White + Burke), to assist us with this work. Over the course of several years, that firm identified a number of potential real estate sites that could meet our needs.  Consideration was given to nearly two dozen sites but the following sites were the subject of in depth analysis:
    • Hill Farm, South Burlington: 108 acres owned by JL Davis Partnership; land
    •  Mountain View Business Park, South Burlington: Partially developed office park with several undeveloped lots (60 acres comprised of lots 2,5,6,7,8).
    •  O'Brien Farm, South Burlington: 78 acres; lan
    •  Technology Park, South Burlington: 62 contiguous acres comprised of lots 9-13 within a partially developed business par
    •  Meadowlands Business Park, South Burlington: 46 acre lot within a multi-owner business par
    •  Dynapower Lot, South Burlington: 39 acre lot; lan
    •  Gilbane Lot, Burlington: 9 acres; Parking lo
    •  K-Mart, South Burlington: 12 acres; Shopping Center
    •  Rathe Road, Colchester: 45 acres; Junk yard, Land

Why did you choose the South Burlington site from this list?

Once we had narrowed our site options, we did a financial assessment to determine the best location that could meet our projected long term patient needs with the least impact on patient health care costs.  Our financial assessment showed that purchasing real estate is much less expensive than leasing.

Based on this financial assessment, we reviewed options for where we could purchase rather than lease land and buildings, and we identified the site in South Burlington as well suited for the future development of an outpatient hub.  It meets the long-term needs of our patients in a financially responsible way, and the location off of Hinesburg Road has other advantages, including:

  • It fits within the regional land use plan developed by the Chittenden County Regional Planning Commission:  http://ecosproject.com/
  • It aligns with South Burlington’s smart growth goals, planned land use patterns and is located in an area of the city already served by existing infrastructure and prioritized for development. 
  • Additionally, we currently have several clinics located on Tilley Drive, and have approximately 175,000 patient visits annually to this site.

How will patients get to the Hinesburg Road location without a more robust public transportation system? 

We are committed to working with the City of South Burlington, the Chittenden County Regional Planning Commission, and the Chittenden County Transportation Authority with the goal of helping to create a holistic plan for public transit in the region that includes our strategy for an outpatient campus at this site.  We will have time for this planning, since the approval we seek is to purchase the land and existing buildings, so future development is years into the future.  In the meantime, in conjunction with CCTA and SSTA, as well as with other health care providers, developers and advocacy groups, Fletcher Allen has been subsidizing an on-demand shuttle service for patients traveling to the Tilley Drive campus; we contributed approximately $11,000 to this service in 2014.  Also, Fletcher Allen contributes $37,500 to the United Way’s “Neighbor Rides Program,” which identifies qualified volunteers to provide transportation to seniors and persons with disabilities who have no available means of personal or public transportation.

What services would move to South Burlington?

At the moment, our focus is on securing the real estate to meet future outpatient needs.  We anticipate moving selected outpatient services to South Burlington in the coming years, but we still need to do the comprehensive planning with our clinical and operations teams to determine what services make the most sense to move.  Cardiology, orthopedics, endocrinology and our pain management clinic are examples of services that have already been moved successfully to Tilley Drive.  Other services that might move there from Burlington, or other sites, would be those that don’t have close clinical relations to our inpatient units on the main medical center campus. 

Will you build a new hospital in South Burlington at some point in the future? 

Absolutely not.  Our inpatient hub will remain in Burlington for the long term and continue to be co-located with our Emergency Department and all other services with close affinities to our inpatient care.  This is critical to our partnership with the University of Vermont and enhances integration of our collective missions of teaching, research and patient care.  We have a long-term master facility plan, which includes a plan for replacing our aging inpatient facilities on the main campus over time; our current proposal to build a new inpatient building over the Emergency Department is part of that long-term plan.  We are currently in the permitting process with the City of Burlington for our new inpatient building, and we are preparing to file a Certificate of Need this fall for construction of the building. 

Will you move primary care services from Burlington to South Burlington?  What about behavioral health services?  

We are not moving primary care services from Burlington to South Burlington.  We are committed to maintaining our primary care presence in Burlington, just as we do in other cities and towns across Chittenden County.  Nor are we moving behavioral health services from Burlington to South Burlington.  We are committed to delivering primary care close to where people live.

What will this cost, and how can the hospital afford it?

The proposed South Burlington investment carries an estimated total cost of approximately $52 million. The total estimated price tag includes the cost of:

  • Five vacant lots on Tilley Drive
  • Four commercial office buildings on Tilley Drive – two that we currently lease space in for Cardiology, Pain Management, Endocrinology and Orthopedics; and two that currently house other businesses
  • A 38-acre parcel of vacant land, known as the O’Brien Farm
  • Closing costs, CON fees, financing expenses and other due diligence costs

The ultimate total price tag may vary slightly depending upon the outcome of a fair market value appraisal process that will be conducted after regulatory approvals are obtained.

This proposed investment has been in our capital plan and our multi-year financial plan for a number of years.  The financial plan allows us to assess the affordability of any proposed capital spending based on our current financial position, future expense assumptions, and debt. Based on these factors, our analysis shows that this investment can be supported by current operations, and will not require any additional rate requests to fund it.  The proposed investment includes land and two buildings, which we currently lease.  If we eliminate the leases on the two buildings by purchasing them, we will break even on that portion of the overall investment in approximately 10 years.  And with what we will save on those two buildings in the following 10 years, we will be able to cover the cost of the land.  Thus, we anticipate that the overall investment will pay for itself in 20 years.  Also, today’s low financing rates add to the affordability of the proposed investment.

Who has been involved in the process?

We have worked with a variety of internal and external stakeholders to develop these plans.  We’ve engaged Halsa Advisors to assess our inpatient and outpatient programs and project future patient volumes. We’ve worked with MorrisSwitzer~ Environments for Health to test building size, capacity and viability concepts. White + Burke, our real estate advisors, helped determine appropriate real estate locations. Within our organization, we’ve engaged our Medical Group, Facilities, Finance, Planning, Network Development and others to plan appropriately for outpatient needs. 

In terms of community stakeholders, we have kept our Burlington Ward I neighbors informed of our plans; we’ve met with representatives from both Burlington and South Burlington; we’ve shared our plans with members of CCTA and the Chittenden County Regional Planning Commission; we are currently meeting with other interested stakeholders from the community; and we have provided a public tour of the property to interested stakeholders.

What’s the project timeline?

If we gain approval from the Green Mountain Care Board to purchase the properties, we estimate that we’ll begin planning to move selected services in three to five years. Important steps in the interim will be our continued work on public transportation to and around Tilley Drive, as well as the development of an inclusive campus master plan.  As the academic medical center partner of a four-hospital system (Fletcher Allen Partners), we have a responsibility to  meet evolving patient care needs in the region over time, and the acquisition of the South Burlington land allows us the flexibility to expand outpatient services on that campus when needs arise in the future.

Whom can I contact with questions?

Dave Keelty, Director of Facilities Planning and Development, at 802-847-8443 or Dave.Keelty@vtmednet.org.