How long do Certificate of Need approvals add to healthcare development timelines? In most states, Certificate of Need (CON) approvals add 3–12 months to a healthcare project, and 12–24 months if the application is challenged or appealed; plan for 90–120 days of pre-filing preparation plus the state’s review and potential hearing schedule. Why it matters Timeline is critical. A 40,000 SF ambulatory surgery center projected to generate $2.0–$3.0 million in annual EBITDA forfeits roughly $165,000–$250,000 for every month opening is delayed. Meanwhile, construction inflation of 4–6% annually (0.3–0.5% per month) and interest carry on predevelopment spend compound the cost of waiting. CON delays also disrupt strategic sequencing. Missing a market window can cede first-mover advantage to a competitor, force physicians to extend expiring leases, and push projects into tighter labor or materials markets that increase total project cost by 5–10%. How it works Most CON processes follow a predictable path: pre-application planning (60–120 days), submission, completeness review (2–4 weeks), staff review (60–120 days), public comment/hearing (as scheduled), decision (within 30 days of hearing), and potential appeal (3–12 months). Batch cycles in some [...]

How do you minimize disruption to existing operations during facility expansion? You minimize disruption by sequencing construction in phases, creating swing space, scheduling off-hour work for noisy or invasive activities, and tightly managing shutdowns through infection control and life safety protocols. Why it matters Construction inside an operating clinic can reduce access, frustrate patients, and depress provider productivity if not carefully planned. A 20,000 SF multi-specialty clinic seeing 120 visits per day at a $70–$100 contribution per visit can forfeit $42,000–$60,000 in margin with just one week of downtime. Disruption also compounds staffing risk. Noise, dust, detours, and unpredictable utility interruptions increase burnout and turnover, while unclear wayfinding harms patient experience scores and referral confidence. How it works Start with an operational baseline and critical thresholds. Map daily patient volumes by hour, exam room turns, imaging schedules, and procedures that cannot be moved. Identify “red lines” such as maximum acceptable room closures, parking loss, and call center hold times to anchor phasing decisions. Build a phased plan with swing space. Decant one service line at a time into temporary space—modular units, shelled [...]