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Board of Managers approve constructing two community hospitals

June 21, 2022 was a historic day for University Health and its expansion of services in Bexar County.

The Bexar County Hospital District Board of Managers voted to approve a capital improvement program to construct community hospitals and medical office buildings on the two properties University Health has purchased or has under contract. They will be at I-35 and Retama Parkway north of Loop 1604, and on a site adjacent to Texas A&M–San Antonio.

This news made the front page of the San Antonio Express-News on Thursday, June 23.

The Board also requested that Bexar County Commissioners Court approve a resolution authorizing the publication of a notice of intent to issue Bexar County Hospital District certificates of obligation to fund about half the cost of the project. Commissioners voted to approve the plan.

Why is this project needed?

Bexar County is one of the fastest growing counties in Texas. By 2030 it is expected to be home to 2.5 million people. The population of Bexar and the seven surrounding counties will include 3.2 million people, an increase of 28%.

At the same time, University Hospital’s reputation for providing excellent health care has added to a growing number of patients. A Market Insights 2021-2022 Consumer Study conducted by NRC Health ranks University Hospital as the preferred hospital in San Antonio for all health care needs. The study found University Health has the best doctors and nurses and provides the highest quality of care in the community. Since 2014, the number of patients served by the Emergency Department has grown 22%, and hospital admissions have increased 23%.

While the inpatient growth is welcome, meeting community demand for hospital beds has become more challenging. The opening of University Health’s Women’s and Children’s Hospital in the summer of 2023 will help meet immediate needs, though many of the added beds will be filled immediately, and further expansion of hospital capacity will be needed to meet future demand.

The vision: A “hub and spoke” approach to hospital care

University Hospital is an excellent academic quaternary care hospital, but is the only hospital serving University Health patients who require advanced, specialized care and more complex surgical procedures. At the start of the COVID-19 pandemic, the limitations of a “one hospital” system became clear. The inability to provide necessary care to non-COVID patients resulted in a decrease in necessary elective surgeries, outpatient procedures, and medical admissions. The hospital’s location in the medical center also made access to its services challenging for people living in other parts of the community.

A plan to improve access for underserved areas of Bexar County

In the past two years, to better address the need for hospital beds closer to residents in underserved areas, University Health acquired three tracts of strategically located land: the site near Texas A&M in rural, southern Bexar County, the Retama site in northeastern Bexar County and property in the far western part of the county near Shaenfield Road. These purchases lay the foundation for smaller community-focused hospitals that can more efficiently serve the medical needs of the community. The Hospital District’s Board of Managers agreed with staff recommendations to first move forward with the development of the hospital projects at the Retama and Texas A&M locations.

The community hospital campuses will focus on:

  • Five adult service lines: General Medicine, Obstetrics, General Surgery, Cardiac, and Orthopedics, all of which are appropriate acute care services for a community hospital setting.
  • Shifting inpatient activity to the two new community hospitals to provide additional capacity at University Hospital for more complex medical and surgical patients.
  • Improving health equity and addressing social determinants of health at the local level by expanding convenient opportunities for patients living in these areas to access high quality acute care, emergency care, and outpatient services closer to home.

Each site will include:

  • A community hospital, including four floors and 140 beds, with an estimated footprint of 446,579 square feet. One additional floor will be included as shell space for potential future development.
  • An adjoining medical office building, integrated with the hospital, including physician offices for employed and community physicians as well as other clinical services and administrative space.

Once an architect is selected, the design of the facilities will be the same in both locations and is estimated to take 12 months. Construction will be approximately 28 months, for a total completion time of 40 months.

The Retama location currently has the needed infrastructure to initiate construction immediately after design. The Texas A&M – San Antonio location is under contract and the City of San Antonio has made necessary zoning changes. The plat for the 68 acres is in progress and should be completed by the fall of 2022. Utilities are estimated for completion in the fall of 2023.

Based on the proposed clinical program requirements to develop the two community acute care hospitals and medical office buildings, the estimated project cost is $950 million. The Bexar County commissioners Court in July approved financing that includes using $450 million in University Health cash reserves and issuing $500 million in certificates of obligation. The plan requires no increase in the tax rate.

The Retama-area hospital could open as soon as 2026, and the hospital near Texas A&M could follow in 2027.

The development of these community hospitals in strategic parts of the community positions University Health to meet growing community needs with high quality care closer to where people live, while being sensitive to health equity needs and the social determinants of health.

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