Life Cycle Costing (LCC) model in use

Transcription

1 Life Cycle Costing (LCC) model in use André Bode senior staffmember R&D department Netherlands Board for Healthcare Institutions (NBHI)

2 The needs Financing of capital costs: Past (until now): real costing of capital cost (standards for interest and depreciation) -> investment maximalisation Present: Introduction of DRG s for certain elective operations excluding capital cost. Future: DRG s with capital cost component? ->investment optimalisation ->risk on investments ->impuls for efficiency

3 Financing investments capital costs through the life cycle capital cost interest depreciation capital costs years

4 Housing costs in the DRG s "Oude kapitaalslasten" versus Integrale Huisvestingscomponent Rente Aflossing Huisvestingscomponent

5 Benefits of LCC Relation between investments and running costs Insight in the total housing-costs Major decision-support-tool in several stages: initiative (strategic scenario studies) design stages technical work-out Finding the optimum

6 Questionaire / choices Refurbishing or new building? How large? Functions? Optimal proces / logistics? Design (structure, building mass)? Flexible / adaptable / changeable? Future proof? Lifespan? Saleable / Real estate policies? Reduction of running costs (energy, maintenance)? etc.

7 Health care specialties Changing environment more market, competition, needs for efficiency/cost reduction Changing demands aging, privacy, more space, quality Developments medical-technologies new players Lots of installations and equipment with a short technical lifespan (in parts of the hospital) Needs for the future? Innovations demands dynamic real estate

8 Hospitals

9 Finding the optimum, the model

10 The development of the LCC-model Dutch research in 2003 No literature Seldom attention for running costs Cooperation between Multiconsult and Bouwcollege (NBHI) LCC-model adaptabilty module

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14 Data bank Investments: Building note Bouwcollege More detailed cost analyses (Sfb elements) from our own references / studies Other public (external) data Running costs: Benchmark75 hospitals Weight per functiongroup

15 MOM costs Hospitals Costs per m² Management civil functions Maintenance Ziekenhuizen Costs of protection and surveillance Energy costs and w ater Planned maintenance and replacements

16 MOM costs hospitals 2004 Ene r gy kosten per m² Ziekenhuizen

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19 Testcase Scenariostudy merged hospital on two sites Scen. 1.: Complete New building on one location (gross area = ± m²) Scen. 2. t/m 4.: Two-location models with various parts of refurbishing / new building (gross area = ± m²) Scen. 5.: Continuing existing situation, including necessary refurbishment (gross area = ± m²)

20 5 Different scenarios compared Annual costs Annual costs per m² scenario's INVEST MOM-kosten scenario's INVEST MOM-kosten Total sum annual costs Initial investments and MOM (NPV) scenario's MOM-kosten INVEST scenario's INVEST MOM-Kosten

21 LCC is not stand-alone! Lcc Logistics/ workprocess Adaptablity/ designstrategies/ CREM

22 Core Hospital Differentiation of Buildings

23 Strategic asset approach Level 1- hot floor: theatres, diagnostics, intensive care etc. Level 2 - hotel accommodation: low care nursing Level 3 office accommodation: out-patients, administrative Level 4 factory accommodation: laboratories, kitchen

24 Examples from NBHI competition Core Hospital

25 6 College bouw Step Relations hybrid model (B)

26 Office Specificity Investment cost Capacity fluctuation Asset marketability

27 6 College bouw Step Division functions industry 9% office 24% hot floor 46% 47% Hybrid model (B) hotel 21% industry 13% office 36% hot floor 24% hot floor 24% Extreme model (C) hotel 27% 5

28 Step Hybrid model (B) hotel hot floor office industry Extreme model (C) hotel hot floor office industry Sections

29 Financial benefits Figuur 17: Vergelijking rendement van de monoliet en het extreme model (C) Monoliet * Extreem Hotel Hot floor Kantoor Fabriek bruto vloeropp. (m²) bouwkosten excl. BTW (mln.) 68,0 63,4 17,5 19,0 17,7 9,3 investeringskosten incl. BTW (mln.) 99,1 92,4 25,4 27,7 25,7 13,6 levensduur (jaren) Internal Rate of Return (IRR) 6,00% 7,49% 6,92% 7,47% 7,33% toename rendement 25% 15% 25% 22% * = voor de vergelijking zijn de bruto vloeroppervlakten gelijk en zijn de bouwkosten van de monoliet 7% hoger t.o.v. het extreme model lifecycle

30 Dordrecht Albert Schweitzer

31 Mapping Functionality Adaptability Technical quality Cbz Monitoring

32 % buildings Functionality 100% 90% above average 80% 70% 60% below average 50% 40% 30% below minimum 20% 10% 0% Algemene verpleging Special care Polikliniek Beeldvormende technieken Spoedeisende hulp Verlosafdeling

33 Technical quality % buildings 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% gemiddeld totaal bouwkundig bouwkundig extern intern installaties condition uitstekend goed redelijk matig (zeer) slecht

34 Adaptability: matches Algemene verpleging Special care Polikliniek Beeldvorm. Techniek Spoedeisende hulp Operatieafdeling bouwdeel A laag laag laag laag bouwdeel B laag laag laag laag bouwdeel C laag laag laag matches 3 3 matches 1 1 match 4 4 matches 2 2 matches

35 Flextool Totalscore 0,9 Level Flextoolscore of flexibility -> 0,8 0,7 0,6 0,5 0,4 0,3 Low functionality & low flexibility High functionality & medium flexibility Low functionality & one flexible scenario scenario 1 scenario 2 sceanrio 3 scenario 4 0,2 0, Level of functionality -> Mappingscore

36 Future? Open market New incentives Be prepared!

37 Thank you very much! Netherlands Board for Healthcare Institutions College bouw - Bouwcollege Churchilllaan 11, 7e etage 3527 GV UTRECHT The Netherlands [email protected]