ATTACH E.4 - VFTHE Feasibility Study Performance Work Statement for Washington DC VAMC - v3.docx

PERFORMANCE WORK STATEMENT SUPPLEMENT TO THE MAHSO/VFTHE BPA FIRST CALL ORDER

A. GENERAL INFORMATION

Note: Environmental baseline site information and environmental market area analysis are being conducted in a standalone parallel effort to the feasibility study. The VA will provide the completed environmental reports to the contractor for incorporation/integration. The contractor shall ensure that the environmental aspects/concerns/issues/constraints are accurately presented in the feasibility report analysis.

1. Title of Project: Individual Feasibility Studies completed to Determine Replacement Options for Washington, DC VAMC in the vicinity of Washington, DC metropolitan area.

AIR Commission Recommendation

a. Modernize and realign the Washington, DC VAMC by:

1. Constructing a replacement VAMC with inpatient medical and surgical services, inpatient mental health services, outpatient surgery, emergency department services, and outpatient services in the vicinity of Washington, DC: The Washington VAMC offers inpatient acute care, long-term care, and outpatient services. The VAMC has 164 inpatient acute care and 80 CLC beds. The market is projected to experience an increase in enrollees and demand for all services except RRTP and inpatient medical and surgical services through FY 2029. The facility is a major training center, supporting over 1,200 trainees from George Washington University, Georgetown University, and Howard University. The current VAMC has ongoing facility challenges, high operating and maintenance costs, and limited room for expansion. Completion of current projects will still result in Washington VAMC facilities that do not meet current VA planning standards or contemporary health care service standards35. By building a replacement facility, VA’s recommendation will resolve these issues while maintaining its ability to provide tertiary and quaternary inpatient care and complex outpatient care in the market and across VISN 5. The new replacement VAMC will maintain clinical services by providing inpatient medical and surgical services (88 beds), inpatient mental health (76 beds), primary care, outpatient mental health, outpatient specialty care, outpatient surgery, and emergency department services. The new replacement facility may be on or in the vicinity of the existing Washington VAMC campus, based on space development requirements in Washington, DC.

2. Relocating the CLC to a stand-alone site in the vicinity of Washington, DC: A new, stand-alone site of care for CLC services will allow VA to design and construct a new VAMC that is focused on delivering acute care services and separately activate a CLC that can be more flexible in its design to focus on elder care needs in a more contemporary setting. In the Washington Market, 28.0% (34,814) of Veteran enrollees are over the age of 65. The number of Veteran enrollees in the Washington Market over the age of 65 is projected to increase by 36.5%, from 34,814 to 47,524 by FY 2029. In FY 2019, there were 140,432 enrollees within a 60-minute drive time of the proposed site. The Washington VAMC has 80 CLC beds. In-house demand for long-term care across the Washington Market is projected to reach an ADC of 136.9 by FY 2029. Community providers have limited capacity for long-term care within the district boundaries of Washington, DC. The CLC will be placed in an area of Washington, DC that is most convenient to the elderly Veteran population in need of those services and increase CLC beds from 80 to 120.

3. Closing the current Washington VAMC: On the completion of a new replacement Washington VAMC, relocation of services to the new VAMC will allow for closure of the existing VAMC.

The Washington, DC VAMC has a space requirement of approximately 2.1M SF, a space gap close to 900,000 SF, and a plant replacement value approaching $4B.

2. Scope of Work: The Contractor shall provide all resources necessary to accomplish the deliverables described in this Performance Work Statement (PWS). The Contractor shall be responsible for the following:

The scope requires the individual preparation of an Economic Business Case Analysis for the replacement of the Washington, DC VAMC in the Washington, DC vicinity. These reviews shall be based on:

· Review of current facility plans and projects.

· Review of past and current site Environmental, Historic and Cultural plans, assessments, evaluations, constraints, and potential issues of concern

· Generic site planning.

· Costs to acquire, construct and operate at a new site of care.

· Costs to maintain the existing site(s) of care.

· Possible reuse or valuation of the existing site when vacated and reused as needed.

· For all topics that have geo-based findings, include GIS layers as well as PDF maps. For any topics that are not applicable to these locations (such as sea level rise, CZMA requirement), include a statement acknowledging the PWS requirement and provide the basis for not evaluating.

· Develop a schedule of actions, milestones, and deliverables.

The Washington, DC VAMC has long-term plans including the potential of becoming a more major and integrated healthcare partner.

The following 4 economic and site feasibility analysis options listed below will be performed in support of this study: Baseline Option, Replacement Facility Option, Remain at Current Campus Option, or Hybrid Option which will consider the potential for VA to focus on specific care programs and then develop partnerships through either a Joint VA-DoD facility or VA-Community Partner facility in providing select care services.

3. Baseline Option. The Contractor shall review and consider the execution of projects already planned and appropriated (Majors, Minors, NRM and Seismic). Examples to considered will include new parking requirements vs. existing parking capacity, New Site Square Footage (SF) requirement vs. Existing Site SF (including all planned projects and associated costs to match SF), thus allowing a truer comparison of all the Options. This will take into consideration costing items identified in Scope item 2 listed above (traffic and utilities).

4. New Replacement Facility Site Location Option (offsite). The Contractor shall complete generic site planning and costs to acquire, construct and operate at a new site of care within the Washington, DC metropolitan areas utilizing the documents provided by VA. For each new site location under consideration public access to the site must be available currently or when the new site becomes operational.

Utilize demographic, enrollment, workload data of the VISN 5 Washington, DC Veteran Market, and user provided information to create, validate and update the PFD. Consider both in-house and community care projections and the opportunities to recoup care by verifying workload data and distributing recouped workload, and recommending distribution of care (In-House or in the Community closer to Veterans) if a properly sized and equipped VA facility was available. Differences between data, criteria and user input will be discussed, documented, and flagged accordingly. Contractor will provide strategic recommendations for efficient space usage based upon professional expertise and recent Market Assessment experiences. The Final PFD, in all formats, will be provided with full access and control. Training on tools to be provided (as necessary) to Washington, DC VAMC staff.

The Contractor shall engage with VA in discussions about potential collaboration, collocation, and/or sharing of services and/or facilities with the identified Community Partners and potential DoD locations. The Contractor shall help define VA's understanding of the potential partnership strategic visions, identifying key considerations around healthcare delivery, operational complexities associated with sharing of services and/or facilities, and potential financing and deal structuring (not to include actual structuring). In addition, develop materials for VAMC, VISN and CFM leadership that outline discussions and the unique opportunities that exists in the Washington, DC metropolitan area. Considerations shall be made for geographic changes and the impacts to affiliate partners. VA will provide advisement and data to support contractor lead analysis.

The healthcare community in Washington, DC is fully supportive of the VA’s mission goals.

5. Existing Site Option. The Contractor shall complete a similar analysis as noted above in Paragraph A.3.a. to determine the costs of the facility remaining in the existing location long-term. This analysis shall include an evaluation of all activities needed to allow the existing site to be 100% compliant with VA standards and criteria from a cost, access, and impact perspective. The analysis will include, but not be limited to:

· The existing planned capital portfolio.

· Additional construction needs to close space and parking gaps.

· Facility compliance with VA Physical Security, Emergency Management, Utility system, Energy conservation, and functionality standards.

· Addressing current safety, facility condition, and site access concerns.

This analysis will provide appropriate consideration to accomplish these activities on a functioning Medical Center in a Land-Locked location, and the duration necessary to complete the work. Included would be the potential for selected services - Outpatient Basic, Outpatient Intermediate, Ambulatory Procedure Center Basic, Ambulatory Procedure Center Advanced - functioning from a remote satellite campus location.

6. Hybrid Site Option. The Contractor shall provide basic concepts for reuse of the existing campus facilities both within or outside VA while developing an off-site plan for services currently located at the main facility campus that are anticipated to be decanted off-site to free up existing space. The study should consider use of the existing campus facilities which do not require substantial investment to be compliant with VA criteria, e.g., as a potential homeless housing facility, administrative uses, and location for other VA programs at the VISN, regional, and national level. This option is intended to allow the facility to close all existing space, security, condition, parking, and access gaps by a combination of relocation to a new site for certain services while other services would remain in existing structures at the current campus. The determination of which services would remain at the current campus will be based on fitting those services into existing VA criteria compliant structures within existing campuses and the necessity of maintaining close geography to affiliate and/or key community provider partnership programs. Potential options may include use of leased property for delivery of a care program(s).

The scope of these services shall consider the inclusion of a Healthcare Analysis and Evaluation of the Community’s capacity to absorb VA workload if the VISN 5 Washington, DC Veteran Market’s projected growth and current or proposed sites for a Health Care Center (HCC), Multi-Specialty Outpatient Clinic (MSOC) and/or Community Based Outpatient Clinic (CBOC) indicate that this is needed. The PFD to be created by the Contractor for Washington, DC VAMC and will be reviewed and validated based upon projected workload and assumptions related to Community and Contracted Care.

General tasks to complete the scope of the Tasks noted above will include, but not be limited to:

· Construction feasibility within active, in-use buildings.

· Economic Analysis and Risk Analysis of performing construction programs.

· Cost and schedule estimating for performing construction programs.

· Site planning for new facility based on the Validated PFD and select partnership programs (i.e., affiliates, community care providers, DoD).

· Real Estate Investigation and Analysis for site sizes (vertical vs. horizontal).

· Disposal options, reuse, and analysis for end of facility life at existing campus. May include using the VA Enhance Use Lease program or moving campus care services to CBOC leased spaces.

· Environmental, Historical and Cultural consideration analysis and risks under each option. (see description above under Section 2: Scope of Work).

· Utility availability to meet the anticipated demands of a new facility- Water Volume, Sewer Volume, Gas and Electric.

7. Performance Period: The period of performance is three hundred sixty6(350) calendar days from the date of Notice to Proceed (NTP). Work at the Government site shall not take place on Federal holidays or weekends unless directed by the Contracting Officer (CO).

8. Place of Performance: The primary place of performance will be at the Contractor’s facilities; however, some tasks may require work to be performed at a government facility. Any work at the Government site shall not take place on Federal holidays or weekends unless directed by the Contracting Officer (CO). The Contractor shall be required to travel to Washington, DC to meet with VISN 5 staff, CFM staff, conduct site visit(s) and provide presentations, and to execute real estate related tasks no less than five (5) times. The Contractor shall be required to obtain the necessary security clearances and identification badges for Washington, DC VAMC campus access.

9. Type of Contract: Firm Fixed Price.

10. CONTRACT/TASK ORDER AWARD MEETING

The Contractor shall not commence performance on tasks in this PWS until the CO has conducted a Kick- Off Meeting or has advised the Contractor that a Kick-Off Meeting is waived and issued a Notice To Proceed (NTP).

11. GENERAL REQUIREMENTS

The following general requirements apply to this contract:

1. The Contractor shall identify its proposed technical approach in writing for every task. The technical and professional team members shall have a minimum of ten (10) years of very high level of experience in the tasks described in this contract, including Architect/Engineer, Healthcare Planning, Construction Management, Real Estate and Cost Estimating personnel.

a. Contractor shall have experience (at least 10 years) performing work for high-cost economic areas.

b. Contractor’s A/E Team shall have experience (at least 10 years) performing work for healthcare campuses containing multiple buildings and limited physical space.

c. Contractor’s Cost Estimating Team shall have experience (at least 10 years) performing cost estimating in high-cost and dynamically changing construction markets. Specific experience in the South Texas Healthcare Market is preferred.

d. Contractor’s Healthcare Planning Team shall have experience in healthcare planning (at least 15 years) performing work with healthcare analysis, market and demographic surveys and analysis, workload and staffing projections, and service line projections and recommendations for medical facilities in the fifteen to twenty (15-20) year forecast.

e. Contractor’s Design Team shall have experience (at least 10 years) performing work with healthcare providers performing construction expansion and renovations within active medical facilities (medical centers, community hospitals and ambulatory healthcare facilities.

f. Contractor’s Construction Management Team shall have experience (at least 10 years) performing work in construction management and oversight within an active Medical Center environment and campus.

g. Contractor’s Site Planning Team shall have experience (at least 10 years) performing analysis of medical (hospitals and ambulatory health care) facility needs and development of site requirements at the concept development stage for future healthcare campuses.

h. Contractor’s Real Estate Team shall have experience (at least 10 years) performing analysis of medical facility reuse, sale, and decommissioning of medical facilities.

i. Contractor’s Environmental Team shall have experience (at least 10 years) performing GIS related analysis and project delivery.

2. All deliverables shall be phrased in layperson language. Statistical and other technical terminology shall not be used without providing a Glossary of Terms.

3. Unless otherwise specified, the following schedule requirements apply:

a. Where a written milestone deliverable is required in draft form, the VA IPT will complete its review of the draft deliverable within ten (10) working days from date of receipt.

b. The Contractor shall have seven (7) working days to deliver the final deliverable from the date of receipt of the Government’s comments.

4. The Contractor shall provide, via email, minutes of all Government-Contractor meetings. The Contractor shall provide these minutes within two (2) business days after completion of the meeting unless otherwise specified in an individual task.

5. Except for proprietary information in company quotes identified and marked in accordance with FAR 522.215-1(e), the Contractor shall not deliver to VA any proprietary products or information of any type in completing the requirements of each task order PWS. The Contractor’s internal development tools (that is, those development tools not developed for VA work and not required by VA to install, use, or revise the deliverables) are exempted from this requirement. If the Contractor believes an exception to these requirements is necessary for the effective or efficient execution of a task order, the Contractor shall request a specific exemption, in writing, to the CO, and shall not use the proprietary tools or information until approval is received from the CO.

6. The Contractor shall verify that contract employees maintain an open and professional communication with the staff at the Washington, DC VAMC facilities. For transparency purposes, email to VA staff shall not be blind carbon copied (BCC) to other personnel. Complaints or violations validated by the Contracting Officer’ Representative (COR) or VA staff will be reported in writing to the CO, Office of the Inspector General (OIG), or Head of the Contracting Activity (HCA) for action. If the Contractor fails to correct validated complaints raised by the COR and or CO, it will be considered a failure in performance.

7. The CO may require the Contractor to meet with the CO, COR, Contract Administrator, and other Government personnel at least quarterly, and as required more frequently by the CO. The Contractor may request a meeting with the CO when deemed necessary.

8. All project documents shall be provided in a timely and expeditious manner to the VA IPT in presentation form as well as in native form, when applicable. VA shall be provided with unrestricted access to Microsoft® (MS) Excel files and other documents used to cost out projects and/or analyze a specific matter.

9. Deliverable format for Executive Summaries also includes PowerPoint slides in pdf and native formats. Reports (pdf and native) to include (as appropriate for the content):

a. Executive Summary

b. Intent and Scope

c. Methodology and Data Sources

d. Needs/Benefits Overview

e. Detail options with financial and qualitative costs/benefits

f. Analysis and Recommendations

g. Conclusions

h. Appendices: Presentations, data tables/sources, references, etc.

12. SPECIFIC MANDATORY TASKS AND ASSOCIATED DELIVERABLES

1. Task One: Project Management Plan (PMP), Schedule, Briefing

The Contractor shall provide a Project Management Plan (PMP), including a detailed schedule, and a briefing for the VA IPT, which presents the Contractor’s plan for completing all tasks and deliverables in this PWS. The Contractor shall keep the PMP up to date throughout the period of performance. Updates to the PMP shall be provided by the Contractor every two (2) weeks.

Deliverable 1: PMP, Project Schedule, and Briefing

2. Task Two: Communications

2.1 Kick-Off Meeting

2.2 Status Teleconferences/Web Meetings (weekly). Virtual conferences shall use Microsoft® Teams Platform.

2.3 Meeting Minutes with tracked action items.

Deliverable 2: Kick-Off Meeting and up to fifty (50) Weekly Status Conferences

3. Task Three: Healthcare Planning

Program For Design Creation & Validation

3.1 Market Analysis. The Contractor shall review the Veteran Market demographics provided for VISN 5 Washington, DC facilities, that includes: growth projections vs. losses, understanding both internal and external supply and demands for care, and how key relationships with academic medical and community partners impact care delivery; an analysis of the economic status of the Washington, DC region shall also be conducted in terms of how it impacts the operation of the medical center being studied. This shall include (if appropriate) planning to distribute services from the Washington, DC VAMC to designated HCC, MSOC and/or CBOC locations. Identify what services, training, and residency programs, how much, and number of staff projected to be distributed. Remaining services intended to stay at the Washington, DC campus locations shall be included in the space planning. In addition, some assumptions regarding community care shall be included in this task.

The Contractor will also study the impact of any decision or recommendation as to how it may impact the greater Washington, DC Market and other Sub-Markets in VISN 5.

3.2 Data Validation. Verification of workload (Documented Base Year 2021) reports from VISN 5 to VA Central Office (VACO). (Documented Base Year 2021) vs projections by Departmental Stop Codes and staffing (actual vs. projected) to identify the actual needs for the intended project. This information is required for the Data Input section in SEPS used to build the actual PFD space program.

The Contractor shall consider Relative Value Units (RVUs) for the respective service lines that will be included in the scope of work for the proposed project and review Physician Productivity Standards to verify accurate sizing of departments / services for the project.

The Contractor will also review the current Washington, DC Facility Condition Assessment (FCA) data and planned projects to incorporate information, as appropriate, into the Cost Estimating for each facility Option, Economic Analysis and Risk Analysis.

3.3 Space Planning. This will be led by the Contractor, working in concert with the CFM Regional Planners. The Contractor and CFM Regional Planner will evaluate SEPS needs/requirements as outlined by the Washington, DC facilities and verify that each department is properly sized based on data projections, staffing estimated, and other select input from users. This entails coordination meetings with the Washington, DC VAMC User Groups to clearly define the scope of the project options and fully understand user specific requirements that impact the overall space plan. Space discussions will include swing space needs when project phasing is necessary to resolve gaps associated with making capital investments. Meetings with Washington, DC VAMC personnel will be scheduled so that the assigned CFM Regional Planners will be in attendance.

3.4 Risk Assessment. The Risk Assessment typically includes high-level risk items seen for construction projects, i.e., constrained site, hot construction market, huge impact to facility operations, etc. Applies to all scenarios as since Risk will feed the Cost Estimating and Economic Analysis for each Option.

3.5 Master Planning. The Contractor shall be tasked to prepare a recommended campus wide Ten (10) Year Master Plan, to include Phasing sequences to define project milestones and key decision points. Depending on the options developed, the Contractor shall develop a High-Level Phasing Plan and Schedule to execute each of the Options. This is not a “Master Plan” but a plan for the Options.

3.6 Program For Design (PFD). The Contractor shall utilize demographic, enrollment, workload data of the entire Washington, DC market’s User-provided information to create, validate and update the PFD from the Business case Analysis. The Contractor will consider both in-house and community care projections and the opportunities to recoup care if a properly sized and equipped VA facility was available. Differences between data, criteria and user input will be discussed, documented, and flagged accordingly. The Contractor will provide strategic recommendations for efficient space usage based upon professional expertise and recent Market Assessment experiences. Final PFD—in all formats—will be provided with full access and control to the VA IPT. Training on tools to be provided (as necessary) to Washington, DC VAMC staff as needed.

Facilitate Affiliates Discussions

3.7 The Contractor shall support the VA with discussions about potential collaboration, collocation, and/or sharing of services and/or facilities with their existing Academic Affiliates. Help define VA's understanding of their current affiliates’ strategic vision, identifying key considerations around healthcare delivery, operational complexities associated with sharing of services and/or facilities, and potential financing and deal structuring (not to include actual structuring). In addition, the Contractor will develop materials for VA leadership that outline discussions and the unique opportunity that exists within the Washington, DC community.

Deliverable 3: Executive Summary, Report of Findings, Healthcare Planning Analysis and Recommendations, Validated Program For Design, Future with Affiliates Recommendations

4. Task Four: Real Estate Investigation and Analysis

4.1 Using Site Planning Analysis and Recommendations from Task 3, the Contractor will generate a range of site sizes that will meet the functional requirements for a Replacement Facility. The Contractor shall conduct a real estate search and analysis to identify sites within the delineated areas than will meet the size and zoning/entitlement requirements.

4.2 The Contractor shall provide Real Estate Analysis for the existing VA property, as well as potential sites for a New Facility or Hybrid Facility. Analysis shall include:

· Evaluation of site location

· Pertinent site conditions

· Acreage

· Visibility

· Convenience of access, including roadways and public transportation

4.3 Document pros and cons for each site.

Deliverable 4: Executive Summary, Report of Findings, Analysis and Recommendations to include weighted property requirements to support identification of optimal sites (ex. Drive Times, Roadway Improvements, Utilities, Site Visibility, Site Access, Surrounding Support facilities).

5. Task Five: Site Planning – New Facility

5.1 The Contractor shall develop two (2) Generic Site Plans that meet the requirements of the Business Case (to be provided), including roadways and parking, energy center, and all Physical Security and Resiliency Design Manual (PSRDM) requirements. Include options for incorporation with key DoD:

· One Site Plan Option will incorporate more vertical elements (smaller site).

· The Second Site Plan Option will follow best practices and more closely match VA standards and criteria.

5.2 Provide Blocking and Stacking Plans for each Site Plan.

5.3 Document pros and cons for each Site Plan.

Deliverable 5: Executive Summary, Report of Findings, Analysis and Recommendations

6. Task Six: Site Planning – Existing Site

6.1 The Contractor shall consider the projects currently planned for the existing site, including Major/Minor/NRM projects. Consider how these projects will:

· Interact with each other.

· Be impacted by options of one versus multiple contractor(s).

· Be affected by costs associated with temporary moves and relocation of patients and staff.

· Be impacted by the risks associated with this project work over the next ten (10) years. Include options for incorporation with any key partners (academic affiliates, community providers, DoD).

6.3 The Contactor shall develop pros and cons for returning out placed and out-sourced programs and services to the Durham campus.

6.4 The Contactor shall develop pros and cons for addressing the 8 Issue Points in the Appendix, Background, Paragraph (C).

6.5 The Contactor shall provide pros and cons for Durham VAMC programs and services remaining at current location.

Deliverable 6: Executive Summary, Report of Findings, Analysis and Recommendations

7. Task Seven: Site Planning – Hybrid Site

7.1 The Contractor shall consider the projects currently planned for the existing site including Major/Minor/NRM projects. Consider how these projects will interact with each other, options of one versus multiple contractor(s), costs associated with temporary moves and relocation of patients and staff, and the risks associated with this project work over the next ten (10) years. Include options for incorporation with any key partners (academic affiliates, community providers, DoD).

7.2 The Contractor shall develop a plan for continued use of the existing site, utilizing the requirements of the Business Case (to be provided), including construction of space/buildings, roadways and all PSRDM requirements, which are needed to fill in the space gaps.

7.3 The Contactor shall develop two (2) Generic Site Plans for a new off-site facility that meet the requirements of the Business Case (to be provided), including roadways and parking, energy center, and all PSRDM requirements. Include options for incorporation with any key partners (academic affiliates, community providers, DoD), if applicable. Options may include use of VA Enhanced Use Lease program of leasing clinical space via the VHA Leasing program.

7.4 One Site Plan Option will incorporate more vertical elements (smaller site).

7.7 The Contactor shall document pros and cons for each Site Plan Option.

7.8 The Contactor shall develop pros and cons for returning out-placed and out-sourced programs to the Durham VAMC campus.

7.9 The Contactor shall develop pros and cons for addressing the 8 Issue Points in the Appendix, Background, Paragraph (C).

7.10 The Contactor shall provide pros and cons for Durham VAMC programs evolving to occupying hybrid locations.

Deliverable 7: Executive Summary, Report of Findings, Analysis and Recommendations

8 Task Eight: Construction Cost Estimating

8.1 The Contactor shall develop a detailed, fully burdened, and escalated Construction Cost Estimate for the two (2) Site Plans in Task Five: Site Planning – New Facility. Construction Cost Estimate to include supporting documentation elucidating cost estimating methodology and sources/references for inputs (e.g., labor, materials, escalation, etc.); methodology should include incorporate actual costs of relevant completed construction projects.

The Construction Cost Estimate for each Option shall be based on most recent VAMC Unit Cost Guide plus estimates for project components outside this document.

8.2 Based upon the results of Task Five, the Contactor shall develop a burdened and escalated Construction Cost Estimate for the completion of the current construction program, as well as additional capital investments required to close all health care system gaps as identified in the Scope of Work Paragraph A.3.b.

8.3 Based upon the results of Task Six: Site Planning – Existing Site, the Contractor shall develop a burdened and escalated Construction Cost Estimate for the completion of the current construction program, as well as additional capital investments required to close all health care system gaps as identified in the Scope of Work Paragraph A.3.c.

8.4 Based upon the sites identified in Task Six, the Contractor shall develop a range of costs for:

· Property.

· Off-site utility work.

· Other necessary infrastructure improvements, including land due diligence, remediation, etc.

8.5 Based upon the results of the review of the Baseline Option, the Contractor shall develop a burdened and escalated Construction Cost Estimate for the execution of projects already planned and appropriated (Majors, Minors, NRM and Seismic), as well as additional capital investments required to close all health care system gaps as identified in the Scope of Work Paragraph A.3.a.

8.6 The Contractor shall update costs in the same format as other Options and run these costs through the same Economic Analysis for a true construction cost comparison of the Options.

8.7 Based upon the results of Task Seven: Site Planning – Hybrid Site, the Contractor shall develop a burdened and escalated Construction Cost Estimate for the completion of the current construction program, as well as additional capital investments required to close all health care system gaps as identified in the Scope of Work Paragraph A.3.c.

8.8 Based upon the site(s) identified in Task Seven, the Contractor shall develop a range of costs for:

· Property.

· Off-site utility work.

· Other necessary infrastructure improvements, including land due diligence, remediation, etc.

8.9 The Contractor shall develop a detailed, fully burdened, and escalated Construction Cost Estimate for the two (2) Site Plans in Task Seven. The Construction Cost Estimates shall include:

· Supporting documentation elucidating cost estimating methodology.

· Sources/references for inputs (e.g., labor, materials, escalation, etc.).

Methodology shall include and incorporate actual costs of relevant completed construction projects.

8.10 Based upon the results of Task Seven, the Contractor shall develop a burdened and escalated Construction Cost Estimate for the completion of the current construction program, as well as additional capital investments required to close all health care system gaps as identified in the Scope of Work Paragraph A.3.d.

8.11 The Contractor shall provide Basic Phasing Plans for each Option to show how expeditiously the replacement option(s) would progress.

Deliverable 8: Executive Summary, Construction Cost Estimates

9 Task Nine: Disposal and Reuse Options, including analysis for Existing Site.

9.1 The Contractor shall evaluate and present options for disposal, reuse, exchange, etc., of the existing facility with current VA or other federal authorities. Analysis must address the preservation of historical assets, to include the Kerrville, TX VA Hospital by identifying the highest and best use for reuse or disposal options.

9.2 The Contractor shall determine the value of the existing site and buildings and present a breakdown by individual asset.

Deliverable 9: Executive Summary, Report of Findings, Analysis and Recommendations

10 Task Ten: Economic Analysis and Risk Analysis

10.1 Utilizing all the data collected and developed in Tasks 1-9, the Contractor shall conduct an Economic Analysis covering a twenty (20) year period comparing the Existing Facility Planned Activities to the Replacement Facility Strategy. The Planned Activities are described in the Background Section for each VAMC location.

10.2 Utilizing all the data collected and developed in Tasks 1-9, the Contractor shall develop a Risk Analysis for the Options presented over the next twenty (20) years and summarize its findings in a Risk Register in Microsoft® (MS) Excel file format.

10.3 Utilizing the data above, the Contractor shall provide an Executive Summary showing a comparison between the alternatives of the three (3) Options for Courses of Action described above in the Scope of Work.

Deliverable 10: Executive Summary, Report of Findings, Analysis and Recommendations

11 Task Eleven: Executive Brief

11.1 Prepare and present Executive Briefing plan to CFM leadership. Present for IPT review and COR approval prior to delivery.

Deliverable 11: Executive Brief delivered in a face-to-face meeting in CFM’s headquarters located in Washington, DC.

APPENDIX – BACKGROUND

Various complexities will likely result in a request for an infusion of funds to allow the project to go forward.

(A) In addition to ongoing and anticipated budget challenges for construction, renovation, upgrade and repair projects, the disruptive nature of Medical Center construction will negatively impact patients, staff, visitors, and the surrounding community for a period of at least eight to ten (8-10) years.

(B) This study shall analyze the practicality of accomplishing renovation to approximately 100% of of the existing VAMC on an active and constrained site. The study will also identify those issues that can pose significant risks, including:

· Patient dissatisfaction due to multiple movement of health care services during construction.

· Inpatient and outpatient dissatisfaction associated with dust, noise and vibration generated by renovation-type construction activities inside occupied healthcare buildings.

· Limited and delayed patient access due to parking shortages, utility outages and detours. During construction, the distance from the parking structure to the temporary entrance(s) of the facility will be greater than current conditions, or if significant distances exist for many of our veterans and guests to walk.

· Cost overruns due to current conflicts and delays between multiple Major, Minor, NRM and ongoing recurring maintenance efforts, and the risk/loss due to work overlap.

· Cost and schedule conflicts resulting from coordination issues between multiple entities on multiple concurrent projects and site constricted campus.

· Increased staff turnover due to the duration, complexity, and coordination required to maintain hospital operations during multiple construction efforts.

· Increased life safety hazards due to ongoing construction activity including heavy equipment and increased vehicular traffic.

· Increased community concerns due to traffic, noise, vibration, and other construction related activities.

· These construction projects do not address the space gap and operational changes within VA healthcare over the past thirty (30) years, including the physical space layout changes and physical security requirements now required for VA healthcare facilities.

(C) After completion of the above referenced projects, the following deficiencies will still be present on the existing campus and require significant capital investments to correct. Each of the following deficiencies would be addressed through construction of a replacement Medical Center and the VA could avoid the significant risks identified above and below:

· Safety: A listing of current Safety Concerns will be provided.

· Increased Workload: VISN 5 has been experiencing unprecedented growth and is forecasted to add numerous additional jobs over the next five (5) years. (Data to be provided.) Similarly, the Projected Utilization by Parent Facility report estimates total in-house outpatient relative value units (RVU) demand in the VISN 5 area will increase substantially between 2019 and 2029.

· Space: The existing Washington, DC VAMC campus is undersized by approximately one million feet based on current VA space standards. (More granular data to be provided.)

· Access to Care: The Washington, DC VAMC has a huge parking gap. (Data to be provided.) Due to space constraints, this cannot be corrected on the existing site without a parking structure.

· This gap will worsen significantly as surface parking lots will be occupied by temporary buildings housing mission- critical functions during construction.

· The new Washington, DC VAMC will provide ample, well-lit, and safe parking structures. located near hospital entrances, making care convenient and accessible for patients.

· Physical Security: Existing site constraints at the main campus make it virtually impossible to comply with VA physical security design requirements, and the planned projects will not resolve most of the health care system’s physical security deficiencies. Additionally, due to site congestion and the associated limited parking areas, practically any vehicles which visit existing campus may pass within 50 feet of the existing buildings.

· Emergency Management: The current size and existing development on the Washington, DC campus has disallowed installation of required emergency water reserve and sewage retention systems. The existing campus also compromises the facility’s ability to maintain an appropriate inventory of medical and disaster relief supplies to be readily available in case of emergencies such as bioterrorism or pandemic infections.

· Infrastructure: Existing utility systems are antiquated. (Detailed data to be provided.) VISN 5 will verify if the following conditions are present – e.g., systems have exceeded expected end-of-life and are beyond capacity.

These systems typically will include undersized piping, which was not designed to meet the current needs of the Washington, DC VAMC; whether much of the piping and the valves are corroded, thereby hindering operation and maintenance activities; and identification all systems that require replacement.

The Washington, DC Facility Condition Assessment (FCA) identifies approximately $122M in maintenance corrections. (More granular data to be provided.)

· Saturated Site: The Washington, DC campus is a fully developed and landlocked site in a densely populated commercial/residential area, which is not conducive to supporting large construction projects; coordination, continuity of operations, and cost control for multiple major projects on this small campus will be problematic. Between reduced surface-level parking, access challenges and a total absence of construction contractor work and laydown space, attempting to execute the projects on the existing site is incredibly risky.

The Scope of Work is to collect and present data that VA CFM Executive Leadership will use to make a timely and informed decision whether to continue to invest capital resources into the existing Washington, DC campus or use those planned expenditures to invest in a new Medical Center site.

Feasibility Studies to Determine Replacement Options for Washington, DC VAMC – Nov 2022