Bureau of Medicine and Surgery MILCON Program Update

1. Bureau of Medicine and SurgeryMILCON Program Update for Leadership Forum January 2011

2. RDML Vinci Summary Introduction

3. MHS MILCON Investments • The health care industry typically invests approximately 5% per year in facility recapitalization • DoD prior to 2009 programmed about 1.5% in MILCON or roughly $220M annually • Since the spring of 2008 Congress (Walter Reed Bldg 18) and the Department have budgeted to recover from years of under-funding • Medical MILCON programming goal is 4.3% (~$1.3B). O&M (SRM) closes the gap to 5% • Note: The spike as depicted in blue line represents both; increase in MILCON program funding and supplemental inserts into the program ~$1.3B *Level of work effort continues 3-5 years beyond year of appropriation

4. 2012 Budget Estimate Summary Navy – MILCON (Note: Does not include supplemental inserts) Projects listed in FY2014 and beyond must re-compete as part of CIDM POM 14

5. Naval Hospital Guam Replacement Guam, Mariana Islands$207.5M Working Estimate • Drivers • Strategic, remote Western Pacific AOR • Obsolete WWII cantonment design • 1954 infrastructure antiquated and requires urgent replacement • Modern facility will meet current seismic and life safety codes for patient safety • Dysfunctional facility layout cannot deliver an efficient environment of care • Population/Enrolled Beneficiaries • Current DOD beneficiaries served • 14K AD/ADFM, 6K Ret + FM, 9K Veterans • Army, Navy, Air Force build-up of 8K AD/ADFM will be complete FY10 • USMC relocation of 18K AD/ADFM from Okinawa under DPRI agreement w/Government of Japan subject to final implementation plans now under negotiation between US and GOJ Description • Modern 282K sf replacement • Delivers capacity for projected DoD healthcare needs plus VA resource sharing agreement workload • IO&T contract budgeted at $80M (FY 12) • Design Status: 100%, D-B-B • Construction Award: Sep 2010 • Beneficial Occupancy: Aug 2014 • Major initiative: World Class health facility with evidence based design focused on our patients 5

6. Branch Health Clinics Apra Harbor and Finegayan • BHC Apra Harbor • Scope: 49K GSF • Estimated Cost: $96M • 35% Design complete: Sep 2009 • Est. Construct Award: Mar 2011 • Planned Completion: Sep 2013 • BHC Finegayan • Scope: 58K GSF • Estimated cost: $110M • Planned design start: JFY 11 (JFY 11 • starts Apr 2011) • Est. construct award: JFY 13 (JFY 13 • starts Apr 2013) Description • DPRI-funds, Government of Japan • Primary care, dental care, limited urgent and extended hours care delivered at branch clinics • Includes mental health, ancillaries, preventative medicine, and support services • BHC Apra Harbor clinic (replacement) is the planned primary care site for the current Naval Hospital DHP beneficiaries and garrison Naval Station active duty • BHC Finegayan clinic (new) will serve the Marines + family members that are planned to arrive on Guam as part of DPRI

7. Naval Hospital ReplacementCamp Pendleton, CA$505.7M Working Estimate Description • Modern 513K sf replacement (ARRA-2009) • Accounts for all DoD plus VA sharing agreement workload • Design Type: Design/Build (DB) • Award: Sep 2010 + IO&T bid option in FY 13 • Beneficial Occupancy: Jan 2014 • Major initiative: World Class facility with maximum natural light (75% of spaces), courtyard in spine and innovative waste water system resulting in a 30% reduction in water consumption • Drivers • Hospital not compliant with California Law SB 1953 (hospital seismic criteria) and is classified as structural performance category-1, the worst performance category • Seismic retrofit uneconomical due to disruption of existing hospital services and projected costs • Modern design will eliminate dysfunctional adjacencies and provide efficient ambulatory care environment with 54 private patient rooms • Population/Enrolled Beneficiaries • AD/ADFM population = 83K • Current catchment population = 132K • Enrolled population = 25K hospital based / 55K BHC’s • Projected addition of 2.5K AD for Marine Corps Grow-the-Force • Projected outpatient visits = 333K

8. Walter Reed National Military Medical Center • Building 62 • (WTU BEQ/Admin/Dining) • 153 Two-Bedroom Suites • 355,000 sqft • ECD: 7 Jul 11 • Building A – America Building (Outpatient) • 6 Floors w/ basement; 515,000 sqft • ECD: Aug 2010 • IO&T: Dec 2010 Gate 1 • Patient Parking Garage • Total Spaces: 943 • Complete: Feb 2010 • Building 17 (Admin/Gym/Parking) • 237,173 sqft • Total Spaces: 550 • ECD: Aug 11 • Buildings 1-10 Renovations • 392,880 sqft • ECD: 31 Jul 11 Traffic Mitigation Non-BRAC MILCON DAR Metro Access Fisher Houses, Navy Exchange, NICoE Building Construction Award (TBD), PA - $20M Construction Award (TBD), PA - $26M, 4,675 sqft RFP 1 Construction Awarded March 2008/ PA - ~$650M, 1,070K sqft • Building B – Arrowhead Building(Inpatient) • 4 Floors w/ basement; 162,000 sqft • ECD: Sep 2010 • IO&T: Jan 2011 • Multi Use Parking Structure (MUPS) • Total Spaces: 1,220 • ECD: 31 Aug 11 NICoE Utilities Construction Awarded October 2008/ PA - ~$7.99M Gate 2 • NICoE Utilities • BOD: Jun 2010 RFP 2 Construction Awarded August 2009/ PA - ~$200M, 592K sqft DAR/Metro Access Project • Navy Exchange (NEX) • ~$57M • 150,000 sq ft of new construction, plus 500 space parking garage Additional work at Gates 3, 4 and 5 UNCLASSIFIED

9. Past FY Special Project Execution Summary * Projected figures do not include NNMC Bethesda requirements Special Project Program (~$100M annual budget) guidance is to be 100% obligated by end of 3rd QTR

10. BACK-UP

11. Naval Hospital OkinawaCamp Foster, JP~$500M Working Estimate Description • Modern 443K sf replacement hospital plus 13 major support facilities • GOJ funded design and construction • USG funded IO&T budgeted at $100M • Design type: Design-Bid-Build • Hospital construction start: May 2009 • Hospital and essential buildings transfer to USG: Nov 2012 • Major initiative: World Class facility with advanced GOJ design features to include patient healing gardens and copious light courts • Drivers • Constructed in 1958 by U.S. Army as a 700 bed inpatient facility • Advanced facility age with significant structural, electrical, and mechanical deficiencies • Modernization of old chassis is cost-prohibitive . • Joint GOJ USG initiative to realign, reduce, and consolidate U.S. facilities and areas on Okinawa under SACO • Population/Enrolled Beneficiaries • Eligible population = 29K • Enrolled population = 24K • Inpatient admissions = 4.2K • Live births = 1.1K (annual) • Outpatient encounters = 265K

12. Naval Hospital Camp LejeuneCamp Lejeune, NC$43.7M (Add) $34.6M (Reno) Working Estimate Description • 109K sf “grow-the-force” outpatient clinic addition and 162K renovation with 7K MRI Addition • Design status: Design-Bid-Build x 2 100% • Construction award: Sep 2010 x 2 • BOD clinic addition : Jan 2013 • BOD renovation with MRI addition: Jan 2015 • Major initiative: World Class health facility with modern design features focused on our patients • Drivers • Marine Corps “Grow the Force” initiative • bring thousands of additional Marines and • family members to the Camp Lejeune area • Provides for expansion within the current hospital for additional clinics supporting family medicine/ primary care, orthopedics, physical and occupational therapy, ENT, ophthalmology, and enlarged emergency room • Population/Enrolled Beneficiaries • Eligible population = 136K • Enrolled population = 69K • Outpatient encounters = 479K • Inpatient admissions = 6.3K

13. Naval Hospital RenovationJacksonville, FL$14.6M Working Estimate Description • Functional modernization of departmental spaces and clinical adjacencies (ARRA-2009) • Modernizes medical and surgical specialty functionality and marries up to a recently completed 62K sf ($41.8M) addition • Construction Award: Apr 2009 • Beneficial Occupancy: Jul 2011 • Major initiative: World Class facility with evidence based design to renovate and upgrade key clinical areas of the existing facility • Drivers • Renovation recaptures approximately $6.5 million/yr in DoD DHP funding from surgical and obstetric care workload • Reduces training deficiencies in the Navy’s largest Family Practice Residency program • Existing 1960 design negatively impacts infection control, patient privacy, and customer satisfaction • Eliminates AT/FP deficiencies • Population/Enrolled Beneficiaries • AD/ADFM population + retirees = 194K • Enrolled population = 84K • Inpatient bed days = 10K • Outpatient visits = 400K

14. 2012 Budget Estimate Summary(BES) – DHP MILCON Projects listed in FY2014 and beyond must re-compete as part of CIDM POM 14

15. 2012 BES continued Projects listed in FY2014 and beyond must re-compete as part of CIDM POM 14

16. 2012 BES continued Projects listed in FY2014 and beyond must re-compete as part of CIDM POM 14

17. FY11 Special ProjectsProgram Projects listed are subject to revision based on funding limit changes or unforeseen conditions

18. FY11 Special ProjectsProgram Projects listed are subject to revision based on funding limit changes or unforeseen conditions

19. FY11 Special ProjectsProgram Projects listed are subject to revision based on funding limit changes or unforeseen conditions

20. Leadership in Energy & Environmental Design LEED = Internationally recognized green building certification system that concentrates on energy savings, water efficiency, CO2 emissions reduction, improved indoor environmental quality, and stewardship of resources and sensitivity to their impacts. A LEED rating is certified in order of merit as: 1. Platinum = Highest rating possible 2. Gold = 2nd highest rating possible 3. Silver = 3rd highest rating and mandated by ASN I&E • Navy Goal: Reduce the total cost of ownership of shore facilities by implementing sustainable design concepts and principles MILCON & BRAC Projects with LEED qualities include: • NH Camp Lejeune addition and renovation • WRNMMC Bethesda BRAC • NH Guam Replacement • NH Camp Pendleton Replacement

21. Evidenced Based Design (EBD) EBD Defined: MHS design and construction agents, in partnership with service medical departments gather evidence where facilities contribute to positive patient health outcomes in order to improve future MTF designs. The project delivery team (facility planners, design/construction agents, and A-E firms) provide professional expertise, acquisition guidance, and healthcare experience. Continuing EBD efforts: HA/TMA and the Services are continuing to explore links between healthcare design and patient outcomes at various Military and non-military heath treatment facilities: • Walter Reed Army Medical Center, National Naval Medical Center – Bethesda • Malcolm Grow Medical Center at Andrews AFB • Fort Belvoir’s DeWitt Army Community Hospital • Three non-military hospitals, including Dublin Methodist Hospital in Ohio EBD environment of care elements under further examination are: • Noise level impacts to patients • Patient handling injuries • Intra-hospital patient transfer and transport process • Hospital acquired infections • Patient, family, and staff satisfaction with the environment of care