GREENBRAE -- Marin General Hospital has made several adjustments to its plan to rebuild the facility, with a price tag now estimated at nearly $650 million for what the administration describes as "a natural evolution" in the planning process for such a large-scale project.

[caption id="attachment_91433" align="alignleft" width="224"] John Friedenberg[/caption]

Jon Friedenberg, chief fund and business development officer, said the apparent increase in cost is the result of moving the entire emergency department from one side of a proposed building to another, along with an altered square-footage imprint and other changes

"The design evolves over time," Mr. Friedenberg said. "Even if you don’t get new information, you get new ideas. As you start to engage them and get more information, over time design evolves."

Much of the evolution is related to the general and wide-spread trend in health care of shifting to outpatient care versus costly inpatient hospitalization, prompting hospitals nationwide to reduce bed count.

While previous estimates of the project were often reported as $500 million, Mr. Friedenberg said that figure only includes the replacement hospital and doesn’t factor in the entire project, which includes an outpatient building and parking structures.

Phase one of the project will total approximately $534.3 million, which includes a new four-story hospital tower, an addition to the west wing lobby, a new parking structure and improvements to the west wing's pharmacy and intensive care unit. The second phase, about $108 million, includes a new ambulatory services structure and capital improvements to the current central hospital wing.

No exact timeline has been established, but the earliest work on the parking structure will likely begin either late this year or early 2015. Work on the hospital tower -- expected to take up to three years -- would begin shortly thereafter.

The outpatient facility and other improvements to the current building would likely begin in the early 2020s.

Factoring in the entire footprint and the alterations in the plan, the total cost could reach up to $700 million, Mr. Friedenberg said.

The Marin Healthcare District, which owns the hospital, won voter approval for a general obligation bond totaling $394 million to fund a good portion of the construction. The remainder will be made up through a capital campaign and borrowing.

"If the voters approved $394 million, we’d probably need to raise $50 million in philanthropy and borrow about $100 million," Mr. Friedenberg said.

Among the most significant changes in the plan include the shifting of the ED in the new proposed hospital that will face Bon Air Road in Greenbrae, along with added architectural features to the front of the facility.  The reasoning, Mr. Friedenberg said, was easier access for patients.

"In terms of hospital access for patients and visitors, I think they’re going to enjoy having that change," he said.