The Clinical Space &
Cost Program
How many operating rooms the volume actually supports, how much building that requires room by room, and what it costs to build — settled before a design contract is signed.
Design fees get committed before anyone knows what to build
The usual sequence is backwards. A sponsor group decides it wants a surgery center, hires an architect, and discovers the program during schematic design — which is the most expensive place to discover it. Room count gets set by preference rather than throughput. Square footage gets estimated from a comparable project in a different state under a different code.
By the time the number is wrong, there is a signed design contract, a lender expecting a budget, and physicians who have been told a story.
Phase 0 is the step that belongs before all of it. It answers four questions — how many rooms, how much building, what it costs, and what volume it has to run to work — with enough rigor that the design team can start from a settled program and the lender can underwrite something real.
That is the entire purpose of this report. It is not a design. It is the brief the design is built from.
Four answers, each with its arithmetic shown
Room count from throughput
Case time plus turnover against operating hours gives cases per room per day. Room count follows from volume, not from preference. The report shows the utilization against capacity so you can see the headroom you are paying for.
Room-by-room space program
Operating rooms, pre-operative bays, PACU Phase I, Phase II step-down, sterile processing, clinical support, administration. Departmental net area grossed to building area with a stated circulation factor — not a rule of thumb.
Trade-level cost model
Site work, shell and structure, interior finishes, mechanical, electrical, plumbing and medical gas, fire and life safety. Plus contingency, soft costs line by line, and medical equipment. Presented as a range, because a single number at Phase 0 is false precision.
Feasibility screen
Payer mix and blended reimbursement against a modeled operating cost, with a case-volume ramp rather than day-one stabilization. Returns EBITDA and a break-even case volume — properties of the facility, not of the deal.
Sized to the code your state actually enforces
Every program is sized to the governing code for the state entered — FGI 2022 where a state adopts it, the state's own code where it does not.
A state that adopts FGI "as currently published" moves forward automatically with each edition. A state that adopts a named edition does not. Arizona's rule incorporates the 2018 edition and states that it includes no future editions or amendments — so an FGI 2022 claim on an Arizona project is not imprecise, it is false. Colorado is the same shape, locked to 2018 plus errata frozen at November 2019.
Several states are frozen much further back. Washington's ASC chapter has not been amended since 2009 and still runs the 2006 Guidelines — even though Washington adopted FGI 2022 in December 2024 for hospitals. Kansas is on a 1996 AIA document. Hawaii's standard is a 1979 federal publication as it existed on December 31, 1984.
Texas runs on 26 TAC §508 with NFPA 101, NFPA 99 and the IBC — FGI appears nowhere in the rule. California replaced every FGI reference with its own Building Code sections. South Dakota maintains a thirty-four section prescriptive construction chapter. Kentucky's ASC rule dates to 1982 and was last substantively amended in 1990.
Several of these set their own minimum operating room clear floor area, and the numbers vary widely — from 180 square feet to 400. Designing to an FGI habit in one of those states can produce a room that cannot be listed as an operating room for licensure.
It says so, on the face of the report. An unverified state returns a program sized to FGI 2022 clinical minimums with an explicit note that the state's own code has not been confirmed and should be verified with the licensing agency before permit submission.
That is less satisfying than a compliance badge and considerably more useful than a claim that cannot be defended.
A rough order of magnitude, in ten seconds
Enter three numbers for a directional range. This is not the program — it applies national averages and a regional cost factor, and it does not know your specialty, case mix, equipment, sterile processing strategy or state code. The Level 1 report does.
Indicative only. Construction cost excludes equipment, soft costs and contingency, which together typically add 55–70% on top of the construction number.
Download a real sample report
Eleven pages. A three-operating-room orthopedic ambulatory surgery center in Tampa, Florida — room count, full space program, trade-level cost model, feasibility, and the Florida regulatory basis with citations.
Every figure in it was produced by the IronClad HC engine, not written for illustration. It names no client. Share it freely.
The Clinical Space & Cost Program
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