The Cost of a Late Clinic | Ber Wilson

The Cost of a Late Clinic

Borrowing costs crossed 5 percent this fall. Here is what each week of schedule is worth, and how prefab steel gives it back.

By Ericson Tua'one, CEO, Ber Wilson

In March, Intermountain Health announced a new clinic for Washington City, a quarter mile east of I-15 on Washington Parkway. Primary care, an InstaCare urgent care clinic and occupational health. Completion is targeted for early 2028.

In October, Intermountain broke ground on an 80,000-square-foot medical building at McKay-Dee Hospital in Ogden. It is planned to open in the spring of 2028. In West Valley City, Intermountain is turning the nine-story Fairbourne Building into an outpatient campus for 2027, while the University of Utah builds its Eccles Hospital and Health Campus in the same city for late 2028.

Utah is growing, and its health systems are building care closer to the families who need it. That is good news for this state.

For the people who approve these projects, every one of those dates is also a number. A clinic under construction carries interest, insurance, overhead and a staffing plan, and it earns nothing until the first patient walks through the door.

The detail that matters most is what happens when that day moves. A clinic that opens late pays for each lost week twice: once in carrying cost while it is still a jobsite, and again in the margin it was supposed to be earning.

This fall, that week got more expensive.

Delay Is Getting More Expensive

On September 16, the Federal Reserve raised interest rates for the first time in three years. That same fall, the 30-year AAA municipal yield, a benchmark for the tax-exempt bonds many nonprofit health systems rely on, climbed above 5 percent for the first time since 2011. DPR Construction reports construction costs 7.5 percent higher than a year ago and expects escalation to run higher in 2027.

Demand is not slowing down to wait. Vizient's 2026 Impact of Change forecast projects outpatient volumes will grow 20 percent over the next decade, while inpatient discharges grow 7 percent. Office and clinic visits alone are expected to reach 2.87 billion a year by 2036.

The buildings are not keeping up. According to DPR, medical outpatient occupancy reached 92.7 percent in 2025, and new construction starts are running at about 1.1 percent of existing inventory, less than half the historical average. And as I wrote in October, the industry needs 349,000 new workers this year just to keep pace.

Put those together, and time becomes the most expensive material on the job.

Build the Clinic Before You Break Ground

Most clinics are still framed one piece at a time, out in the weather. Crews read the drawings, measure, cut every piece to fit and correct the mistakes in the field. Every trade waits on the one before it.

Prefabrication changes the order. At Ber Wilson, our cold-formed steel trusses, wall panels and framing kits are engineered to the project's loads, then cut, punched and marked in our plant to the drawing set. While the site is graded and the slab is poured, the frame is already being built. It arrives bundled and numbered in the order the crew sets it, and it goes together with screw guns and a standard framing crew.

The steel earns its place over the life of the building. It does not burn. It does not rot, warp or swell. Mold has nothing to feed on, and termites cannot touch it.

I will not claim either choice is free. Factory work can carry a premium. Steel conducts heat, so steel-framed walls need continuous insulation in most climates, and that cost belongs in the estimate from the first day. Factory-built panels can arrive with that insulation already installed.

The Hospital That Beat the Clock

Saint Joseph Hospital in Denver is one of the most closely studied prefabrication projects in American healthcare. Mortenson built the 360-bed hospital with prefabricated exterior walls, bathroom pods, headwalls and overhead utility racks, and University of Colorado Boulder engineers analyzed the results in partnership with the builder.

The number most people leave out comes first. The prefabricated pieces cost about 6 percent more than building the same work on site.

The project came out ahead anyway. The schedule shrank 10 percent, and more than 150,000 work hours moved off the jobsite. ENR reported 72 workdays and $4.3 million saved, along with seven safety incidents avoided. Those figures estimate value, not audited cash, and researcher Matthew Morris was plain that prefabrication works best on repetitive projects with an owner and design team fully on board.

Repetitive is the word to remember, and few buildings repeat themselves like a clinic does, exam room after exam room.

In Dayton, Ohio, Skanska put that repetition to work on Miami Valley Hospital's addition, prefabricating 178 identical patient rooms along with utility racks, bathroom pods and headwalls. Then the ground pushed back. Unforeseen soil conditions delayed the start, and prefabrication helped win back more than two months. Skanska estimates it cut overall costs by 1 to 2 percent, and the prefabrication work finished with zero injuries.

At clinic scale, the story holds. Parts of Advocate Aurora's 20,000-square-foot clinic in Lake Villa, Illinois, arrived as finished steel modules, with framing, plumbing and electrical work, drywall and paint already in place, according to engineer raSmith.

Nobody in these projects promised 30 percent savings. That is why I trust them.

What a Week Is Worth

Saint Joseph gave back 72 workdays, roughly 14 weeks. Here is what one of those weeks is worth on a clinic.

On a debt-financed $10 million clinic at 5 percent, a week of interest runs about $9,600. After this fall, 5 percent is no longer a hypothetical rate.

Every week a clinic opens sooner adds margin. At illustrative ramp-up volumes for an eight-provider clinic, that is roughly $4,000 a week. If your contract shares savings, every week cut also trims the contractor's overhead.

Two things have to be true for that speed to count. Hiring, credentialing and payer enrollment have to move with the construction schedule. And the value belongs inside your own cash-flow model, not stacked on top of it.

A CFO should also hear this from a steel builder. DPR reports iron and steel input prices up more than 10 percent from a year ago. Lock steel pricing when you release fabrication, before the next increase reaches your bid. With escalation expected to run higher in 2027, a clinic that holds its schedule also stays ahead of next year's prices.

The Line Your Broker Will Circle

Builder's risk insurance is priced on what the finished building is worth. Lockton's Clay Arvola reports steel-framed projects at about half the wood-framed rate. Hotaling Insurance publishes much higher rates with a similar ratio. On a $10 million clinic, those published ranges put the difference during construction anywhere from about $10,000 to $195,000, depending on the market.

The advantage continues past the ribbon cutting. Builder's risk converts to property insurance at occupancy, and Arvola says the two rates tend to move together. A health system that owns a clinic for decades keeps that advantage for decades. It applies when wood is the alternative, which is common for outpatient clinics. As I wrote in June, the right move is to price both alternatives and let the quotes decide. Ask your broker to quote both designs.

Then there is the loss you never have to file. U.S. fire departments respond to about 4,440 fires a year in buildings under construction, averaging $370 million in damage annually, according to the National Fire Protection Association. Packaging and stored materials can burn on any jobsite. A steel frame keeps the building itself from becoming fuel.

Built to Stay Open

A clinic earns its keep by staying open, and in Utah that question has an earthquake attached to it. The Utah Geological Survey puts the chance of a magnitude 6.0 or larger earthquake in the Wasatch Front region at 57 percent over the next 50 years, and about 85 percent of Utah's residents live within 15 miles of the Wasatch fault.

Weight matters when the ground moves. Cold-formed steel buildings weigh roughly a quarter to a third as much as reinforced concrete, according to UC San Diego, and a lighter building takes less force.

In 2025, researchers from Johns Hopkins and UC San Diego stood a 10-story cold-formed steel building on the world's largest outdoor shake table and hit it with 18 simulated earthquakes, the last two half again stronger than its design level. When the shaking stopped, it was still plumb. The stairs worked. The doors opened. Your clinic will still need a design for its own site, and the system behind it has already proven itself at full scale.

What It Means for the People Inside

Prefabrication settles the rooms early, which makes full-scale mockups worth building. At Miami Valley, staff and regulators walked through mockups before production started. A nurse who finds a sink in the wrong place on a mockup saves the project a change order after the walls are finished.

Coordination is where healthcare projects get hurt. In February, I wrote about a Midwest operating room where the oxygen and medical air lines were swapped and the mistake surfaced only at commissioning. The walls came down to fix it. Settling pipe and conduit routes in a digital model before steel is cut keeps that kind of mistake on the screen and out of the wall.

Repeated rooms put supplies and equipment in the same place every time, and research funded by the Center for Health Design links a standardized work area around the patient to steadier work patterns. On an active campus, factory assembly also means fewer trades, less noise and shorter disruptions near patients.

Why Ber Wilson

Ber Wilson is a Utah design-build and EPC contractor that manufactures its own structure. Our steel is American, produced in our own operation in the Rocky Mountains, and we deliver engineering, procurement and construction under one contract, with a single point of responsibility for the schedule, the budget and the finished facility.

That discipline comes from federal work. Ber Wilson is a GSA approved builder with USACE quality management certification, and our federal credentials include NAVFAC and the VA. In October 2025, we were awarded new unaccompanied housing for soldiers at Fort Polk, Louisiana, as general contractor and construction manager with SNA Consulting as prime, framed in Ber Wilson prefab steel to current DoD barracks standards. A second award at Fort Polk, this one design-build, is next.

The same team that controls the digital model controls the crews, the punch list and the handover. Our sites run on safety practices built on the U.S. Army Corps of Engineers EM 385-1-1 standard.

I treat a clinic as critical infrastructure because that is what it is. When one opens late, or closes after a disaster, a community loses its care.

The Decision in Front of You

Every clinic in Utah's pipeline will get built. What is still open is how many weeks each one spends as a jobsite before it becomes a place of care.

No health system controls interest rates or next spring's steel prices. What a health system does control is when the factory starts, when steel pricing is locked and how many design decisions are settled before the first panel is cut. Those choices are made in the first months of a project, and they shape the schedule long before anyone pours concrete.

That is where the cost of a late clinic is decided, and that is the room we want to be in.

Start a Project

Send us your plans or a sketch, along with the clinic program, the approximate size, the location and the date you need to see your first patient. We will come back with scope, budget and a delivery window. We can price the steel package on its own or deliver the whole building under one contract.

If prefab steel is the wrong answer for your clinic, I will tell you that too.

The numbers behind this post are in our guide, Where Prefab Steel Pays Off.

Start a Project·

A late clinic pays for every lost week twice. Call us before the first one is gone.