Every square foot you put into a new center is a square foot you pay for at clinical rents, and once you have two or three sites you start paying for the same functions over and over. Before you program the next center, sort every function into three groups: what has to be in every center, what can live in one hub or be contracted out, and what doesn't need clinical space at all. Then test the biggest swing first. If 3,000 square feet of staff offices could become exam rooms or day center capacity, price both uses before you draw the floor plan.
Your first center has to hold everything, because there is nowhere else to put it. By the second or third, that changes. You can share a dental suite, a kitchen, a pharmacy, or a finance team across sites, or you can build each of them again in every building and pay clinical rent on all of it.
I saw both approaches on center tours at NPA this month. One PACE program runs a converted hospital as a hub for dental, podiatry, optometry, and audiology across three centers. Another feeds several centers from one commercial kitchen, so each site only needs a warming kitchen. Neither choice is right for every program. Both are decisions those programs made deliberately, and they shape how big, how expensive, and how fast every other center in the network gets built.
Which services have to be in every center?
Start with what the participant or patient experiences every visit. For a PACE program that means the day center, dining, primary care, nursing, and therapy, because participants use them daily and can't be bussed somewhere else for them. For an outpatient clinic, it means exam rooms, the front desk, and whatever clinical support runs alongside every visit.
Everything else is a candidate to centralize, contract out, or move off the floor plate entirely. Sort it before the architect starts, because once a function is drawn into a test fit, it tends to stay there.
Usually belongs in every center
- Day center and dining (PACE), or exam rooms and front desk (clinic)
- Primary care and nursing
- Therapy used weekly or more
- The IDT or care team that sees participants in person
- A warming or serving kitchen
Candidates for a hub, a contract, or off-site space
- Dental, podiatry, optometry, audiology
- Pharmacy
- Commercial kitchen and food production
- Fleet storage and maintenance
- Finance, billing, enrollment, intake, IT, and leadership offices
Should you build specialty services in-house or contract them out?
An in-house dental suite gives you control over scheduling and quality, and participants get care in a building they already know. It also means operatories, sterilization, plumbing and vacuum lines, equipment, and a dentist and assistant on payroll. If the chair sits empty three days a week, you are paying clinical rent and salaries on idle capacity.
Contracting it out keeps the square footage and the payroll off your books, but every visit becomes a van trip, a scheduling handoff, and a wait. For a frail participant, a 45-minute ride to a community dentist is a hard day.
Decide service by service, using four questions:
- Volume. Do you have enough participants or patients to keep the room busy most days? If not, a part-time rotation or a hub that serves several centers may get you there.
- Local supply. Are there community providers nearby who will take your population and your payment terms? In some markets there aren't.
- Travel time. What does each outside visit cost you in transportation and staff escorts, and what does it cost the participant?
- Who builds it. Some partners will build and run the service in your space. At one program I toured, a third-party pharmacy operator built out a full pharmacy in space the program provided, and the program pays it for services and medications. The program got a pharmacy without funding the build-out.
The answer usually changes as you grow. A service you contract out at one center may justify an in-house suite at the hub once you have three. Revisit the list every time you add a site, and use it when you weigh one deep market against several shallow ones, because a hub only works if the centers it serves are close enough to reach it.
Who actually needs a desk in your building?
Walk your org chart and ask where each person spends the day. Two groups usually stand out.
Staff who are in the field most of the time. Home care nurses, social workers doing home visits, and outreach and enrollment staff may be in the building for an hour in the morning and an hour at the end of the day. A dedicated office for each of them is space you pay for and they rarely use. Touchdown or dock-in workstations, a few small rooms for private calls, and lockers usually cover it. Both programs I toured at NPA have moved in this direction.
Staff who could work from home or from another building. Billing, finance, claims, scheduling, some intake, IT, and parts of leadership don't need to be steps from the exam rooms.
That doesn't make the answer automatic. Each move has implications you need to weigh before you take the offices out:
- Culture and performance. Care teams that sit together catch things faster. Presenters at NPA described their IDT communication improving once the dietitian, nurses, and social workers shared one room. Keep the people who make care decisions together, and be deliberate about how you manage and develop the people you move out.
- Technology. Remote and hybrid staff need devices, secure access, and phones that work outside the building, and someone has to support them.
- Information security. Staff handling protected health information at home or in a shared office raise HIPAA questions about devices, networks, printing, and who can see the screen. Get your compliance and IT leads to sign off before you design the building around a remote model.
What is 3,000 square feet worth to you?
Take 3,000 square feet of staff offices in a new center and price it the other way. In an outpatient clinic, that is roughly eight to ten exam rooms once you include the corridors and support space they need. In a PACE center, it is meaningful additional day center capacity. In the Florida program presenting at NPA, the state requires 35 to 40 square feet of program space per participant, and office space doesn't count toward it.
Every square foot of office in a clinical building is a square foot that can't hold a patient or participant, so price both uses before you commit the floor plan. If those rooms let you add a provider or push back the date you need another center, the offices are the most expensive space in the building.
Run the numbers both ways. Office space for staff who are in the field or could work remotely costs you clinical rent plus the capacity you give up. Exam rooms or day center space cost you more to build, but they generate revenue. Decide which function earns the square footage, then design around that answer.
Can the office work happen next door?
Office rents are often lower than medical or retail rents in the same submarket, depending on the market. If there is an office suite in the same center, across the parking lot, or a short walk away, you may be able to move administration there and give the freed-up space in the clinic to patient care.
Say clinical space in your market leases at $40 per square foot and a nearby office suite leases at $28. Moving 3,000 square feet of administration saves about $36,000 a year in rent before you count anything else. That's a real number, but it's rarely the main reason to do it. The main reason is the eight to ten exam rooms, or the day center seats, that you get back in the clinical building.
Check a few things before you sign the second lease:
- Distance. Can staff walk between buildings in a few minutes, or does the split create a second commute?
- IT and security. Can you extend your network and access controls to the second space at a reasonable cost?
- Lease timing. Line up the office lease's term and renewal options with the clinic lease, so you're not stuck with one when you leave the other.
- Use. Make sure the office lease allows the work you're putting there, including any records storage or occasional participant meetings.
How do you make the call for your network?
Do this before every new site, not once:
- List every function in your current centers and where the people doing it spend their day.
- Mark what has to be in every center, what can be centralized or contracted, and what doesn't need clinical space.
- For each specialty service, answer the volume, local supply, travel time, and partner questions.
- Price the office space both ways: as offices at clinical rent, and as exam rooms or program space.
- Check nearby office options and the IT, security, and lease timing they bring.
- Program the new center around what's left, and test fit it before you sign.
Make this decision on purpose at every new site. If you copy the first building, which held everything because it had to, into every building after it, you pay clinical rent on the same functions at every address, and a second site ends up costing more than it should. If you are programming a PACE center from the care model out, start with this list.
Key takeaways
- Your first center holds everything. From the second center on, sort every function into what belongs in every site, what can be centralized or contracted, and what doesn't need clinical space.
- Decide build or buy for specialty services like dental, podiatry, optometry, audiology, and pharmacy based on volume, local provider supply, travel time, and whether a partner will build and run the service in your space.
- Staff who are in the field most of the day, or who could work remotely, may not need dedicated offices in the clinical building. Weigh culture, performance management, technology, and HIPAA before you move them.
- 3,000 square feet of offices is roughly eight to ten exam rooms in an outpatient clinic, or meaningful day center capacity in a PACE center. Price both uses before you commit the floor plan.
- Office rents are often lower than medical or retail rents nearby. An adjacent office suite can free clinical space for patient care, if distance, IT, security, and lease timing work.
Frequently asked questions
What services should a PACE program centralize across multiple centers?
Candidates include specialty services like dental, podiatry, optometry, and audiology, as well as pharmacy, commercial kitchen and food production, fleet storage and maintenance, and administrative functions. The day center, dining, primary care, nursing, and frequently used therapy usually need to be at every center because participants use them daily. Retained CRE works through this list with programs before each new center is programmed, so the building is sized for what it actually has to hold.
Should a PACE center have an in-house dental clinic?
It depends on volume, local provider supply, and travel time. An in-house suite gives you control and avoids van trips, but it adds operatories, sterilization, plumbing, equipment, and staff. If you don't have the volume to keep the chair busy at one center, a hub that serves several centers or a contracted community provider may make more sense.
Do clinic staff need dedicated offices?
Staff who spend most of the day in the field, like home care nurses and social workers doing home visits, often need touchdown workstations rather than private offices. Staff in billing, finance, scheduling, and IT may be able to work remotely or from a nearby office suite. Keep the care team that makes clinical decisions together, and confirm the technology and HIPAA requirements before moving anyone out of the building.
Is it cheaper to put clinic administration in a separate office space?
Often. Office rents are frequently lower than medical or retail rents in the same submarket. Moving 3,000 square feet of administration from $40 clinical space to $28 office space saves about $36,000 a year, and the larger benefit is the clinical space you free for exam rooms or program capacity. In Retained CRE's site work, we check nearby office options alongside the clinic search so the two leases line up.
Planning Your Next Center?
I help operators decide what each new site has to hold before the test fit: which services to centralize, which to contract, and how much clinical space the building really needs.
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