Keokuk Clinic serves southeast Iowa area

In a healthy place: When the COVID-19 pandemic struck, Great River Health’s new clinic in Keokuk, Iowa, put it in a good position to provide care to the community.

By CRAIG T. NEISES
Carl A. Nelson & Company

KEOKUK, Iowa — When Great River Health announced a plan in 2017 to expand services in this southeast Iowa city of about 10,000 people, ownership of the local hospital was in flux and there already was competition from another regional physician group.

From a business standpoint, health system officials said, it was the right time to grow, and leave behind inadequate quarters that limited the health system’s ability to offer care.

The new Keokuk Clinic opened in December 2018, about a year after Carl A. Nelson & Company began the construction phase of the design-build project. In the almost 20,000 square-foot clinic, Great River Health was able to go beyond providing only internal medicine and add a whole range of new services, such as urgent care, laboratory, diagnostic imaging and physical therapy, as well as primary care and specialty clinics.

“A lot of what is in the current community is only primary care,” Keokuk Clinic manager Ashley Haas said. “We’ve been able to bring in specialists to make access better.”

During almost three full years in operation, Haas said, services offered at the clinic have increased significantly. There are more providers, and urgent care hours have expanded. 

Medical services include orthopedics, obstetrics, nephrology, cardiology, internal medicine, primary care, mental health and occupational therapy. Diagnostic services include 3D mammography, X-ray and bone density scanning, laboratory testing. An outpatient rehabilitation gym and treatment rooms support physical therapy services.

Russ Rodriguez, chief physician practice executive for Great River Health, said the ability to receive specialized care without travel to another community is a significant draw for patients in the Keokuk area. The availability of primary and specialty care, he said, allows patients who arrive seeking care for an acute health concern to also have access to follow-up and preventive care.

While the new clinic expanded Great River Health’s footprint in the southeast Iowa area, and into nearby regions of Illinois and Missouri, it also enabled the health system to meet the moment when, about 15 months after it opened, the COVID-19 pandemic turned the delivery of healthcare on its ear.

The clinic is designed with a central staff area, and patient services organized by hallways. At the beginning of the pandemic, the clinic curtailed its services dramatically, just as most healthcare providers did to limit the spread of the illness among patients and employees. When primary and specialty services began to reopen, however, the design of the building played into the staff’s ability to keep patients safe.

Haas said the size of the building, and spaciousness of its waiting areas, enabled a two-clinics-in-one approach. Patients with respiratory complaints were shepherded into the urgent care segment of the clinic, while acute care and non-respiratory patients were seen in the primary care clinic and could be spread out through the facility’s spacious waiting areas.

“We would not have been able to do that if we didn’t have the space that we have,” Haas said.

As design-builder, Carl A. Nelson & Company was able to lead the project from the beginning until after completion, assisting with design development, budgeting, construction scheduling, self-performing portions of the work and providing service after completion.

John Mercer, director of facilities for Great River Health, said the $7.58 million project was completed for $6.9 million, with construction coming in at $5.81 million — about $390,000 less than the guaranteed maximum price. Construction was completed in less than a year, in part by working through brutal winter conditions with temperatures in the single digits. That commitment continued throughout construction.

“The team with Carl A. Nelson & Company was beyond helpful,” Haas said, citing timeliness of the work and communication during and even after the project was finished, when some features of the building ran into use by patients, requiring some modifications and repairs.

Since those early fixes, the clinic has stood up well to use.

"It’s an easy building to maintain,” Mercer said, citing design and materials choices that provide durability and efficiency, from finishes to mechanical systems — much of which had been recommended by the CANCO project team, he said.

Recently, many of the choices made in 2018 were replicated on a new Outpatient Services Plaza being erected on Great River Health’s campus in West Burlington, Iowa. Lessons learned on the Keokuk project have been applied to the new building, too, Mercer said.

CANCO was general contractor for construction of the 25,000 square-foot building, and self-performed portions of the work on the foundation and shell, which Mercer said amounted to about $3 million of the $4.5 million project. The first 9,000 square-feet being put into use will house diagnostic imaging, lab and urgent care services, and is scheduled to open Nov. 1, 2021.

Meanwhile, with the volume and range of services it supports, Rodriguez said he expects the Keokuk Clinic to adequately address the healthcare needs of patients for years to come. And if continued growth means that isn’t the case, he said, “that will be a good problem to have.” 

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