99 Jesse Hill Jr. Dr. SE, Atlanta, GA

Project Details:


Grady Health System is constructing a 225,000 SF center for advanced surgical services (“CASS”) and 330,000 SF parking deck on land adjacent to the main hospital.


Planning for the Project began in 2016 when the Sponsor acquired the land from the Fulton County Health Department. The need for Project arose when Grady reached bed and operating room capacity, with these spatial limitations becoming detrimental to Grady’s ability to serve the Atlanta metro area as a result of the COVID-19 pandemic. The services programmed to be a part of the CASS include 8 operating rooms, 4 endoscopy rooms, the Cancer Center, surgical clinics including orthopedics, general surgery, ENT, oral surgery, and the Eye Center. Support services to these programs include imaging, pharmacy, lab, central sterile supply and common support spaces.


By constructing the new CASS, the Sponsor will be able to separate ambulatory services from inpatient services, allowing for improved efficiencies and capacity for growth in both ambulatory and inpatient services. The expansion will increase Grady’s surgical clinic capacity by 45% and surgery capacity by 25%. Further, as a result of moving a portion of the services from the main hospital to the new CASS, it will enable the main hospital to increase its bed capacity by approximately 50 beds. Additionally, the new integrated parking deck will make access to Grady more convenient for patients and their families.


Since its founding more than 100 years ago, Grady Health System has served as the safety net hospital for greater Atlanta including Fulton and Dekalb counties. The hospital’s mission has been to provide care to anyone who walked through its doors, regardless of ability to pay. Grady is now Georgia’s largest hospital, and nationally, Grady is the 5th largest public hospital, and one of only 60 super-safety-net hospitals. As metro Atlanta’s primary hospital for low-income persons and minority communities, Grady provides approximately 80% of its care to minority patients and approximately 85% of its care to uninsured patients or patients covered by Medicaid/Medicare, translating into $79 million of unreimbursed care annually. Further, Grady spends approximately 17% of its annual operating budget on community benefit programs, including charity care, community health improvement efforts, and subsidized health care. Based on information provided by the Sponsor, that percentage of impact more than doubles the national average of 7.5% for similar health systems. Correspondingly, Grady’s operating margin is just 4.5%, compared to the national average of 12-18%, based on information provided by the Sponsor.


Distress Criteria

  • 34% of People in Poverty
  • Unemployment Rate 1.55x the national rate
  • Medically Underserved Area

Community Impacts

  • 210 FTE jobs created
  • 703 Construction Jobs created

Community Alignment

The Project is located in a severely distressed census tract based upon the 2011-2015 census data by virtue of being located in a census tract with a poverty rate of 34% and unemployment rate 1.55 times the national unemployment rate. Additionally, the Project is located in a medically underserved area and identified state. The Project is anticipated to increase the Sponsor’s ability to accommodate new patients seeking medical care and as a result serve 24,255 LIPs (60% of total patients served) and provide access to 31,089 LICR unique patients per year (77% of total patients served). It is estimated the Project will create and retain 5,824 direct full-time jobs and support 703 temporary construction jobs. The Project addresses priorities outlined in the 2019 Grady Community Health Needs Assessment. Based on the CDE’s mission of providing subsidized financing to medical facilities, which support distressed communities, this Project appears to directly align with the CDE’s mission.