How Will Health Care Facilities Change in 2014?
In such a rapidly changing health care environment, it’s hard to forecast what might happen in the next year. But we’ve asked some experts in the industry for their predictions about what the future might hold. Below are their responses to the following question:
In 2014, what do you expect to see happening in South Florida health care construction, facility planning and real estate?
Richard A. Polemeni
Director, Design and Construction
We have two major projects underway now, which were initiated a couple of years ago. At Broward Health North, we have a $70 million capital project for the expansion of the emergency department (ED) and operating rooms (ORs). This is a revenue-generating project that is very important to the hospital’s mission and margin. It is a much-needed investment at that campus, which is the last campus to have its ED and ORs renovated.
We are also renovating our central energy plant, which, while not a revenue generator, is a very important investment in our infrastructure to keep the hospital working effectively and efficiently.
Other projects include remodeling the post-partum unit at Chris Evert Children’s Hospital, and remodeling existing patient floors at Broward Health Medical Center, which we’ll be working on now and in the foreseeable future. We need to enhance these service lines in order to be competitive in the marketplace and to attract good customers. In today’s South Florida marketplace, people have many choices of where they can go because there are a lot of beds; at best, we’re only filling a little over half of them. Being competitive in the health care marketplace and being able to attract patients requires that health care be offered in a better setting. That’s why we’re continuing to make investments in changing semiprivate rooms to private rooms; consumers are demanding it.
Everyone is concerned about the importance of the Affordable Care Act, and what we do know is that they will be reducing reimbursements. As a result, all operational and capital expenses will be undergoing even more scrutiny to verify and justify that they are needed; we will be looking to reduce costs while not sacrificing our ability to deliver excellent health care. On the operational side, this means looking at measures to be responsible in the cost structure; on the capital side, it means balancing preserving reserves versus borrowing to pay for capital projects in order to remain competitive within the marketplace.
From a fundamental standpoint, the question is why continue to engage in capital projects? The fact is, most are the result of technical achievements in medical equipment or technology; these drive the need for facilities to prepare for the new equipment. Last year, for example, we established an OR hybrid merging a CT scanner within an operating theater and installed a DaVinci robot.
When new technology is supportive of our service lines, we need to make the investment. A lot of our capital investment is spent in technology and IT resources which are implemented throughout the system so that we can make sure that our staff and physicians can be more efficient in delivering health care. There are also investments needed to maintain our facilities to make sure that they meet current codes and perform in a way that meets those goals. One of the reasons that we are investing in the central plant, for example, is because it is beyond its useful life. We need to replace much of the equipment with more energy-efficient systems in order to ensure that the hospital is operating optimally from an investment standpoint.
As to building a new hospital, I don’t see that happening. We’re trying to move our model to a lower cost per square foot delivery, which is especially important in outpatient facilities, as patients’ length of stay is decreasing. It’s important to have more, lower cost models of outpatient care, like urgent care centers, where consumers have local access to physicians and health care.
Another driver of capital projects is responding to where the clinical needs are, in our case, those service lines that are more attractive to an aging demographic, like cancer and cardiac care, orthopedics for Boomers or mental health services to deal with Alzheimer’s disease. We need to ensure that we are being responsive to the needs of the population we’re serving and have the necessary facilities in place to support these service lines.
Ann M. Kistinger, NCIDQ, LEED AP
A&D Business Development/ Sr. Interior Designer
As a licensed interior designer specializing in providing storage solutions in the health care environment, I see a number of trends in the industry, including the fact that clients will want to control supplies to the point of need. They will control the exact quantity with tools that eliminate counting, such as smart cabinets that are connected to the supply vendor, and double bin systems featuring software programs that notify the facility when a bin needs to be refilled. Facilities are working toward right sizing their inventory.
In the area of inventory and supply control, I see clients going toward “lean supply” management—keeping exactly what supplies they need on-hand. They will do this by taking advantage of smart cabinets such as SmartCabinet by Logi Tag which enables hospital facilities to manage their high-value inventory under consignment. These cabinets can be connected directly to the supplier, eliminating overbuying, under buying and precious time spent counting.
FrameWRX by Spacesaver is a bin system that can double the capacity of storing less valuable supplies. Great success stories are found in clean supply rooms instead of using the typical wire cart. The bin system can be color coded, clear acrylic or wire for easy viewing. As an added benefit, the system can be used as a double bin system connected to SmartBox by Logi Tag which is a software program that notifies the facility when one bin is empty. This allows the facility to replenish when notified and eliminates an employee from checking stock a few times a day; it also helps the facility manage overstocking, keeping supplies at a needed level and saving space.
Another area of change that I see is that care continues to move outside costly settings such as hospitals and into more affordable retail clinics and mobile health settings. Consumers value the convenience, and costs can be as little as one-third of the bill at a traditional health care site. In this scenario, storage may be moved to a main distribution center remote from the hospital that can be shared by the hospital and its smaller hub health centers. A product that can be used to reduce space is Active Rac by Spacesaver which allow shelving to go mobile. Again, this can allow more than double the amount of storage in the same space. Saving space can lead to reducing the footprint to save revenue spent on real estate.
Looking at the last five years, capital expenditures have gone down and ambulatory care has remained steady. Even with the uncertainty clouding the future of health care, we are expecting health care providers to direct lower-cost care though an expanded outpatient footprint.
Just as DPR uses the lean process in construction, I expect to see health care providers looking to ‘lean’ to improve clinical processes and to continue making renovations to implement the latest technology in their facilities. They will be re-looking at reutilizing space to treat only the highest acuity patients in the hospital.
Responding to the cost of implementing electronic medical records and changes in reimbursement and payment structure will drive new types of partnerships, and health care providers may become open to partnering with private industry to create outpatient opportunities.
The key for us as builders in this environment is to understand the changing health care environment and to help provide solutions creating alternative delivery options of the care model.
Vice President, Preconstruction Services
OHL-Arellano Construction Co.
At Arellano, we’re currently seeing an increase in the senior living sector; there are definitely more starts in that market. There is also more activity in outpatient facilities and in general off-campus medical construction.
Another trend we are seeing is in the emerging technologies sector, which includes hybrid type operating room construction, cardiology and cancer treatment.
Charles A. Michelson, AIA, LEED AP
Saltz Michelson Architects
Now that there is a resolution to President Obama’s health care law, providers of medical care have a clearer direction of what they need to do. On the whole, they are now able to make plans of action since they better know what they are dealing with.
In response to the health care law and changes in the medical community, we’re seeing new and continued investment in technology and IT data transfer and computer systems; these will become the foundation of medical care in the future. Sophisticated computer systems are helping to connect medical records in a single location where multiple physicians have access to them, inside or outside of the hospital. More sophisticated systems are even tracking people and equipment within the hospital—if a patient needs an X-ray, for example, the technician just looks at a computer screen to see where the closest portable X-ray equipment is located. Telemedicine is also enabling physicians to connect to other doctors in remote locations where they can see a patient’s vital statistics right on the screen; they can deal with the patient in real-time, rather than responding to a call from a nurse.
Another evolution in the design of medical spaces is that patients come to one place and are treated through a multidisciplinary perspective. Someone with a cardiac issue, for example, has access to a cardiologist, pulmonologist and gastroenterologist in one place. People with chronic illnesses are looking for a team physician approach, and to receive treatment at one facility within the hospital or at an outpatient medical facility. Patient satisfaction and convenience are now front and center more than ever before.
These new medical approaches may also involve more than physicians—we’re designing spaces now that have areas specifically for nurse practitioners, dieticians or psychologists. In the past, a person with a cardiac condition would visit the cardiologist and that was it. Now they visit a cardiovascular institute where they see a cardiologist; a dietitian who tells them to give up red meat and French fries; and a psychologist or counselor to deal with depression. They also deal with a patient navigator to schedule their next tests. This goes above and beyond anything the traditional medical office ever did. Today’s caregivers are more engaged with patients; they look at the patient in his or her entirety as opposed to isolating a series of individual sicknesses, or providing treatment by an individual doctor or specialist.
In response to Obamacare and enhanced technological abilities, we’re seeing more outpatient types of facilities doing a variety of testing and treatment to keep expenses down; the cost to the consumer is not as high as doing the same work inside a hospital. More health care providers are planning to create facilities outside the hospital now that patient care is moving back into the community where space is less expensive. Hospitals will serve as places for very serious medical treatments only, saving money for the medical system and the patients receiving treatment.
This is a very dynamic and fluid time in medical facility design. What’s happening behind the scenes is just as important as the advances in medicine being made. It is an excellent time to be involved in medicine as a designer, though we are still faced with budgetary limitations. Working with a limited pool of money, our challenge is to create the best possible design that clients financially can afford; one that is efficient and responsive to health care providers’ needs.