With the Affordable Care Act still in its infancy, Building
Teams are seeing reverberations in the investment decisions of healthcare
providers.
With the Affordable Care Act still in its infancy, Building
Teams are seeing reverberations in the investment decisions of healthcare
providers, including new ideas about the types of buildings they are asked to
create.
“To reduce costs, many hospitals, physicians’ groups, and
healthcare systems are merging to eliminate duplication of operations,” says
Kelly Altes, P.E., Project Executive for KJWW Engineering Consultants and a
member of BD+C’s “40 Under 40” Class of 2014. “These and other trends are in
many cases the result of the Affordable Care Act, which has providers focusing
more than ever on patient experiences and outcomes, as well as outpatient
services. This shift is resulting in a significant increase in medical office
building and clinic construction and renovation projects.”
The latest version of the annual Hospital Construction
Survey conducted by the American Society for Healthcare Engineering with Health
Facilities Management magazine confirms this trend. The percentage of
respondents planning medical office building expansions, completely new MOBs,
neighborhood outpatient facilities and primary-care clinics, and ambulatory
surgery centers were all up significantly. Meanwhile, 41% said the new regulatory
environment makes it less likely that they’ll proceed with large new hospital
construction projects.
With care models changing, medical office buildings
increasingly provide services that were once the exclusive province of
hospitals, from cancer care to emergency treatment to operations. According to
Cushman & Wakefield, 80% of surgeries can successfully be completed in an
ambulatory setting.
By moving these procedures away from large hospital
campuses—which are often landlocked with little room for expansion—the volume
of patients requiring the hospital is reduced, making way for patients with
more complex needs. Since many off-campus MOBs are part of a network associated
with a larger hospital, patients who end up needing more advanced care can
simply transition to the main campus.
Locations of new MOBs are carefully considered, with
developers opting to place them near shopping, restaurants, major roads, and
public transit. In the past, many retail centers were wary of making deals with
medical tenants because of the overall stigma of having a healthcare provider
near retail and dining. Retail developers also believed medical tenants
wouldn’t produce attractive levels of revenue. However, some developers have
decided that having healthcare tenants is better than no tenants at all.
In particular, medical groups have made good use of large
spaces vacated by defunct retail franchises, both stand-alone and within malls.
Kaiser Permanente recently opened a 32,000-sf MOB in Portland, Ore., via
adaptive reuse of a Circuit City location the healthcare organization bought
out of receivership in 2010. Minnesota’s HealthEast Care System has created
clinics in St. Paul-area spaces once occupied by Borders, Gander Mountain, and
eq-life retail stores.
New partnerships and
development models
A Cushman & Wakefield investor survey on medical office
buildings reports that many healthcare providers are now seeking to form joint
ventures, often between for-profit and not-for-profit health systems. These
partnerships may offer the for-profit business the name recognition of the
nonprofit, and give the nonprofit access to the financial and physician
resources of the for-profit. When smaller clinics partner with larger,
better-funded hospitals, they can pool their resources to care for more
patients.
A Jones Lang LaSalle report indicates that real estate
investors are increasingly enthusiastic about the profit potential of MOBs. In
2013, 78% of MOB buyers and sellers were investors rather than developers or
hospitals—a dramatic shift from 36% in 2012. Hospitals and healthcare providers
still control 85% of healthcare real estate and are generally not interested in
selling, leading to a tight property market, JLL says. The firm predicts that
hospitals may be increasingly willing to reconsider leveraging under-used
property assets, in light of strong investor interest in the sector.
Regulations transform
hospital design
Though construction of big new hospitals has slowed,
healthcare groups are still investing in updates to keep properties functional,
safe, and competitive. A twist pointed out by the HFM/ASHE report: Obamacare’s
“two-midnight rule,” whereby hospital stays lasting less than two midnights
must be billed as outpatient services. Some hospitals are creating dedicated
units for observation-status patients, a tactic that may reduce overall length
of stay.
Private patient rooms
are the new normal, typically flooded with natural light and richly equipped
with accessibility features. New Facility Guidelines Institute recommendations
for 2014 emphasize sterilization and infection control in both hospitals and
outpatient facilities. Some clients are also debating pros and cons of
“same-handed” layouts, wherein all patient rooms are similarly oriented, versus
traditional “mirror” floorplans with back-to-back headwalls.
“To achieve desired healthcare outcomes, evidence-based
design and Lean design are becoming increasingly critical tools to design
facilities in ways that minimize patient stress, increase patient and staff
safety, and improve staff effectiveness and quality of care,” Altes says. “As a
result, we’re seeing increased attention on such things as the incorporation of
natural elements; ‘family-centered’ spaces; single-bed, same-handed patient
rooms; and decentralized materials management.”
Source: BDC
Network
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