Healthcare Planners on the Affordable Care Act, Part 1

Paula Buick, RN, LEED GA, CLSS and Karen Pottebaum, AIA, ACHA, LEED AP are two of PAYETTE’s Healthcare Planning Leaders. They provide professional and technical expertise during design with respect to clinical practice and operations to assure optimum integration of strategic and facility planning and programming.

Paula brings a unique perspective of clinical operations, having been an ICU nurse and Senior Project Manager at Massachusetts General Hospital and Karen brings over 20 years of healthcare planning and design experience to our team.

Today Paula and Karen answer some key questions about the impact of the Affordable Care Act on the future of how we design for healthcare.

Have you noticed any changes to healthcare client priorities or decision making processes since the introduction of the ACA?
KP: In line with the focus of the ACA on preventative and outpatient care, most clients invested in MOB and ambulatory buildings during the initial period following the release. Most institutions held off significant inpatient construction unless it had already been funded due to lack of clarity in reimbursements. Overall, healthcare construction has been making a comeback now that the Supreme Court has upheld the ACA and systems have started working on backlog renovations and realigning services to the new reimbursement regulations.

PB: The ACA, along with the ACO model (Accountable Care Organization) and payment reform, changed the financial payment model for hospitals and providers. In simple terms, hospitals previously billed for ‘their business’ and ‘physicians/clinicians’ billed for theirs. Today, as an example, your healthcare providers (hospitals/MDs etc) will get a single payment for your knee replacement v. charging the patient for each visit. As a further example, since 2013 when the Centers for Medicare and Medicaid (CMS) started “Bundled Payments for Care Improvement Imitative (BPCI), CMS saved $42.3M alone on cardiac bypass surgery in demonstration hospitals.

This financial incentive and realignment, creates stronger partnerships and encourages capital planning to be more holistic. Healthcare organizations with a long history of ‘being one’ such as the Mayo or Cleveland Clinics or those who already had an integrated model (e.g. Kaiser Permanente: hospital + providers + health insurance) I think had an advantage during this transition from volume based care to value based care. The results of the ACA tracking survey reveal healthcare is a complex enterprise and needs a systems thinking approach.

Now that the Supreme Court has upheld a critical portion of the ACA, do you anticipate more healthcare clients implementing significant changes to their facilities in response to requirements of the ACA?
KP: Health Systems will likely look to improve their outpatient facilities and to expand these services into the community – especially in urban areas – to enhance preventative care services. In terms of existing facilities and new inpatient facilities, flexible design that can support both inpatient and outpatient care will likely be stressed. Also, there will likely be less competitive driven construction that has been seen in the market in the last few decades. The one-upmanship of competing hospitals to attract patients with bigger and better facilities will diminish significantly as there will be less available funding.

PB: I think we have already seen the impact in parts of our country. With the consolidation of hospitals and providers into ‘healthcare systems,’ the ownership of the continuum of care is much stronger (e.g. healthcare systems investing in home care, attention to the coordination of care which reflects the investment in the electronic medical records to share your health information across the platforms – hospital, specialists, PCPs, home care etc).

The healthcare systems are not focusing on the brick and mortar ‘hospital’ – they have been investing in partnered community hospitals facilities and extending their brand. When the quality of care for your laparoscopic cholecystectomy is the same at your community hospital and costs less, that’s where you’ll have it done.

The Medicare Shared Saving Program Academic Medical Centers are experiencing reduced admissions as care is more outpatient driven and directed to community hospitals.

What parts of the ACA do you anticipate having the greatest impact on healthcare facilities design?
KP: With the ACA requiring more insured patients, there could be an expectation that fewer people will use the ED as their primary care service and therefore reduce the lower-acuity patient volume. Likely, Emergency Department design will focus more on higher acuity treatment and less on overall patient volume. The ACA also includes financial incentives to reduce admission rates, so there can be an expectation that the overall number of inpatient beds will remain steady if not decrease in the immediate future. This will also reduce the demand for inpatient support services and drive facilities to evaluate how to transition underutilized space for better use.

Related:
Cultural Shifts Transforming Healthcare Design: An Introduction
Does Remote Health Monitoring Mean the End of the Exam Room?
Adapting Healthcare Design to Accommodate Future Generations
The Future of Flexibility in Healthcare
DMB UNITE: Healthcare Environments
A Challenger to Proton Therapy?
Inpatient Care Units & Wireless Telemetry
Healthcare Trends: Looking Back to Move Forward
Impacts of the Affordable Care Act on Hospital Design
Leveraging Opportunities in Hospital Design for Resiliency