How Will The Senate’s American Health Care Act (AHCA) Bill Affect Hospitals and Health Systems?

Despite Uncertainty in Healthcare Policy, Some Strategies Remain Unchanged

June 23, 2017

Healthcare Strategist, NBBJ

@dbellef

On June 22, Senate Republicans released their American Health Care Act (AHCA) proposal to repeal and replace Obamacare. While it has differences in timing and method from the House bill, it maintains core Republican tenets of states’ rights and freedom of choice.

 

What does the Senate bill do?

Whatever final version of the Republican repeal-and-replace legislation emerges from conference, it will almost certainly:

  • Give states much greater latitude in designing their Medicaid programs and individual commercial insurance markets.
  • Put more choice and purchasing power into the customer-patient’s hands, including the option not to purchase health insurance at all.
  • Not add net new dollars into the system, even with the “puts and takes” of tax credits, subsidies and the restoration of disproportionate share hospital (DSH) payments.

And if that isn’t enough, other transitions are already underway:

  • Medicare continues to change how it pays for care, using a variety of methods: bundled payments, accountable care organizations and more.
  • Commercial insurers, in response to their customers, continue to develop a variety of different products to lower the cost to employers, which inevitably passes higher cost on to the customer-patient.

 

What doesn’t the Senate bill do?

It does not address the continuing rise in the cost to produce and deliver healthcare. Whether Republicare, Medicare or commercial care, everyone is just reshuffling how the payer pays — and hopefully reducing the amount. Obamacare was the exception: it put more money into the system but still did nothing to control the rise in cost.

But payers don’t provide care, nor can they control cost. This leaves it in the hands of care providers to figure out new ways of producing and delivering care, as all payers — from individuals, to insurers, to the Federal government — reduce the amount they are willing to pay. It cannot be overstated: no matter what Congress does, over time there will be less third-party money coming into the system, and the customer-patient will be expected to pay more and more out of pocket.

 

What now?

Because this trend will continue independent of healthcare policy, our advice hasn’t changed. Hospitals and health systems should continue to:

  • Form more partnerships with community organizations and others who have deep interests in improving community health.
  • Accelerate the development of lower-cost ambulatory and digital healthcare offerings. We are moving inexorably toward a future where healthcare is highly distributed, in the community, the home and the person.
  • Seek greater operational efficiency. Efficiency and quality go together, and we must raise the bar on both. Technologies and systems now exist in healthcare that can do this, and they should be applied to hospital and ambulatory care alike.

Regardless of whether the Senate proposal passes in its current form, in an altered form or not at all, hospitals and health systems need to accelerate their transition to becoming providers of highly reliable care that is high in quality, is error-free and provides the results it intends to provide. This is what will lower the cost of producing and delivering healthcare for us all.

 

Image courtesy of Benjamin Benschneider/NBBJ.

Share this:  envelope facebook twitter googleplus tumblr linkedin
Comment Follow nbbX

Caring for Caregivers

Five Workplace Amenities that Support Healthcare Workers

June 13, 2017

Healthcare Practice Leader, NBBJ

Editor’s Note: This post was coauthored by George Takoudes and Kelly Griffin.

Millions of dedicated clinicians and medical professionals work in hospitals and clinics around the world. Unfortunately some of these employees experience long hours, occupational injuries and stress due to the nature of their work. Not surprisingly, in a survey of the most stressful jobs, RNs, surgeons, social workers and emergency dispatchers all placed in the top 10.

As a result, many healthcare organizations are increasingly focused on designing amenities, policies and workplaces to better support their clinicians, health providers and administrators. Interestingly, healthcare facilities — academic medical centers in particular — are wrestling with similar issues as corporate workplaces. Both seek to increase productivity, collaboration and work-life balance, and an improved workplace environment can help facilitate these goals.

Here are a few of the unique needs clinicians and other medical professionals face and the ways new workplaces — and specifically workplace amenities — have the potential to help:

Variety. A day in the life of a medical professional is varied and filled with physical movement — from reviewing patients, sitting with colleagues and teaching, to hands-on work interrupted by ringing pagers. Amidst this controlled chaos, doctors and clinicians also need places to wrap up emails and consult with colleagues. In terms of physical space for medical professionals, it’s about balance: finding the right ratio of shared spaces to individual workspaces to support spaces. It can also be about smart spaces that support improved processes and workflows.

Privacy. Patient privacy rules require healthcare workplaces to keep information confidential and discussed verbally only in a secure environment. Yet clinicians, clinical faculty and medical professionals also need privacy to decompress and, sometimes, to grieve the loss of a patient. As in corporate workplaces, allocating a range of quiet workspaces — from private offices to individual workstations to phone spaces — is key. While traditionally healthcare facilities feature more private offices than most corporate workspaces, some academic medical centers are experimenting with an unusual office approach, with as little as 60% individual workspaces and as much as 40% shared spaces.

100273_N9_1024

Staff lounge at the University of Washington Medical Center Montlake Tower (Benjamin Benschneider/NBBJ)

Respite. Many clinicians and medical professionals, especially those in palliative care, have difficult jobs supporting sick patients and their families. The workplace must give them the space to think, grieve and recuperate, and thus help prevent physician burnout. Amenities that are now commonly found on corporate tech campuses providing visual and acoustic privacy — retreat spaces, yoga rooms, support lounges and soothing gardens — can help bring calmness to a clinician’s or medical professional’s day. In Seattle, the University of Washington Montlake Tower features a room for exercising and relaxing with views of Mount Rainier and the Montlake Cut. On the east coast, Brigham and Women’s Hospital has a dedicated garden for staff, while at Massachusetts General Hospital, the surgical floors have access to daylight, which helps energize surgical teams who may spend long hours in the OR.

Community. Team-based medicine requires opportunities for group communication, and just like corporate office workers, clinicians and medical staff also need places to build community and celebrate events like birthdays and the lives of patients who recover as well as those who pass away. These can include home-like areas for gathering, welcoming visitors and sharing meals, which often facilitate social support. Yet areas for engagement and community-building are not just limited to indoors — the health care and insurance provider Kaiser Permanente is hosting farmers’ markets across the U.S. outside of their health centers and clinics.

Collaboration. Finding creative, flexible ways to encourage knowledge-sharing and idea-generation is essential to improving patient care. In a healthcare setting, this can mean trading private offices for shared space. For clinicians, it’s about providing shared spaces large and small that help ease the workday transition from clinical to office to community space. Departmental organization matters, too: at the OhioHealth Riverside Methodist Hospital Neuroscience Center in Columbus, Ohio, neuroscience, heart and vascular clinicians work together in one building, fostering an interdisciplinary approach to improve neuroscience patients’ experiences. In Boston, the newest medical technology at Massachusetts General Hospital syncs to smartphones so clinicians and nurses can communicate more easily, quickly and quietly.

 

The most successful amenities are not just “nice-to-haves” but crucial elements that make life better, easier and more joyous. The benefits are many, for employers — workforce recruitment, engagement and satisfaction — and for employees — stress-relief, refuge, privacy and emotional support — alike. In a healthcare setting, the lives of patients, loved ones and colleagues depend on facilities that support both the functional and emotional needs of clinicians, medical professionals and caregivers.

Banner image courtesy of Benjamin Benschneider/NBBJ.

Share this:  envelope facebook twitter googleplus tumblr linkedin
Comment Follow nbbX

How Designers Can Help Lead the Conversation about Science

Reflections on the March for Science in Washington, DC

May 30, 2017

Partner, NBBJ

“Energizing” is the word I would use to describe the March for Science in Washington, DC, last month on Saturday, April 22. Along with the People’s Climate March a week later, and with ongoing drama over the Paris climate accord, it’s obvious that people are feeling the need to get out and speak up on the issues surrounding our planet.

At the march I attended, it was wonderful to see such a wide diversity of age, race, geography, religion and profession uniting around the significance of science.

In particular the unanimous support for the reality of climate change is a call to action to reverse this human-instigated circumstance which could make many species — including our own — extinct in the next century.

The “science” of designing, building and operating the physical environment contributes significantly to adding carbon to the atmosphere — the leading cause of climate change — so our role as architects should be pivotal in reversing this. Designers can shape the dialogue in three ways:

1. Get Involved
I spoke to dozens of people along the March for Science and most were scientists and academics: although it’s possible I missed a few individuals, nowhere did I see the American Institute of Architects (AIA) or U.S. Green Building Council (USGBC) participating. I would argue our profession is at least half science, and therefore our input is paramount. Climate change is certainly discussed in architecture circles; however, it would be great if more people trained in design and architecture were in the political realm. Policy is the root of change and getting in at the ground level is key.

2. Implement Best Practices
There are a number of things the design industry can do that are simply best practices taken seriously, yet even today, 13 years away from the deadline of the 2030 Challenge, we are not taking the basics to heart. Design begins with one’s relationship to the environment, so appropriate responses to climate and solar and wind orientation are the most fundamental. Simple energy modeling that allows us to make big or even incremental moves can save megawatts of energy over decades. There are many passive design opportunities, from building orientation, to enclosure design, to building materials, to sun shading and louvers that we can take advantage of more frequently. We have a really big tool chest to work from!

3. Innovate
Then there’s the real science and innovation side, from things like photovoltaics, to making lighter buildings with less material, to sustainable materials like timber. There is no reason why the surface area of buildings can’t also be generators of energy or surfaces for agriculture. Even things like modular construction can significantly help reduce waste, in addition to creating better safety on-site and increasing construction quality. A whole range of potential innovations can be put into practice by the design and construction industry.

This will require help from our partners — clients, engineers, contractors — but the design professions can play a leading role. As the holders of the design vision, we have the platform and the point of view to orchestrate the conversation, to describe the issues and challenges. Initiatives like the USGBC and the AIA’s 2030 Challenge are a great start, but we in our profession we need to ramp it up.

 

Tens of thousands of people marching down Constitution Avenue and at over 600 similar events around the world send a clear signal to our elected leaders to take this matter seriously — science is the foundation of our future health, prosperity, even our very lives!

Image courtesy of Pixabay.

Share this:  envelope facebook twitter googleplus tumblr linkedin
Comment Follow nbbX
Next Page »