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.

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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.

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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.

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The Four Types of Strategic Real Estate Amenities

From Swimming Pools to Pirate Ships, Amenities (Even Crazy Ones) Aren’t Just Perks, but Assets to Enhance Performance

May 9, 2017

Researcher, NBBJ

As competition for tenants, patients, employees and students has intensified, amenities have become an important asset and differentiator across all building types. For example, the total amount of space devoted to amenities in commercial office buildings has risen from 3 percent to 12 percent for high-end tenants, while hospitals and higher education institutions have spent billions to create amenity-rich campuses. Amenities not only draw potential building users, but they also can have a positive impact in terms of asking rates, employee retention [PDF], patient satisfaction and patient outcomes.

While food service has become a baseline amenity in a wide range of facilities, four other amenity types are gaining popularity, namely, those which support fitness & health, access to nature, flexibility & control, and positive distraction.

NBBX_Amenities_Graphic_3_2048

 

Fitness & Health

Gyms are high on the list of employees’ desired amenities, particularly among millennials. In fact, three quarters of European employers already provide fitness facilities, expecting to benefit through reduced healthcare costs and improved productivity. Companies like Chesapeake Energy provide not just gyms but basketball courts and Olympic-sized swimming pools, while even coworking spaces like Brooklyn Boulders Somerville feature major fitness amenities like 22-foot climbing walls.

In healthcare, wellness and fitness centers have evolved from marketing gimmicks into profitable and popular amenities supporting integrated care and population health models. Akron General’s Health & Wellness Center–Green, for example, incorporates a fitness center with outpatient services and emergency department in a sprawling complex, while Florida Hospital is building an 80,000-square-foot wellness center that features indoor farmers’ markets.

 

Access to Nature

Green space is one of the most desired yet underprovided amenities in office buildings, according to surveys of millennials, and has a restorative effect on the weary. Some of the more innovative examples of green space amenities include multi-story glass spheres at Amazon’s new headquarters in Seattle, and a 43,000-square-foot urban farm at Pasona Group’s main offices in Tokyo.

Evidence-based design studies have also demonstrated that patients with a view of nature have less anxiety and pain [PDF], which has helped popularize healing gardens and other green amenities in the healthcare industry. For example, Diakonie-Klinikum Stuttgart has over 150,000 square feet of green space and gardens, while Massachusetts General Hospital’s Lunder Building has an atrium featuring hanging gardens.

 

Flexibility & Control

Employees that have a higher degree of control over where they work, including access to private space and a range of task-appropriate work environments, tend to have a higher degree of workplace engagement. Companies like ViaStat and Thermo Fisher Scientific have actively encouraged employees to modify and redesign their work environments to provide more flexibility and personal control.

Other studies have found that giving patients more personal control and choice reduces stress, an insight hospitals accommodate by creating relaxation rooms and enabling patients to control variables like lighting, sound and temperature. UCSD Jacobs Medical Center’s new facility gives patients iPads which control windows shades, room lights, the thermostat and an Apple TV.

 

Positive Distraction

Game and recreation areas have long been common in the tech industry but are becoming a more widespread phenomenon. These spaces may seem juvenile, but research suggests that helping people feel younger improves productivity. Other workplace amenities like lounges, libraries and terraces can help to create more varied, stimulating environments. Some more unusual examples include a mock pirate ship at Inventionland’s headquarters, and a 65-foot Ferris wheel at Acuity’s main offices.

Hospitals have invested in common spaces like lobbies and lounges to create areas of positive distraction and to reduce stress. At the Minnesota Health Clinics and Surgery Center, waiting spaces have discovery bars where patients can explore research and educational materials via iPads, while Lurie Children’s Hospital has a custom fire truck that kids can play in.

 

Research and anecdotal evidence suggest that amenities which support fitness & health, access to nature, flexibility & control and positive distraction can have tangible benefits. The right type of amenity can be not just a perk but an asset that contributes to the bottom line, whether it’s more engaged employees, better patient outcomes or more desirable properties.

Banner image courtesy of Pixabay.

Infographic © NBBJ.

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