flexiblefullpage -
billboard - default
interstitial1 - interstitial
Currently Reading

Life after Obamacare

Giants 400

Life after Obamacare

Hospital systems are finding ways to get facilities built with a lot less money.


By Peter Fabris, Contributing Editor | August 18, 2017
The 300,000-sf Major Health Partners Replacement Hospital, Shelbyville, Ind.

Courtesy BSA LifeStructures.

No matter how things play out with the American Health Care Act, the proposed replacement for Obamacare, hospital administrators agree on one thing: “They’re going to have less money available for the care they provide,” says Collin Beers, AIA, Senior Principal, Stantec.

That has put the pinch on large-scale projects. “With uncertainty over reimbursement rates, we’re seeing fewer proposals for greenfield hospitals,” says Randy Keiser, Vice President, National Healthcare Director, Turner Construction Company. For approved projects, one popular cost-saving tactic has been to shrink rooms. “There’s been a downsizing of about 10% over the past decade,” says Keiser. “Now, many hospitals are under 2,000 sf per bed.”

Healthcare organizations continue to look for merger and acquisition opportunities to realize economies of scale, restructure their organizations, expand their geographic reach, and “rightsize” to eliminate redundant services. Stantec’s master planning service helps hospital systems with strategic planning, programming, project sequencing, and cost estimating for capital projects.

Mergers can sometimes result in improved quality of care, Beers says. “They can aggregate specialty services and create centers of excellence,” he says. A larger, more financially sound organization could have the resources to build a centralized, state-of-the-art facility in, say, cardiology or ophthalmology, with the aim of attracting top-notch specialists and fortifying the organization’s brand.

 

ALSO SEE: BD+C GIANTS 300 HEALTHCARE RANKINGS

Top 125 healthcare architecture firms

Top 80 healthcare engineering firms

Top 110 healthcare construction firms

 

Malls and strip malls have become popular locations for specialty centers and other outpatient facilities. There’s usually a lot of parking, and there may even be bus service. “In retail zones, patients have things they can do before and after their appointments,” Beers says.

Adaptive reuse of big-box stores offers unique advantages. The high ceilings of a former Kmart provide flexibility to install the extensive networks of infrastructure, Beers says. The fact that only the front elevation may need a facelift is also a plus. And with the shell already in place, the construction timetable could be faster than new construction.

But extensive and costly HVAC renovations are often necessary. Many spaces have to be partitioned. Existing systems that served big open spaces have to be rebuilt. In the end, the cost savings of turning a big-box store into an outpatient facility may not be that great. “All in all, it might be only slightly more affordable than it would be to build new,” Beers says.

 

The 142,000-sf Scott Bieler Clinical Science CenterThe 142,000-sf Scott Bieler Clinical Science Center serves as the new campus entryway for the 15-building, 24-acre Roswell Park Cancer Institute in downtown Buffalo, N.Y. The tower’s angular glass exterior is accented with a three-story “infusion box” with highlights of copper-mesh-embedded glass. On the Building Team: FXFOWLE (architect), Severud Associates (SE), Watts Engineering (MEP), C & S Companies (CE), and Axis Facades USA (façade consultant). © Robert Benson.

 

BETTER HEALING THROUGH TECHNOLOGY innovation

Some hospitals have adopted mobile tracking technology so that nurses can quickly locate equipment. “This can reduce the amount of equipment needed and the amount of spaces for their storage,” Beers says.

Technology can also come in the form of a wristband worn by patients. Instead of stewing in a noisy, stressful waiting room, patients (and their families) can relax in the cafeteria or healing garden and be notified instantly when it is their turn for a test or X-ray. This improves the patient experience and allows the facility to reduce or repurpose waiting areas.

Another technology-related trend to watch: telehealth, which offers virtual monitoring of a patient’s condition. Fifty-four hospitals have opened telehealth ICUs across the country, according to Crain’s Chicago Business. They look like air traffic control rooms, with giant monitors filled with patients’ medical data. High-definition cameras and audio equipment allow doctors and nurses to zoom in on patients and speak to them from afar.

The $54 million, 125,000-sf Mercy Virtual Care Center, in Chesterfield, Mo., enables more than 300 medical professionals to watch over patients at 38 hospitals in seven states. A Mercy official has stated that a 40% reduction in expected mortality rates in its ICUs was largely due to early interventions enabled by the Virtual Care Center’s monitoring capability.

Hospital designers are helping healthcare organizations improve patient outcomes, especially for preventable, never-should-happen occurrences like infections and slips, trips, and falls, says Keiser. Light fixtures that can kill deadly microorganisms such as MRSA and Aspergillus are gaining favor, as are antimicrobial hardware and curtains. Medical facilities are doubling down on handrails and slip-resistant flooring in patient rooms and bathrooms to reduce injuries.

In surgical units Keiser notes that advances in cardiology have made it possible for less invasive heart surgery. This makes for not only faster recovery times but also faster surgeries. As a result, some hospitals have reduced the number of ORs for cardiology and converted those spaces to catheter labs.

At a time of great uncertainty for healthcare providers, facilities designers need to be open to finding new approaches as a project progresses.

“The vast majority of healthcare projects have changes during design and construction,” Keiser says. “This seems more prevalent than it was 20 years ago.”

Related Stories

Giants 400 | Mar 23, 2022

M&A Update – GRAEF continues expansion in Florida by acquiring Erickson Consulting Engineers

The acquisition of Sarasota’s ECE by GRAEF is the fifth Florida transaction that Morrissey Goodale has advised on in 2022.

Giants 400 | Feb 16, 2022

Call for surveys: 2022 Giants 400 Report

The 2022 Giants 400 Report will feature more than 130 AEC firm rankings across 25 building sectors and specialty categories.

Senior Living Design | Jan 5, 2022

Top Senior Living Facility Design and Construction Firms

Perkins Eastman, Kimley-Horn, WSP USA, Whiting-Turner Contracting Co., and Ryan Companies US top BD+C's rankings of the nation's largest senior living sector architecture, engineering, and construction firms, as reported in the 2021 Giants 400 Report.

Giants 400 | Jan 3, 2022

2021 Religious Sector Giants: Top architecture, engineering, and construction firms in the U.S. religious facility construction sector, as reported in the 2021 Giants 400 Report

Gensler, KPFF, Crossland Construction, and Rogers-O'Brien Construction head BD+C's rankings of the nation's largest religious facility sector architecture, engineering, and construction firms, as reported in the 2021 Giants 400 Report.

Giants 400 | Jan 3, 2022

2021 Government Sector Giants: Top architecture, engineering, and construction firms in the U.S. government buildings sector

Stantec, Jacobs, Turner Construction, and Hensel Phelps top BD+C's rankings of the nation's largest government sector architecture, engineering, and construction firms, as reported in the 2021 Giants 400 Report.

Giants 400 | Dec 31, 2021

2021 Science and Technology Sector Giants: Top architecture, engineering, and construction firms in the U.S. S+T facilities sector

HDR, CRB, Jacobs, Skanska USA, and Whiting-Turner Contracting Co. top the rankings of the nation's largest science and technology (S+T) sector architecture, engineering, and construction firms, as reported in the 2021 Giants 400 Report.

Giants 400 | Dec 5, 2021

2021 Reconstruction Sector Giants: Top architecture, engineering, and construction firms in the U.S. building reconstruction and renovation sector

STO Building Group, Alfa Tech Consulting Engineers, Gensler, and Stantec top BD+C's rankings of the nation's largest reconstruction sector architecture, engineering, and construction firms, as reported in the 2021 Giants 400 Report.

Giants 400 | Dec 5, 2021

2021 Telecommunications Facility Sector Giants: Top architecture, engineering, and construction firms in the U.S. telecommunications facility sector

Alfa Tech Consulting Engineers, AECOM, Kimley-Horn, and BRPH head BD+C's rankings of the nation's largest telecommunications facility sector architecture, engineering, and construction firms, as reported in the 2021 Giants 400 Report.

Giants 400 | Dec 5, 2021

2021 Justice Facility Sector Giants: Top architecture, engineering, and construction firms in the U.S. justice facility/public safety sector

Turner Construction, DLR Group, AECOM, and Stantec top BD+C's rankings of the nation's largest architecture, engineering, and construction firms for justice facility/public safety buildings work, including correctional facilities, fire stations, jails, police stations, and prisons, as reported in the 2021 Giants 400 Report.

Giants 400 | Dec 3, 2021

2021 Hotel Sector Giants: Top architecture, engineering, and construction firms in the U.S. hospitality sector

Gensler, Jacobs, Suffolk Construction, and WATG top BD+C's rankings of the nation's largest hotel sector architecture, engineering, and construction firms, as reported in the 2021 Giants 400 Report.

boombox1 - default
boombox2 -
native1 -

More In Category




halfpage1 -

Most Popular Content

  1. 2021 Giants 400 Report
  2. Top 150 Architecture Firms for 2019
  3. 13 projects that represent the future of affordable housing
  4. Sagrada Familia completion date pushed back due to coronavirus
  5. Top 160 Architecture Firms 2021

 


Magazine Subscription
Subscribe

Get our Newsletters

Each day, our editors assemble the latest breaking industry news, hottest trends, and most relevant research, delivered to your inbox.

Subscribe

Follow BD+C: