Healthcare in the United States is currently undergoing the most extreme transformational paradigm shift in a century. As a builder of healthcare facilities, DPR Construction conducted a research initiative to better understand the long-term trends that its healthcare customers will have to manage and asked owners, designers and management consultants: Where is the industry heading? How will healthcare be delivered? What will the physical campus of the future look like?
Forty-two leaders shared their insights into what the future holds for the healthcare industry and for their own systems.CEO’s and senior executives, vice presidents, design and construction directors, design professionals, developers and hospital consultants joined the conversation. It should be no surprise that everyone agrees that uncertainty is one of the biggest challenges facing the healthcare industry today.
The unknowns of reform, reimbursements and regulations are greatly affecting health systems and their planning for the future. As one participant noted, “there’s so much uncertainty right now, but there’s one thing for sure and that’s doing more with less.”
While the healthcare industry is being continually tasked with change and doing more for less, there is an underlying optimism in the new focus on wellness, integration and community embeddedness. Here is what we learned:
1.-Hospitals will be smaller and more integrated at many levels:
Hospitals will be used for the highest acuity patients.Integrated care around the patient, an emphasis on prevention and wellness, less invasive procedures and advancements in research ultimately will reduce the demand for hospitalizations.Systems will reach further into the neighborhoods with different models.
Redundancy will be eliminated by having specialty areas of medicine available within a certain radius,but not necessarily at each campus within a system.“Today, the hospital is the cost center. It should be the last place for it to be. The focus needs to be on home health, primary care and outpatient care.” -CEO
Redundancy will be eliminated by having specialty areas of medicine available within a certain radius,but not necessarily at each campus within a system.“Today, the hospital is the cost center. It should be the last place for it to be. The focus needs to be on home health, primary care and outpatient care.” -CEO
“Environments will be created that are much more supportive of team-based care, where it’s much more collaborative. The physicians will lead, but not dominate.”-Healthcare Consultant, Strategic Planning
2.-Systems will be changing
Size is power. Systems will be consolidating, community hospitals may cease to exist and systems will be vertically integrated. For-profits and not-for-profits are becoming more and more alike, they may partner or merge, and not-for-profits could lose their tax-exempt status.With the Supreme Court ruling on The Patient Protection and Affordable Care Act, much discussion is happening at the state, local and institution level of how to deliver healthcare in the future.
3.-Outpatient services will be the focal point for growth
Patient-centered continuum of care is the future of healthcare, and it is the cornerstone between treating disease and illness and prevention and wellness. Medical Homes and ACO’s are a few models that will start this transition. The million-dollar question is…what will it look like? Current MOB space is clearly not the answer.“The MOB will be ‘mapped’ to the hospital, so that outpatient services are on the same floor as inpatient services and the transition can truly be seamless.” -VP, Strategic Planning.
4.-Specialty areas will focus on those that are the most profitable
These include cancer, heart and neuroscience, reflective of the aging baby boomers.“The population is aging and facilities are not prepared for this ‘tsunami’ of patients. The service lines that will continue to be prevalent are related to the aging population—cardiovascular, arthritis, and sports injuries, as the boomers stay active longer.” -VP, Strategic Planning.
5.-Technology/data intensity will be crucial
IT is seen as “the enabler.” Telemedicine, home monitoring systems, point of care testing, EMR, and data management will all impact the infrastructure and physical space. It also takes capital that might otherwise have gone to facilities.
6.-The economy and availability of capital will be limiting
We are moving into a cash-constrained period. There will not be nearly as many “big spends” as have occurred in the last 10 years. Access to capital is diminishing, and even when it is available, there is concern about being able to re-pay. As a result, institutions are delaying capital projects and reprioritizing them.
“With the current tight capital, mergers and acquisitions will continue. The onesies/twosies are just not going to make it—the lone rangers will be the dead rangers.” -VP, Real Estate
7.-Renovation and adaptive reuse will increase
Projects within hospitals will become more sophisticated and mission critical, and so, a lot of re-purposing of existing facilities is occurring. Under the proposed reimbursement rules, patient satisfaction will factor into reimbursement rates, and so, facilities directors of older facilities are concerned about making sure to provide a state-of-the-art patient experience to avoid getting bad ratings. Under the current economic conditions, if a system finds a building with the right “bones,” it is much cheaper to renovate than to build new.
8.-Sustainability expectations are changing
The industry expects sustainable practices. LEED is seen as adding an unnecessary additional expense, but “green” and especially energy efficiency are highly valued. Clients want access to data and results, specifically operational savings.They are motivated by optimization.
9.-New delivery methodologies and best practices are being embraced
Successful projects are universally described as collaborative and best when the C-Suite is engaged. Creativity, transparency, and follow-through on promises made regarding cost and schedule are highly prized. Design-build is being primarily used for simple project types such as parking garages. Owners don’t want to lose control. Integrated Project Delivery (IPD) is more used and accepted in the West than in the East and is being enthusiastically greeted from the design community.
10.-Demographics are a top concern, both for maintaining qualified staff and for the skewed aging patient population
Systems are not prepared for the different care expectations between those under and those over 45 years old. The growing numbers of the aging population are staggering. And, when healthcare reform gets implemented, with 32 million more insured U.S. citizens, demand will skyrocket, and the numbers of doctors coming out of medical school won’t be anywhere near what will be needed.
Conclusion
Systems have already started to make the changes that will make them more competitive regardless of the impact of government-mandated reform. The consensus is that healthcare, as it is practiced today, is not fiscally sustainable. There must be, and there certainly will be, transformative changes over the next 10 years.
Source:http://www.dpr.com/assets/docs/the-future-of-healthcare.pdf?/futureofhc
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