Hard to believe, but we’re only six months away from the day—January 1, 2014, to be precise—when the Affordable Care Act will usher in a radical transformation of the American healthcare system. Healthcare operators are scrambling to decipher what the new law will mean to their bottom lines and capital facility budgets.
For advice on how AEC firms can succeed under Obamacare, we turned to Patrick E. Duke, Senior Vice President at KLMK Group (www.klmkgroup.com), which advises healthcare operators on the planning and construction of capital facilities.
Duke, a BD+C “40 Under 40” honoree (Class of 2010), says firms must home in on three trends: 1) the shift by healthcare providers toward “population-based management”; 2) the push toward a fast-paced “retail environment” in healthcare; and 3) heightened interest in energy and operational cost savings among healthcare operators.
1. POPULATION-BASED MODEL HELPS SPREAD THE RISK
Today’s version of “fee-for-service,” whereby healthcare operators are reimbursed more on volume than on patient outcome, is on the way out, says Duke. It is being replaced by a system in which healthcare operators will be given a set amount of money to manage the care of a defined population of patients.
TOP HEALTHCARE ARCHITECTURE FIRMS
2012 Healthcare Revenue ($)1 HDR Architecture $185,763,0002 HKS $134,000,0003 Cannon Design $109,000,0004 Perkins+Will $100,962,2555 Stantec $98,471,4576 NBBJ $96,169,0007 HOK $84,300,0008 SmithGroupJJR $66,700,0009 Perkins Eastman $63,800,00010 RTKL Associates $60,746,000
TOP HEALTHCARE ENGINEERING FIRMS
2012 Healthcare Revenue ($)1 AECOM Technology Corp. $180,210,0002 Jacobs Engineering Group $77,100,0003 URS Corp. $43,327,3324 Smith Seckman Reid $40,105,6005 KPFF Consulting Engineers $30,000,0006 Affiliated Engineers $28,217,0007 TTG $24,719,9058 Parsons Brinckerhoff $22,700,0009 Dewberry $21,226,70210 Allen & Shariff $20,300,000
TOP HEALTHCARE CONSTRUCTION FIRMS
2012 Healthcare Revenue ($)1 Turner Corporation, The $1,856,850,0002 McCarthy Holdings $1,750,000,0003 Clark Group $1,055,387,8704 Skanska USA $833,093,7005 Brasfield & Gorrie $780,723,2476 JE Dunn Construction $759,053,6317 DPR Construction $749,013,6118 PCL Construction Enterprises $729,454,5149 Whiting-Turner Contracting Co., The $551,510,96710 Robins & Morton $545,100,000
Giants 300 coverage of Healthcare brought to you by DuPont www.fluidapplied.tyvek.com.
To be profitable under such a regimen, says Duke, healthcare operators will have to control costs by, ironically, keeping people out of the hospital. They will do so through various means: limiting the use of expensive emergency room visits, treating patients in lower-cost outpatient facilities, keeping people healthy through wellness programs, and cutting down on readmissions.
“The common response among providers thus far has been to cast as wide a net as possible to spread the risk over a broader population, just like life insurance,” says Duke. Some healthcare systems are growing their patient bases by buying up or merging with other providers. A more common practice is to build specialty facilities to provide more profitable services outside the hospital setting.
For example, the University of Maryland Medical System will open a 68,000-sf cancer center at its Upper Chesapeake Health affiliate in Bel Air, Md., in September. The new center will save local residents the 30-mile trip to UMMS’s Baltimore campus, while solidifying its position in the suburban market northeast of the city.
“Healthcare providers are looking at the services they can offer that are more specialized, with better outcomes in a lower-cost setting,” says Duke. AEC firms must be prepared to respond to this shift in direction.
2. ‘RETAIL HEALTHCARE’ PUTS EMPHASIS ON SPEED TO MARKET
As healthcare moves into more of a retail mode, getting specialty outpatient and primary-care outreach units to market as quickly as possible will be top-of-mind for hospital execs. Duke believes that will make them more open to modular construction. “If modular can get the facilities up faster to capture a growing market and get the cash registers ringing sooner, they’ll go with it,” he says.
Repurposing existing spaces is another route that healthcare systems are using to widen their patient bases quickly. In the Atlanta area, for example, Kaiser Permanente continues to explore repurposing vacant Blockbuster stores into neighborhood clinics, which then feeds patients into the Kaiser system. Vanderbilt University Medical Center has done the same at 100 Oaks Mall in Nashville, with great success.
“Healthcare operators want designers and contractors who can evaluate a building and come back quickly with solutions,” says Duke. Firms that can offer systems solutions for new facilities—designing standard units, bundling them, and rolling them out fast—will also be in demand, he says.
3. SAVING EVERY NICKEL ON ENERGY AND OPERATIONS
Healthcare providers are finally getting serious about saving on energy and operational costs. “Before Obamacare, they focused on supply chain and wouldn’t get serious about energy or facility operations because they didn’t need to,” says Duke. “As systems consolidate, they have the scale explore options like energy monitoring and retrocommissing, to identify sustainable cost-saving solutions.”
Another route to controlling costs is to develop new facilities under Performance Guaranteed Facilities arrangements. Under a PGF, the hospital contracts with a service provider to finance, plan, design, build, and maintain facilities over a 20- to 30-year period, at a fixed total cost.
“The hospital owns the building and the land, but the service provider takes the risk of developing the facility and maintaining it, including replacing equipment on an ongoing basis,” says Duke. This sheds a lot of risk for the hospital. If, for example, the OR goes down due to a maintenance error, the PGF provider takes the hit.
Duke says that, in Canada, value-for-money studies showed that life cycle cost savings averaged 15-20% on a net present value basis through the use of PGFs to build and operate new healthcare facilities versus traditional project delivery options.
The witching hour for Obamacare is fast approaching. Will your firm be ready to compete in the new American healthcare landscape?
Read BD+C's full Giants 300 Report
Related Stories
| Sep 6, 2013
Nonresidential Construction Index holds steady in Q3
FMI's 2013 Third Quarter Nonresidential Construction Index report shows a NRCI score of 60.3, a .2-point improvement over Q2.
| Sep 5, 2013
Do you have the next big breakthrough for the AEC industry?
Next month's Under 40 Leadership Summit in San Francisco is your place to shine. Our third annual networking and leadership event for young AEC professionals will feature an XPrize-type competition, called Vision U40, that will reward attendees who develop the most innovative solutions to today's pressing issues.
| Sep 4, 2013
Identifying your leadership gaps
U.S. businesses spend more than $170 billion annually on leadership-based curriculum, according to the American Society of Training and Development. Is all that training producing better leaders or just more people who hold positions of leadership?
| Sep 4, 2013
Augmented reality: 12 applications for design and construction professionals
Building Design+Construction reached out to AEC professionals who have studied and applied augmented reality and asked them to pinpoint applications that are ripe for the technology. Here’s what they had to offer.
| Sep 4, 2013
Augmented reality goes mainstream: 12 applications for design and construction firms
Thanks to inexpensive mobile devices and increasingly advanced software apps, Building Teams are finally able to bring their BIM models to life on the job site.
| Sep 4, 2013
K-12 school design that pays off for students
More and more educators are being influenced by the Reggio Emilia approach to pedagogy, with its mantra of “environment as the third teacher”—an approach that gives Building Teams a responsibility to pay even closer attention to the special needs of today’s schools.
| Sep 4, 2013
Video: Autodesk Fellow Tom Wujec on why you should join the Vision U40 competition
Tom Wujec, lead facilitator of BD+C's 3rd Annual Under 40 Leadership Summit, October 9-11 in San Francisco, explains the Vision U40 competition, which will launch at the event. U40 Summit participants will collaborate in small teams to develop innovative solutions to today's pressing social, economic, technical and cultural problems related to the built environment. They will complete for $5,000 in prizes.
| Sep 4, 2013
Smart building technology: Talking results at the BUILDINGChicago/ Greening the Heartland show
Recent advancements in technology are allowing owners to connect with facilities as never before, leveraging existing automation systems to achieve cost-effective energy improvements. This BUILDINGChicago presentation will feature Procter & Gamble’s smart building management program.
| Sep 4, 2013
Twenty-nine-acre brick building complex in Watertown, Mass., to be renovated as innovation hub
The owner of a 29-acre cluster of brick buildings in Watertown, Mass., wants to reinvent the site as a 21st-century innovation hub.
| Sep 4, 2013
Last chance to pre-register for BUILDINGChicago/Greening the Heartland Conference at 20% savings
Attendees of the BUILDINGChicago/Greening the Heartland Expo and Conference can still save 20% off the at-site registration fee by registering online in these final days before the event opens on September 9 and concludes on September 11.