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
Fire-Rated Products | Aug 14, 2023
Free download: Fire-rated glazing 101 technical guide from the National Glass Association
The National Glass Association (NGA) is pleased to announce the publication of a new technical resource, Fire-Rated Glazing 101. This five-page document addresses how to incorporate fire-rated glazing systems in a manner that not only provides protection to building occupants from fire, but also considers other design goals, such as daylight, privacy and security.
Office Buildings | Aug 14, 2023
The programmatic evolution of the lobby
Ian Reves, Managing Director for IA's Atlanta studio, shares how design can shape a lobby into an office mainstay.
Contractors | Aug 14, 2023
Fast-tracking construction projects offers both risk and reward
Understanding both the rewards and risk of fast-tracking a project can help owners, architects, engineers, and contractors maximize the benefits of this strategy and can bring great reward on all fronts when managed properly.
MFPRO+ New Projects | Aug 10, 2023
Atlanta’s Old Fourth Ward gets a 21-story, 162-unit multifamily residential building
East of downtown Atlanta, a new residential building called Signal House will provide the city with 162 units ranging from one to three bedrooms. Located on the Atlanta BeltLine, a former railway corridor, the 21-story building is part of the latest phase of Ponce City Market, a onetime Sears building and now a mixed-use complex.
Office Buildings | Aug 10, 2023
Bjarke Ingels Group and Skanska to deliver 1550 on the Green, one of the most sustainable buildings in Texas
In downtown Houston, Skanska USA’s 1550 on the Green, a 28-story, 375,000-sf office tower, aims to be one of Texas’ most sustainable buildings. The $225 million project has deployed various sustainable building materials, such as less carbon-intensive cement, to target 60% reduced embodied carbon.
Senior Living Design | Aug 7, 2023
Putting 9 senior living market trends into perspective
Brad Perkins, FAIA, a veteran of more than four decades in the planning and design of senior living communities, looks at where the market is heading in the immediate future.
University Buildings | Aug 7, 2023
Eight-story Vancouver Community College building dedicated to clean energy, electric vehicle education
The Centre for Clean Energy and Automotive Innovation, to be designed by Stantec, will house classrooms, labs, a library and learning center, an Indigenous gathering space, administrative offices, and multiple collaborative learning spaces.
Green | Aug 7, 2023
Rooftop photovoltaic panels credited with propelling solar energy output to record high
Solar provided a record-high 7.3% of U.S. electrical generation in May, “driven in large part by growth in ‘estimated’ small-scale (e.g., rooftop) solar PV whose output increased by 25.6% and accounted for nearly a third (31.9%) of total solar production,” according to a report by the U.S. Energy Information Administration.
Resiliency | Aug 7, 2023
Creative ways cities are seeking to beat urban heat gain
As temperatures in many areas hit record highs this summer, cities around the world are turning to creative solutions to cope with the heat. Here are several creative ways cities are seeking to beat urban heat gain.
Government Buildings | Aug 7, 2023
Nearly $1 billion earmarked for energy efficiency upgrades to federal buildings
The U.S. General Services Administration (GSA) recently announced plans to use $975 million in Inflation Reduction Act funding for energy efficiency and clean energy upgrades to federal buildings across the country. The investment will impact about 40 million sf, or about 20% of GSA’s federal buildings portfolio.
