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
Virtual Reality | Jun 16, 2023
Can a VR-enabled AEC Firm transform building projects?
With the aid of virtual reality and 3D visualization technologies, designers, consultants, and their clients can envision a place as though the project were in a later stage.
Mechanical Systems | Jun 16, 2023
Cogeneration: An efficient, reliable, sustainable alternative to traditional power generation
Cogeneration is more efficient than traditional power generation, reduces carbon emissions, has high returns on the initial investment, improves reliability, and offers a platform for additional renewable resources and energy storage for a facility. But what is cogeneration? And is it suitable for all facilities?
Office Buildings | Jun 15, 2023
An office building near DFW Airport is now home to two Alphabet companies
A five-minute drive from the Dallas-Fort Worth International Airport, the recently built 2999 Olympus is now home to two Alphabet companies: Verily, a life sciences business, and Wing, a drone delivery company. Verily and Wing occupy the top floor (32,000 sf and 4,000 sf, respectively) of the 10-story building, located in the lakeside, work-life-play development of Cypress Waters.
Transit Facilities | Jun 15, 2023
Arlington, Va., transit station will support zero emissions bus fleet
Arlington (Va.) Transit’s new operations and maintenance facility will support a transition of their current bus fleet to Zero Emissions Buses (ZEBs). The facility will reflect a modern industrial design with operational layouts to embrace a functional aesthetic. Intuitive entry points and wayfinding will include biophilic accents.
Urban Planning | Jun 15, 2023
Arizona limits housing projects in Phoenix area over groundwater supply concerns
Arizona will no longer grant certifications for new residential developments in Phoenix, it’s largest city, due to concerns over groundwater supply. The announcement indicates that the Phoenix area, currently the nation’s fastest-growing region in terms of population growth, will not be able to sustain its rapid growth because of limited freshwater resources.
Multifamily Housing | Jun 15, 2023
Alliance of Pittsburgh building owners slashes carbon emissions by 45%
The Pittsburgh 2030 District, an alliance of property owners in the Pittsburgh area, says that it has reduced carbon emissions by 44.8% below baseline. Begun in 2012 under the guidance of the Green Building Alliance (GBA), the Pittsburgh 2030 District encompasses more than 86 million sf of space within 556 buildings.
Industry Research | Jun 15, 2023
Exurbs and emerging suburbs having fastest population growth, says Cushman & Wakefield
Recently released county and metro-level population growth data by the U.S. Census Bureau shows that the fastest growing areas are found in exurbs and emerging suburbs.
Healthcare Facilities | Jun 14, 2023
Design considerations for behavioral health patients
The surrounding environment plays a huge role in the mental state of the occupants of a space, especially behavioral health patients whose perception of safety can be heightened. When patients do not feel comfortable in a space, the relationships between patients and therapists are negatively affected.
Engineers | Jun 14, 2023
The high cost of low maintenance
Walter P Moore’s Javier Balma, PhD, PE, SE, and Webb Wright, PE, identify the primary causes of engineering failures, define proactive versus reactive maintenance, recognize the reasons for deferred maintenance, and identify the financial and safety risks related to deferred maintenance.
University Buildings | Jun 14, 2023
Calif. State University’s new ‘library-plus’ building bridges upper and lower campuses
A three-story “library-plus” building at California State University, East Bay (CSUEB) that ties together the upper and lower campuses was recently completed. The 100,977-sf facility, known as the Collaborative Opportunities for Research & Engagement (“CORE”) Building, is one of the busiest libraries in the CSU system. The previous library served 1.2 million visitors annually.
