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
Mixed-Use | Mar 11, 2023
Austin mixed-use development will provide two million sf of office, retail, and residential space
In Austin, Texas, the seven-building East Riverside Gateway complex will provide a mixed-use community next to the city’s planned Blue Line light rail, which will connect the Austin Bergstrom International Airport with downtown Austin. Planned and designed by Steinberg Hart, the development will include over 2 million sf of office, retail, and residential space, as well as amenities, such as a large park, that are intended to draw tech workers and young families.
Performing Arts Centers | Mar 9, 2023
Two performing arts centers expand New York’s cultural cachet
A performing arts center under construction and the adaptive reuse for another center emphasize flexibility.
Building Team | Mar 8, 2023
Call for Speakers: BD+C’s 2023 Women in Residential + Commercial Construction Conference
The 2023 Women in Residential + Commercial Construction conference event will take place October 25-27 in Nashville, Tenn., and will bring together more than 300 women leaders from all facets of the $1.4 trillion U.S. residential and commercial constructing sector.
Multifamily Housing | Mar 7, 2023
Multifamily housing development in Chicago takes design inspiration from patchwork and quilting
HUB 32, a 65-unit multifamily housing development, will provide affordable housing and community amenities in Chicago’s Garfield Park neighborhood. Brooks + Scarpa’s recently unveiled design takes inspiration from the American tradition of patchwork and quilting.
Industrial Facilities | Mar 6, 2023
The largest planned logistics and business park in North America gets under way in Southern California
The $25 billion World Logistics Center will boost the supply chain capabilities of Southern California and will serve as a distribution center for destinations across the continent.
Healthcare Facilities | Mar 6, 2023
NBBJ kicks off new design podcast with discussion on behavioral health facilities
During the second week of November, the architecture firm NBBJ launched a podcast series called Uplift, that focuses on the transformative power of design. Its first 30-minute episode homed in on designing for behavioral healthcare facilities, a hot topic given the increasing number of new construction and renovation projects in this subsector.
Adaptive Reuse | Mar 5, 2023
Pittsburgh offers funds for office-to-residential conversions
The City of Pittsburgh’s redevelopment agency is accepting applications for funding from developers on projects to convert office buildings into affordable housing. The city’s goals are to improve downtown vitality, make better use of underutilized and vacant commercial office space, and alleviate a housing shortage.
Student Housing | Mar 5, 2023
Calif. governor Gavin Newsom seeks to reform environmental law used to block student housing
California Gov. Gavin Newsom wants to reform a landmark state environmental law that he says was weaponized by wealthy homeowners to block badly needed housing for students at the University of California, Berkeley.
Green Renovation | Mar 5, 2023
Dept. of Energy offers $22 million for energy efficiency and building electrification upgrades
The Buildings Upgrade Prize (Buildings UP) sponsored by the U.S. Department of Energy is offering more than $22 million in cash prizes and technical assistance to teams across America. Prize recipients will be selected based on their ideas to accelerate widespread, equitable energy efficiency and building electrification upgrades.
Windows and Doors | Mar 5, 2023
2022 North American Fenestration Standard released
The 2022 edition of AAMA/WDMA/CSA 101/I.S.2/A440, “North American Fenestration Standard/Specification for windows, doors, and skylights” (NAFS) has been published. The updated 2022 standard replaces the 2017 edition, part of a continued evolution of the standard to improve harmonization across North America, according to a news release.
