With the Affordable Care Act still in its infancy, Building Teams are seeing reverberations in the investment decisions of healthcare providers, including new ideas about the types of buildings they are asked to create.
“To reduce costs, many hospitals, physicians’ groups, and healthcare systems are merging to eliminate duplication of operations,” says Kelly Altes, P.E., Project Executive for KJWW Engineering Consultants and a member of BD+C’s “40 Under 40” Class of 2014. “These and other trends are in many cases the result of the Affordable Care Act, which has providers focusing more than ever on patient experiences and outcomes, as well as outpatient services. This shift is resulting in a significant increase in medical office building and clinic construction and renovation projects.”
The latest version of the annual Hospital Construction Survey conducted by the American Society for Healthcare Engineering with Health Facilities Management magazine confirms this trend. The percentage of respondents planning medical office building expansions, completely new MOBs, neighborhood outpatient facilities and primary-care clinics, and ambulatory surgery centers were all up significantly. Meanwhile, 41% said the new regulatory environment makes it less likely that they’ll proceed with large new hospital construction projects.
TOP HEALTHCARE SECTOR ARCHITECTURE FIRMS
2013 Healthcare Revenue ($)
1 HDR $191,150,000
2 Stantec 126,523,841
3 HKS 113,904,765
4 CannonDesign 108,000,000
5 Perkins+will 96,663,046
6 HOK 92,185,580
7 NBBJ 85,544,000
8 Perkins Eastman 69,750,000
9 Hammel, Green and Abrahamson 66,036,440
10 SmithGroupJJR 58,159,528
SEE FULL LIST
TOP HEALTHCARE SECTOR ENGINEERING FIRMS
2013 Healthcare Revenue ($)
1 AECOM Technology Corp. $180,760,000
2 Jacobs 87,770,000
3 URS Corp. 45,036,525
4 Smith Seckman Reid 40,105,600
5 KPFF Consulting Engineers 38,000,000
6 Allen & Shariff 36,000,000
7 BR+A Consulting Engineers 29,900,000
8 Affiliated Engineers 27,947,000
9 CCRD Partners 23,760,000
10 Burns & McDonnell 19,810,000
SEE FULL LIST
TOP HEALTHCARE SECTOR CONSTRUCTION FIRMS
2013 Healthcare Revenue ($)
1 Turner Construction $2,001,060,000
2 McCarthy Holdings 1,738,000,000
3 Skanska USA 1,207,794,377
4 Brasfield & Gorrie 974,254,444
5 Clark Group 867,497,494
6 DPR Construction 806,488,333
7 PCL Construction 721,107,363
8 Whiting-Turner Contracting Co., The 720,455,505
9 JE Dunn Construction 700,315,855
10 Balfour Beatty US 469,422,190
SEE FULL LIST
With care models changing, medical office buildings increasingly provide services that were once the exclusive province of hospitals, from cancer care to emergency treatment to operations. According to Cushman & Wakefield, 80% of surgeries can successfully be completed in an ambulatory setting.
Giants 300 coverage of Healthcare brought to you by DuPont www.fluidapplied.tyvek.com
By moving these procedures away from large hospital campuses—which are often landlocked with little room for expansion—the volume of patients requiring the hospital is reduced, making way for patients with more complex needs. Since many off-campus MOBs are part of a network associated with a larger hospital, patients who end up needing more advanced care can simply transition to the main campus.
Locations of new MOBs are carefully considered, with developers opting to place them near shopping, restaurants, major roads, and public transit. In the past, many retail centers were wary of making deals with medical tenants because of the overall stigma of having a healthcare provider near retail and dining. Retail developers also believed medical tenants wouldn’t produce attractive levels of revenue. However, some developers have decided that having healthcare tenants is better than no tenants at all.
In particular, medical groups have made good use of large spaces vacated by defunct retail franchises, both stand-alone and within malls. Kaiser Permanente recently opened a 32,000-sf MOB in Portland, Ore., via adaptive reuse of a Circuit City location the healthcare organization bought out of receivership in 2010. Minnesota’s HealthEast Care System has created clinics in St. Paul-area spaces once occupied by Borders, Gander Mountain, and eq-life retail stores.
New partnerships and development models
A Cushman & Wakefield investor survey on medical office buildings reports that many healthcare providers are now seeking to form joint ventures, often between for-profit and not-for-profit health systems. These partnerships may offer the for-profit business the name recognition of the nonprofit, and give the nonprofit access to the financial and physician resources of the for-profit. When smaller clinics partner with larger, better-funded hospitals, they can pool their resources to care for more patients.
A Jones Lang LaSalle report indicates that real estate investors are increasingly enthusiastic about the profit potential of MOBs. In 2013, 78% of MOB buyers and sellers were investors rather than developers or hospitals—a dramatic shift from 36% in 2012. Hospitals and healthcare providers still control 85% of healthcare real estate and are generally not interested in selling, leading to a tight property market, JLL says. The firm predicts that hospitals may be increasingly willing to reconsider leveraging under-used property assets, in light of strong investor interest in the sector.
Regulations transform hospital design
Though construction of big new hospitals has slowed, healthcare groups are still investing in updates to keep properties functional, safe, and competitive. A twist pointed out by the HFM/ASHE report: Obamacare’s “two-midnight rule,” whereby hospital stays lasting less than two midnights must be billed as outpatient services. Some hospitals are creating dedicated units for observation-status patients, a tactic that may reduce overall length of stay.
Private patient rooms are the new normal, typically flooded with natural light and richly equipped with accessibility features. New Facility Guidelines Institute recommendations for 2014 emphasize sterilization and infection control in both hospitals and outpatient facilities. Some clients are also debating pros and cons of “same-handed” layouts, wherein all patient rooms are similarly oriented, versus traditional “mirror” floorplans with back-to-back headwalls.
“To achieve desired healthcare outcomes, evidence-based design and Lean design are becoming increasingly critical tools to design facilities in ways that minimize patient stress, increase patient and staff safety, and improve staff effectiveness and quality of care,” Altes says. “As a result, we’re seeing increased attention on such things as the incorporation of natural elements; ‘family-centered’ spaces; single-bed, same-handed patient rooms; and decentralized materials management.”
Read BD+C's full 2014 Giants 300 Report
Related Stories
| Dec 29, 2013
7 ways to make your firm more efficient
In a CEO.com post, Andrew Miller, president of ACM Consulting, shares the seven organizational efficiency strategies he encounters most frequently as he works with corporate executives to boost their performance.
| Dec 24, 2013
First Look: Calatrava's Sharq Crossing in Doha, Qatar [video]
The government of Qatar has released details of Sharq Crossing, a massive infrastructure project designed by Spanish architect Santiago Calatrava.
| Dec 23, 2013
MBI commends start of module setting at B2, world's tallest modular building
The first modules have been set at B2 residential tower at Atlantic Yards in New York, set to become the tallest modular building in the world.
| Dec 23, 2013
First Look: KPF's dual-tower design for Ziraat Bank in Istanbul
Kohn Pedersen Fox Associates (KPF) is designing a new headquarters for Turkey’s largest and oldest financial institution, Ziraat Bank, in a modern, suburban district of Istanbul.
| Dec 20, 2013
Must see for the holidays: Architects re-create iconic structures using gingerbread
Gensler, PBK, Page Sutherland Page, and Kirksey were among the firms to compete in the 5th Annual Gingerbread Build-Off.
| Dec 20, 2013
Can energy hogs still be considered efficient buildings? Yes, say engineers at Buro Happold
A new tool from the engineering firm Buro Happold takes into account both energy and economic performance of buildings for a true measure of efficiency.
| Dec 18, 2013
How small architectural firms can make big money
What separates the great-but-struggling designers from the great-successful ones isn't luck. If you're as good an architect as you think, it will take more than your awesome design skills to become successful. Learn how to manage your firm’s finances and go from floundering to flourishing.
| Dec 18, 2013
Eskew + Dumez + Ripple receives AIA's 2014 Architecture Firm Award
The American Institute of Architects (AIA) Board of Directors has voted for Eskew + Dumez + Ripple to receive the 2014 AIA Architecture Firm Award. The firm will be honored at the 2014 AIA National Convention in Chicago. The Board also voted to posthumously honor Julia Morgan, FAIA, with its 214 Gold Medal.
| Dec 18, 2013
Architecture Billings Index takes step back in November
After six months of steadily increasing demand for design services, the Architecture Billings Index paused in November, dipping below 50 for just the second time in 2013.
| Dec 17, 2013
Kahn appoints Alan Cobb President and CEO
Cobb is the tenth president in the firm’s 118-year history. As President, Cobb is responsible for ensuring that all of the firm’s client issues are effectively address and that overall project team performance meets or exceeds client expectations for each and job the firm undertakes.