How the ACA is effecting construction of Medical Office Buildings

Written by Shane Williams

The delivery of healthcare is evolving due to healthcare reform initiatives
based on the Affordable Care Act (ACA).  Nowhere is that more apparent than
in the design of Medical Office Buildings (MOBs).
Traditionally, MOBs have been comprised of practice suites housing private
physician groups occupying as little as 1,000 SF to as much as an entire
floor, +/- 25,000 SF.  These spaces were designed to support routine
physical examinations, checkups, lab work and minor outpatient procedures.
However, due to changing reimbursement rates as a result of the ACA, an
increasing number of physicians are choosing to be employed by hospital
systems.  As a result, today's MOBs are designed with new configurations to
support increased efficiency, collaboration and revenue generation.  One
benefit of hospital-managed physicians is the ability to leverage shared
support spaces across multiple physician practices.  As a result, the
individual components of the physician suite are being reconfigured.

How many exam rooms do you need?
While different service lines require unique equipment (i.e. dermatology
versus podiatry), the basic exam room component exists for nearly all
service lines.  The question has always been - how many exam rooms are
required for each physician's work day?
In 2009, the Mayo Clinic engaged a research study developed in conjunction
with Steelcase to understand the potential impact of utilizing a
consultation room for patient visits that do not require a physical
examination and if this configuration would result in improved outcomes for
both patients and clinicians.  In the study, both conventional exam rooms
and experimental 'conversation rooms' were utilized in a random assignment
for 63 pairs of patients and doctors.  While the researchers found that both
patients and clinicians were very satisfied with the conventional exam room,
they observed that in the reconfigured conversation room "patients felt they
had more and better access to information, including their own records, test
results, images and online patient education material."1
While this particular study focused on the experience of the room
comparisons, a follow-up study took a deeper dive in looking at the overall
process.  SPARC (See, Plan, Act, Refine, Communicate) is "much more than
redesigning exam rooms and equipping them with new furniture; it is also
about the process and flow of patient care.  How and where patient caregiver
interactions occur and how to most effectively integrate technology into the
patient care experience are essential to informing the space design."2  This
study described the benefits of shared support spaces and combination of
exam rooms and consultation rooms.  Further, in a recent two-day study
conducted by Kaiser Permanente3 that focused on MOB exam room
configurations, these benefits were noted:
"Improved provider flow and patient care.  More available workspace has the
potential to enhance workflow and improve provider-patient communication, as
well as patient safety and satisfaction."
"Design efficiencies.  Flexible exam rooms that could accommodate many
specialties would reduce the number of exam rooms needed within the medical
office building."
"The Multi-Purpose Exam Room could accommodate a larger variety of patient
needs, allowing clinics to more easily accommodate the increasing diversity
of member populations over time."
What all these studies point to, and what Array's simulation software and
Lean analysis indicates -  is that through more efficient use of space, MOBs
can feature fewer traditional exam rooms and a mix of interview/conversation
rooms.
With health systems continuing to recruit physicians and establish new
service lines, designing an MOB with flexible exam/conversation spaces
supports additional physicians to utilize the same space.  This allows
hospitals to construct less space and maintain projected throughput volumes.
For patient visits that do not require a physical examination, the
conversation room configuration can result in overall less square footage
required and improved throughput resulting in greater patient satisfaction.
When paired appropriately with exam room modules, this can also lead to
greater efficiency in the physician's workflow.

Designing to Support Flexibility
Flexibility is essential to the financial success of MOBs. Service lines
evolve and change, medical equipment is continually updated and procedures
become less invasive, allowing a shift from an inpatient environment to an
outpatient setting.    Utilizing universal sizes for exam rooms,
incorporating conversation rooms and right sizing procedure rooms to
accommodate multiple modalities are all design tools to support flexibility.
Perhaps the most efficient design tool to support future flexibility is to
incorporate modularity in MOB design.  Modularity can be seen in a variety
of ways:
*       Traditional planning - by utilizing an established arrangement of
rooms that are repeatable across scale, there can be a range of space from a
very small exam/conversation configuration to a large, multi-practice
configuration through the traditional construction methodologies.
*       Pre-fabricated rooms -construction methodologies are increasingly
looking into pre-fabricated spaces to improve construction quality and
reduce the amount of time to completion.  A modular, repeatable
configuration of interior spaces facilitates this construction approach.
*       Complete building components - taking prefabrication a step further,
it is possible to construct entire building components remotely, deliver to
a prepared site pad and assemble a building configuration.

MOB as "Front Door"
 <http://www.array-architects.com/wp-content/uploads/2013/06/Front-Door.jpg>

Ultimately, the goal of the MOB is to become the primary location for
education, preventative care, wellness, outpatient procedures and outpatient
surgeries - becoming in essence, the hospital's "Front Door."  A successful
MOB will provide a consistent stream of referrals for the inpatient
hospital.  This makes brand recognition across your outpatient and inpatient
facilities critical - and architectural design can be a powerful tool to
create brand loyalty and awareness.   Developing consistent signage and
wayfinding programs is important, so that a patient and their family knows
they are in YOUR hospital.  Incorporating modular layouts for physician
offices, utilizing similar materials, finishes and furniture can help your
patients navigate different locations and make them feel comfortable and
cared for.
At the epicenter of the Affordable Care Act (ACA) is the philosophy that
healthcare should be focused on the wellness of the patient rather than
narrowly focused on the symptom/diagnosis of a singular event.  Creating the
experience of having everything a patient and their family needs under one
roof, conveniently organized and accessible, designed to promote a
conversational and simplified sharing of information will result in a
patient-centered experience and enhanced brand recognition. The future of
Medical Office Building design will be closely tied to how it supports
patient-centered care.  The ability of MOBs to adapt and respond quickly to
developing market conditions as healthcare delivery adapts to the nuances of
the ACA make it the ideal candidate for development of new best practices
founded in Lean design.