HEALTHCARE Realty & Development Services
Building Foundations for the Future
HEALTHCARE Realty & Development Services
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Discussion topics for today:
1. Physical Environment and Operational Efficiency
2. Cost implications in selecting space3. Costs and tax implications of
construction or renovation
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Your practice is your patient manufacturing “plant.” It requires:
●Accessible location●Physical plant●Demographics (patients)●Skilled labor●Value added services
Your office takes patients, applies labor and value added services to produce healthy individuals
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Let’s talk first about “Operations”!
Operations is the driving force behind location and physical plant
Operations determines the demographic criteria you seek in selecting a location
Operations determines the layout and functionality of your “plant”
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How do a bunch “… of pimply faced teenagers run a billion dollar corporation”
One word:
“SYSTEMS”
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By maximizing operational efficiency, we will:
Show you how to utilize your physical environment to maximize income
Enhance the patient experience for better outcomes
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How can you increase income?
See more patients (increase productivity)
Charge more money per patient
Add more labor / providers
Add more billable services
Lower costs
“Fix” patients the first time (manage returns)
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See more patients
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Charge more money per patient
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Add more labor / providers
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Add more billable services
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Lower costs
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“Fix” patients the first time No Returns!
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How can we enhance productivity?
There are four primary ways to increase productivity:
Efficient Space Design
Comfort for Patients and Staff
Technology
Utilize a Systems Approach
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Let’s consider this design:
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Or this design:
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Staff
RecordsPatients
This design failed to properly address the three necessary flows in a medical practice:
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Additional design issues:
Crowding in corridors or at check out
Improper placement of Staff areas
Poorly designed exam rooms
Improperly designed door swings (exposes
patient)
Placement of fixtures results in poor sound
control
Poor staff control over certain patient areas
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Compare to this suite layout:
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This is a self replicating module:
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Let’s examine “exam” rooms:
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What’s wrong with these “exam” rooms?
● Door swings/privacy● Back to back plumbing & electrical outlets create holes for sound transmission● Dr. must go completely around patient in exam 2● Dr. has difficult access to cabinets/supplies in Exam 1● Dr. is blocked in when seated● Chairs have arms
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An efficient exam room:
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Multiple efficient exam rooms:
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We know this is better because of “Evidence Based Design”
Evidence Based Design is achieved by applying scientific and engineering principles, such as time-motion studies, to healthcare design.
“EBD” results in more patients seen, less stress, better infection control, fewer errors, greater comfort, better privacy and better control over traffic and access to services.
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Monetary benefit of good design:
What is the value of two extra patient visits per day?
2 patients x $75 /ea x 240 days/yr
= $36,000 / yr
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Part 2- Enhancing Productivity through “Therapeutic Environments”
Healthcare facilities are designed not only to support and facilitate state-of-the-art medicine and technology, patient safety, and quality patient care, but to also embrace the patient, family, and caregivers in a psycho-socially supportive therapeutic environment. The characteristics of the physical environment in which a patient receives care affects patient outcomes, patient satisfaction, patient safety, staff efficiency, staff satisfaction, and organizational outcomes. The effects can be positive or negative. No environment is neutral.
~National Institute of Building Sciences
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A healthcare environment is therapeutic when it does all of the following:
Supports clinical excellence in the treatment
of the physical body
Supports the psycho-social and spiritual
needs of the patient, family, and staff
Produces measurable positive effects on
patients' clinical outcomes and staff
effectiveness
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Key components of “therapeutic environments”
Reduce / eliminate environmental stressors
Provide positive distractions
Enable social support
Provide patients and staff a sense of control
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How can we reduce stressors?
● Calming art● Reduce paperwork● Reduce wait times● Noise reduction ● Eliminate crowding● Odor control● Natural light● Privacy control● Positive distractions● Indoor air quality● Temperature● Aesthetic design and colors●Cleanliness
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How to provide positive distractions:
Access to outdoors
Natural views
Educational materials
TV loop
Music
Art
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How can we enable social support and provide a sense of control?
Provide adequate space for caregiversProvide culturally appropriate environmentArea seating, quiet rooms, conference rooms for larger gatheringsLighting and temperature controlSchedulingData entryPayment options
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Benefits of a “Therapeutic Environment?”
In reality, everyone benefits! Patient satisfaction is much greater Patient outcomes are much better Staff satisfaction is much higher Absenteeism is greatly reduced Staff turnover is reduced Errors are minimized
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Our “plant” is now in order!
We have created a plant such that patients, staff and records flow smoothly and our facility provides a therapeutic environment. Now what?
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How can we Increase Revenues?
Creating systems using technology
Add extenders (PA / NP)
Add billable services
Value added services
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Let’s talk about systems and technology!
Systems make the world go around. Typical medical systems include:●Communications● Billing●Treatment●Marketing●Human Resources
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Web based scheduling
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Benefits to web based scheduling
Patients benefit by working around their schedulesPatients find it easy to useCapture patient data electronicallyVerify insurance easily and in advanceCapture payment informationPossible to reduce staffing needsCAPTURE SYMPTOMS & PROTOCOLS
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Web based diagnosis!
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Benefits to web based diagnosis
Reduces calls and interruptions from patients seeking advicePatients find it easy to useCapture patient symptom dataProvide staff with possible diagnosisAlert staff to potential emergenciesWhen combined with online scheduling it ALLOWS STAFF TO BATCH PATIENTS
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Electronic Health Records!
The implementation of EHR’s provides a platform for many technical AND treatment improvements in your practice “systems!”
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UCF has a research arm that can help you select the appropriate Electronic Health Records system for you.
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A Benefit of Electronic Health Records - it creates useable space!
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Space that can be used to:
Add staff, particularly nurse practitioners or PA’s
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Benefits of adding extenders:
●Lowers wait times●Adds more billable hours●Allows physicians to select preferred procedures●Provide coverage and backup●Assist in clinical research
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Space that can be used to:
Add services such as lab and x-ray
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Benefits of adding lab and/or x-ray:
Patient convenience
Practice convenience
Increases income
Provides quicker results
Results in better coordination
of care
Better patient outcomes
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Space that can be used to:
Add services such as Pharmacy
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Benefits of adding Pharmacy:
●Patient convenience●Practice convenience●Increases income●Results in better patient outcomes (approximately 35% of patients do not fill prescriptions)
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How to add a Pharmacy:
Register as dispensing physician ($150 +/-)Select only 10 – 12 most commonly used drugsSelect generics where possible and under $10Select a system that takes minimal space & staff timeWork with manufacturer, not a distributorPrice at around co-payDo not bill insurance
20 Rx/day x $5/Rx = $100/day - $500/wk - $26,000/yr
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Space that can be used to:
Add services such as a Sleep Laboratory
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Example: adding a Sleep Lab:
Patient conveniencePatient retentionPractice convenienceIncreases incomeBetter coordination of careResults in better patient outcomes
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Example: Additional revenues - Sleep Lab:
Convert exam rooms to sleep rooms (easy)Lab must be accredited or physician must be boarded in sleep medicine (usually C, P, N)
Select management company to start (provides equipment & tech support)
Sleep labs can also generate significant additional revenues in patient visits and titration studies
3 P/N x $700/P = $2,100/N - $1,350/N (mf) = $750/N ($195,000/yr)
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Space that can be used for telemedicine!
Example: One physician has contracted with 24 day care centers to provide medical services!
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What is telemedicine?
Telemedicine - delivery of health care by a physician to a patient using some type of interactive video technologyVirtually any medical service can be provided via telemedicine for follow-up or consultation purposes
Requires a secure videoconference system with high-speed internet connection and peripheral devices, such as electronic stethoscopes or otoscopes are commonly employed.
Most insurance providers cover interactive telemedicine consultations including Medicare, Medicaid, and most private insurance companies. Patients may still be responsible for a co-pay or deductible, the same as a traditional in-person visit.
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Add services such as E-commerce:
Benefits:Enhances patient communicationEasy for patient and staffTargeted to service lines (diabetes, oncology, etc.)Increases incomeProvides portal for enhancing relationshipA means to providing better outcomes
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E-commerce – how does it work?
Physician discusses product(s)Book: “Yoga for sore backs”Saw Palmetto supplements
Staff reviews recommendations with patient and indicates on tablet.Order sent to e-commerce store.
E-store receives recommendations and sends e-mail to patient. Patient can review cart and checkout.
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Space that can be used for durable medical equipment
Advances in equipment design and size now allow for many common services to be available in-house
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Space that can be used by other providers!
Space in your facility can be used by many different providers who may, or may not provide service to your patients. For example:
Space leased on off days or after hours to specialists
Space leased to labs (under investigation)
Space provided for group sessions/therapy
Space provided for patient education
Space provided for value added services
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Finally - what can fast food restaurants teach us about efficiency?
Batch patients to streamline operations and maximize income!
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Example: Diabetes
Set aside specific times for these patients
Scheduling and Diagnosing programs limits patient access
to these times
Set up in advance for all tasks necessary for this group of
patient’s particular needs
Maximize revenue/patient (orthotics, patient education,
cognitive studies, etc.)
A system can be created for each type of condition
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The final category – savings!
We have already reduced absenteeism and turnover through our therapeutic environment – two huge barriers to efficient practice operations.We have reduced clerical staff through web based services, standardized systems, and EHR. Where else can we save money?
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Energy & Utilities:
Energy saving methods:
●Energy efficient windows●Lighting & Daylighting●Low flush toilets●Water saving faucets●Maintenance●Added insulation●Highly reflective roof●Landscaping & Irrigation
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Non Traditional Savings
Less understood savings
Energy Star
Tax credits
Property tax adjustments
Depreciation
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For more information
Frank RicciHealthcare Realty & Development Services
300 N. New York Avenue, #2802Winter Park, Fl 32789
Ph: 407-947-5074Email: [email protected]