Healthcare Outside the Hospital: a Reflection of National Hospital Week 2015

I've been working in the engineering field for more than 20 years, but it's largely my more recent experience in the healthcare industry that has been the most challenging. I began focusing on healthcare facilities engineering eight years ago, but even though this focus constitutes only a small portion of my overall work experience, it's contained one of the biggest market evolutions.

That evolution involves the growth of business-based healthcare and the facilities in which they reside. For more than a decade, healthcare organizations have been moving outpatient services (from simple flu vaccinations to complex surgical procedures) out of the hospital and into business-oriented facilities; a trend driven by cost savings associated with lower overhead, simpler facilities, and comparable reimbursement rates.

Despite this trend's popularity, significant ambiguity and controversy prevails in respect to regulatory requirements, reimbursement structures, clinical service limits, and best practices within the ubiquitous medical office building. Facility engineers are challenged with providing building elements that meet local building codes, but the agencies that enforce these codes often struggle to classify such facilities due to the contrasting services they provide—from the businesslike administrative and logistics management to pseudo-hospital services like urgent care, ambulatory surgery, or cardiac catheterization.

The growing popularity of business healthcare means very different things to patients, businesspeople, facility engineers, and regulators.


From the Patient's Perspective

Business healthcare benefits patients the most. Besides the obvious availability, business healthcare facilities are usually backed by (or located within) trusted brand names and provide the one-stop services relied upon by many Medicare and Medicaid recipients, all while accepting most insurances. This blog by Dave Huey underscores this ongoing trend.

From the Businessperson's Perspective

Business healthcare facilities are profit centers. By the square foot, they require roughly 75 percent of the upfront costs it takes to build a new hospital and cut annual operations costs in half. Studies have also shown that they provide operational versatility, are constructed faster, and can be renovated at a third of the cost.

From the Facility Engineer's Perspective

Things only get more challenging for the next two groups. Facility engineers can't rely on a one-size-fits-all model, since systems must be customized by the location. The engineers have to be able to respond rapidly to keep up with the evolving market, account for varying levels of roving staff, and be conscientious of existing tenant relationships (particularly when it comes to clinics operating within a leased facility). Furthermore, based on which classification the facility falls under, engineers may have to design for the varying presence of defend-in-place provisions, life safety systems, fire alarms/sprinklers/barriers, smoke compartments, and emergency power systems.

From the Regulator's Perspective

I was once a North Carolina Division of Health Service Regulation inspector, and so can say from experience that classifying such space is a complex science of best-fit categorization. There are varying construction types, from the most businesslike IBC business occupancy (which classifies outpatient facilities in the same category as barbershops, motor vehicle showrooms, and high school classrooms) to the most hospital-like NFPA 101 Ambulatory Healthcare.

The key is to pay attention the classification catalysts—little triggers that can highlight which category is the best fit. These catalysts can include self-preservation capabilities (determined by the presence of anesthesia, immobilization restraints/inherently restraining procedures, etc.), the degree to which system failure would impact occupant safety, inpatient/outpatient status, as well as a number of other non-medical variables (number of floors, square footage, operation, etc.).

Continued Evolution is Inevitable

Healthcare facilities nationwide are following the retail market's blueprint of catering to the consumer and becoming as available as possible. My expectation is that business-based healthcare facilities will continue to expand their clinical services while regulatory, accreditation, and reimbursement structures struggle to catch up.

That said, it never hurts to have an experienced engineer/regulator on your side to guide you through the changes.

  • Alex Harwell
    Alex Harwell
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