HEALTHCARE Realty & Development ServicesBuilding Foundations for the FutureHEALTHCARE Realty & Development Services
HEALTHCARE Realty & DevelopmentDiscussion topics for today:1. Physical Environment and OperationalEfficiency2. Cost implications in selecting space3. Costs and tax implications ofconstruction or renovation
HEALTHCARE Realty & DevelopmentYour practice is your patient manufacturing“plant.” It requires:●Accessible location●Physical plant●Demographics (patients)●Skilled labor●Value added servicesYour office takes patients,applies labor and valueadded services to producehealthy individuals
HEALTHCARE Realty & DevelopmentLet’s talk first about “Operations”!Operations is the driving force behindlocation and physical plantOperations determines the demographiccriteria you seek in selecting a locationOperations determines the layout andfunctionality of your “plant”
HEALTHCARE Realty & DevelopmentHow do a bunch “… of pimply facedteenagers run a billion dollar corporation”One word:“SYSTEMS”
HEALTHCARE Realty & DevelopmentBy maximizing operational efficiency, wewill:Show you how to utilize your physicalenvironment to maximize incomeEnhance the patient experience for betteroutcomes
HEALTHCARE Realty & DevelopmentHow can you increase income?See more patients (increase productivity)Charge more money per patientAdd more labor / providersAdd more billable servicesLower costs“Fix” patients the first time (manage returns)
HEALTHCARE Realty & DevelopmentSee more patients
HEALTHCARE Realty & DevelopmentCharge more money per patient
HEALTHCARE Realty & DevelopmentAdd more labor / providers
HEALTHCARE Realty & DevelopmentAdd more billable services
HEALTHCARE Realty & Development“Fix” patients the first timeNo Returns!
HEALTHCARE Realty & DevelopmentHow can we enhance productivity?There are four primary ways to increaseproductivity:Efficient Space DesignComfort for Patients and StaffTechnologyUtilize a Systems Approach
HEALTHCARE Realty & DevelopmentLet’s consider this design:
HEALTHCARE Realty & DevelopmentOr this design:
HEALTHCARE Realty & DevelopmentStaffRecordsPatientsThis design failed to properly address thethree necessary flows in a medical practice:
HEALTHCARE Realty & DevelopmentAdditional design issues:Crowding in corridors or at check outImproper placement of Staff areasPoorly designed exam roomsImproperly designed door swings (exposespatient)Placement of fixtures results in poor soundcontrolPoor staff control over certain patient areas
HEALTHCARE Realty & DevelopmentCompare to this suite layout:
HEALTHCARE Realty & DevelopmentThis is a self replicating module:
HEALTHCARE Realty & DevelopmentWhat’s wrong with these “exam” rooms?● Door swings/privacy● Back to back plumbing &electrical outlets create holes forsound transmission● Dr. must go completely aroundpatient in exam 2● Dr. has difficult access tocabinets/supplies in Exam 1● Dr. is blocked in when seated● Chairs have arms
HEALTHCARE Realty & DevelopmentWe know this is better because of“Evidence Based Design”Evidence Based Design is achieved by applyingscientific and engineering principles, such as time-motion studies, to healthcare design.“EBD” results in more patients seen, less stress,better infection control, fewer errors, greatercomfort, better privacy and better control overtraffic and access to services.
HEALTHCARE Realty & DevelopmentMonetary benefit of good design:What is the value of two extra patient visitsper day?2 patients x $75 /ea x 240 days/yr= $36,000 / yr
HEALTHCARE Realty & DevelopmentPart 2- Enhancing Productivity through“Therapeutic Environments”Healthcare facilities are designed not only to support andfacilitate state-of-the-art medicine and technology, patientsafety, and quality patient care, but to also embrace thepatient, family, and caregivers in a psycho-sociallysupportive therapeutic environment. The characteristics ofthe physical environment in which a patient receives careaffects patient outcomes, patient satisfaction, patientsafety, staff efficiency, staff satisfaction, and organizationaloutcomes. The effects can be positive or negative. Noenvironment is neutral.~National Institute of Building Sciences
HEALTHCARE Realty & Development ServicesA healthcare environment is therapeuticwhen it does all of the following:Supports clinical excellence in the treatmentof the physical bodySupports the psycho-social and spiritualneeds of the patient, family, and staffProduces measurable positive effects onpatients clinical outcomes and staffeffectiveness
HEALTHCARE Realty & Development ServicesKey components of“therapeutic environments”Reduce / eliminate environmental stressorsProvide positive distractionsEnable social supportProvide patients and staff a sense of control
HEALTHCARE Realty & Development ServicesHow 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
HEALTHCARE Realty & Development ServicesHow to provide positive distractions:Access to outdoorsNatural viewsEducational materialsTV loopMusicArt
HEALTHCARE Realty & Development ServicesHow can we enable social support andprovide a sense of control?Provide adequate space for caregiversProvide culturally appropriate environmentArea seating, quiet rooms, conferencerooms for larger gatheringsLighting and temperature controlSchedulingData entryPayment options
HEALTHCARE Realty & Development ServicesBenefits of a “Therapeutic Environment?”In reality, everyone benefits!Patient satisfaction is much greaterPatient outcomes are much betterStaff satisfaction is much higherAbsenteeism is greatly reducedStaff turnover is reducedErrors are minimized
HEALTHCARE Realty & Development ServicesOur “plant” is now in order!We have created aplant such thatpatients, staff andrecords flow smoothlyand our facilityprovides a therapeuticenvironment.Now what?
HEALTHCARE Realty & Development ServicesHow can we Increase Revenues?Creating systems using technologyAdd extenders (PA / NP)Add billable servicesValue added services
HEALTHCARE Realty & Development ServicesLet’s talk about systems and technology!Systems make the world goaround. Typical medicalsystems include:●Communications● Billing●Treatment●Marketing●Human Resources
HEALTHCARE Realty & Development ServicesWeb based scheduling
HEALTHCARE Realty & Development ServicesBenefits to web based schedulingPatients benefit by working around theirschedulesPatients find it easy to useCapture patient data electronicallyVerify insurance easily and in advanceCapture payment informationPossible to reduce staffing needsCAPTURE SYMPTOMS & PROTOCOLS
HEALTHCARE Realty & Development ServicesWeb based diagnosis!
HEALTHCARE Realty & Development ServicesBenefits to web based diagnosisReduces calls and interruptions from patientsseeking advicePatients find it easy to useCapture patient symptom dataProvide staff with possible diagnosisAlert staff to potential emergenciesWhen combined with online scheduling itALLOWS STAFF TO BATCH PATIENTS
HEALTHCARE Realty & Development ServicesElectronic Health Records!The implementationof EHR’s provides aplatform for manytechnical ANDtreatmentimprovements inyour practice“systems!”
HEALTHCARE Realty & Development ServicesUCF has a research arm that can helpyou select the appropriate ElectronicHealth Records system for you.
HEALTHCARE Realty & Development ServicesA Benefit of Electronic Health Records- it creates useable space!
HEALTHCARE Realty & Development ServicesSpace that can be used to:Add staff, particularly nurse practitioners or PA’s
HEALTHCARE Realty & Development ServicesBenefits of adding extenders:●Lowers wait times●Adds more billable hours●Allows physicians to selectpreferred procedures●Provide coverage and backup●Assist in clinical research
HEALTHCARE Realty & Development ServicesSpace that can be used to:Add services such as lab and x-ray
HEALTHCARE Realty & Development ServicesBenefits of adding lab and/or x-ray:Patient conveniencePractice convenienceIncreases incomeProvides quicker resultsResults in better coordinationof careBetter patient outcomes
HEALTHCARE Realty & Development ServicesSpace that can be used to:Add services such as Pharmacy
HEALTHCARE Realty & Development ServicesBenefits of adding Pharmacy:●Patient convenience●Practice convenience●Increases income●Results in better patientoutcomes (approximately 35% ofpatients do not fill prescriptions)
HEALTHCARE Realty & Development ServicesHow 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 insurance20 Rx/day x $5/Rx = $100/day - $500/wk - $26,000/yr
HEALTHCARE Realty & Development ServicesSpace that can be used to:Add services such as a Sleep Laboratory
HEALTHCARE Realty & Development ServicesExample: adding a Sleep Lab:Patient conveniencePatient retentionPractice convenienceIncreases incomeBetter coordination of careResults in better patientoutcomes
HEALTHCARE Realty & Development ServicesExample: Additional revenues - Sleep Lab:Convert exam rooms to sleep rooms (easy)Lab must be accredited or physician must beboarded in sleep medicine (usually C, P, N)Select management company to start (providesequipment & tech support)Sleep labs can also generate significant additionalrevenues in patient visits and titration studies3 P/N x $700/P = $2,100/N - $1,350/N (mf) = $750/N ($195,000/yr)
HEALTHCARE Realty & Development ServicesSpace that can be used for telemedicine!Example: One physician has contracted with 24day care centers to provide medical services!
HEALTHCARE Realty & Development ServicesWhat is telemedicine?Telemedicine - delivery of health care by a physician to a patient usingsome type of interactive video technologyVirtually any medical service can be provided via telemedicine forfollow-up or consultation purposesRequires a secure videoconference system with high-speed internetconnection and peripheral devices, such as electronic stethoscopes orotoscopes are commonly employed.Most insurance providers cover interactive telemedicine consultationsincluding Medicare, Medicaid, and most private insurance companies.Patients may still be responsible for a co-pay or deductible, the sameas a traditional in-person visit.
HEALTHCARE Realty & Development ServicesAdd services such as E-commerce:Benefits:Enhances patient communicationEasy for patient and staffTargeted to service lines(diabetes, oncology, etc.)Increases incomeProvides portal for enhancingrelationshipA means to providing betteroutcomes
HEALTHCARE Realty & Development ServicesE-commerce – how does it work?Physician discusses product(s)Book: “Yoga for sore backs”Saw Palmetto supplementsStaff reviews recommendations withpatient and indicates on tablet.Order sent to e-commerce store.E-store receives recommendationsand sends e-mail to patient. Patientcan review cart and checkout.
HEALTHCARE Realty & Development ServicesSpace that can be used fordurable medical equipmentAdvances in equipment design and size now allow formany common services to be available in-house
HEALTHCARE Realty & Development ServicesSpace that can be used by other providers!Space in your facility can be used by manydifferent providers who may, or may not provideservice to your patients. For example:Space leased on off days or after hours to specialistsSpace leased to labs (under investigation)Space provided for group sessions/therapySpace provided for patient educationSpace provided for value added services
HEALTHCARE Realty & Development ServicesFinally - what can fast food restaurantsteach us about efficiency?Batch patients to streamlineoperations and maximize income!
HEALTHCARE Realty & Development ServicesExample: DiabetesSet aside specific times for these patientsScheduling and Diagnosing programs limits patient accessto these timesSet up in advance for all tasks necessary for this group ofpatient’s particular needsMaximize revenue/patient (orthotics, patient education,cognitive studies, etc.)A system can be created for each type of condition
HEALTHCARE Realty & Development ServicesThe final category – savings!We have already reduced absenteeism andturnover through our therapeuticenvironment – two huge barriers to efficientpractice operations.We have reduced clerical staff through webbased services, standardized systems, andEHR.Where else can we save money?
HEALTHCARE Realty & Development ServicesNon Traditional SavingsLess understood savingsEnergy StarTax creditsProperty tax adjustmentsDepreciation
HEALTHCARE Realty & Development ServicesFor more informationFrank RicciHealthcare Realty & Development Services300 N. New York Avenue, #2802Winter Park, Fl 32789Ph: 407-947-5074Email: HealthcareRealtyServices@gmail.com