Healthcare reform: How does the pay-for-performance impact the way in which we design healthcare facilities?
As part of the ongoing healthcare reform debate, we are hearing much discussion about the reimbursement model of pay-for-performance (P4P). Although the P4P model is in adoption across the nation presently, in a reformed system, it is envisioned it would have a much wider impact to the way hospitals and physicians would receive reimbursement.
This is very different from the present system which is structured as a fee-for-service where reimbursement for each procedure is not associated with another (e.g., a postsurgery diagnostic imaging follow-up would be billed separately from a surgery procedure). Under a P4P system, there would be greater emphasis on bundling all of the services with the intent of improving the quality or outcome of the service versus the quantity.
How then might this translate to the design of our facility layouts? The buzz word that is thrown out time and time again is the need for highly “collaborative work environments.” One could say that this would necessitate the provision for greater and more convenient amounts of collective work areas such as conference rooms, shared office areas, and improved IT access for interdepartmental communication. There has often been much emphasis on keeping non-revenue–generating space such as this to a minimum, but it would seem with this type of reimbursement, that such spaces would now become the locations where “greater emphasis on improved outcomes” would be occurring. This could result in an increased amount of programmed space relative to these areas than we are seeing now.
As the healthcare bill makes it way through Congress, it remains to be seen what final form it will take but it is likely we will hear more and more emphasis on the need for greater care collaboration to enable a system that can deliver higher quality healthcare with improved outcomes.