Take 5 With L. Kent Doss
In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject. Kent Doss is principal and regional vice president, Mid-Atlantic region, at Array Architects (Conshohocken, Pa.). Here, he shares his thoughts on making the most of data gathering, the pros and cons of microhospitals, and why healthcare providers should seriously think about stepping into the food-supply chain.
1. Data-informed decision making
As more data become available to guide the design process, the way we analyze and communicate this data should also evolve to facilitate more informed decision making. For a recent greenfield hospital, our initial design concept resulted in a 68 percent energy use reduction (when compared to the owner’s existing facility). However, the $3.86 million construction premium over a code-minimum strategy was initially unacceptable to the client (even though the return on investment was just over four years). Using the client’s actual negotiated energy purchase rates and operating revenue, we could demonstrate that every dollar of energy purchased required an offsetting generation of $26.39 in gross hospital revenue. Applying this calculation to the proposed design resulted in $924,237 in annual energy cost savings, which meant $24.4 million less in offsetting revenue-generating services that the hospital would have to deliver every year (or conversely, $24.4 million in revenue that could be directed to patient care instead of energy purchases). Since this project was a replacement facility in a location that had very little potential for demographic growth and/or market share increase, lowering the energy purchase burden to align with revenue potential was the most responsible fiscal decision for our client.
2. Thinking micro
The impact of Medicare’s site payment neutrality continues to be debated within the industry. As facility fees are reduced for outpatient services that aren’t delivered on a hospital campus, many providers continue to explore the microhospital model as a distributed platform to reclaim previous reimbursement levels. While the idea of the microhospital may seem attractive, there are several factors that continue to give some providers pause, including: general and local exceptions and/or exemptions (such as off-campus outpatient cancer facilities) that continue to be identified by the Medicare Payment Advisory Commission; regulatory and licensure hurdles, which are far greater for microhospitals than the typical outpatient facility; and the current political debate regarding the long-term viability of the Affordable Care Act. Additionally, while the microhospital may yield higher billing rates because of its “hospital campus” status, these projects also face higher costs of institution occupancy construction (when compared to less-stringent business occupancy classifications for typical outpatient facilities), the increased costs of operating the facility 24/7/365 (when compared to standard outpatient business hours), and the potential for census reductions or revenue losses in other system facilities as existing patients are redistributed.
3. Accuracy, accuracy, accuracy
As the design industry continues to both compile more evidentiary data and understand how other non-traditional data sources can be integrated into design thinking, our ability to accurately predict the impact of design options is exponentially increasing. For example, by inputting psychographic and consumer segmentation data into probabilistic choice equations and comparing the results to “heat” maps that illustrate the services that are available to specific communities, we can gain a much clearer picture of where facilities should be located and understand the features that our designs should include to maximize market share. After a project’s specific goals are empirically defined, we then have the ability to feed them into Artificial Intelligence (AI) generative design engines such as Autodesk’s Project Dreamcatcher to scenario-test design effectiveness on a much larger scale than has ever been possible.
4. Coordinated care
The Functional Medicine view of total health focuses on understanding the interactions between our lifestyles, dietary habits, and environment with our gastrointestinal, endocrine, and immune systems. This system strives to find root-causation of imbalances and identify behavioral changes that can heal without an over-reliance medications. As this approach becomes more widely taught and practiced, the facilities we design must support holistic and integrated care. In the past, the only way to achieve a full-spectrum of care might have been the creation of super-sized facilities that had full-time multispecialty representatives. With the expanding sophistication and availability of genetic testing, we are beginning to see the ability for providers to more closely pre-align individual plans with facility staffing needs, resulting in smaller facilities that have the capability of delivering wide-ranging care in a single visit. Since smaller facilities require less capital to construct and operate, this means that coordinated care can be much more efficiently and widely distributed.
5. Food as medicine
The potential for the healthcare industry to take a leadership role in diet and nutrition is skyrocketing as the benefits and compromises associated with our food choices are more widely understood and accepted. Instead of allowing commercialized, mass-marketers such as Walmart and Amazon (which recently purchased Whole Foods) to take control of the food supply chain, the time is right for future-thinking healthcare providers to step in. As the mandate for population health management (hopefully) transitions from concept to efficacy, the healthcare industry will continue to be challenged to identify revenue streams outside of episodic care. Creating a meaningful alignment with the food supply industry has significant untapped potential to augment the healthcare industry’s bottom line in a way that can be extremely beneficial to a community’s health.
Want to share your Top 5? Contact executive editor Anne DiNardo at anne.dinardo@emeraldexpo.