As Baby Boomers age—10,000 Americans will turn 65 every day for the next 20 years—the total demand for inpatient care will witness enormous growth. With the number of mental health patients on the rise, micro-hospitals are steadily evolving into consumer-friendly environments, taking their cue from the hospitality industry.
In addition, architects are prone to further incorporate digital technologies into how both patients and employees interact with and within medical spaces. So what features should health-care designers watch out for in 2018? Architect Jason Carney, partner at Environments for Health Architecture, shared his views with Commercial Property Executive, highlighting the industry’s top trends for 2018.

What are the major trends impacting the health-care industry today?

Carney: The trend of health care as a commodity continues in many different markets across the country. It’s driving the tailored placement of core services at convenient locations and in the design of consumer-friendly spaces that draw from the hospitality industry to attract patients. In these cases, market competition is driving providers to focus on building the “right” styles of facilities, with the “right” services, in the “right” places to attract patients, many of whom are increasingly making health-care provider decisions based on how close a facility is to mass transit, a highway off-ramp or a shopping center. Technological innovation and medical breakthroughs are accelerating changes in the way care is delivered and spaces are configured.

It certainly seems that industry leaders are moving away from developing inpatient structures, while micro-hospitals are growing more popular. How does your vision fit in this general framework?

Carney: Long-term success of micro-hospitals requires flexibility. As growth occurs or markets change, micro-hospitals need to be able to adapt. It is important to understand the core medical services that are needed in each market to sustain a micro-hospital and how that facility may grow and adapt over time as the market changes.

How can outdated health-care facilities be upgraded and adapted to the needs of patients and staff in 2018?

Carney: Space within an existing hospital campus comes at a premium and must be thoughtfully designed to provide an optimal experience, utilization and return on investment. In some cases, the best choice is to remove outdated buildings and provide for replacement within the existing campus structure.
One version we are seeing is the creation of the “hospital within a hospital”—essentially, a specialty hospital sited within the existing or reconfigured shell of a larger “host” hospital. These can include maternity hospitals, heart-focused hospitals or other specialty hospitals that sit inside a larger medical center. And whether it’s expanding access to telehealth or creating spaces, where appropriate, that feel more like extended-stay hotels than inpatient hospitals, opportunities abound to reconfigure existing hospital spaces to better serve patients.

How can large-hospital services be integrated into smaller, off-campus facilities?

Carney: One leading solution we see health-care providers opting for is “micro-hospitals,” which are typically 15,000 to 50,000 square feet in size, open 24/7 and providing five to 15 inpatient beds for observation and short-stay use. Micro-hospitals are an affordable, effective way to provide a large variety of big-hospital services in the community, including surgery, radiology, emergency departments and related services.
At least 19 states now have at least one micro-hospital and many more are coming. Now that the Centers for Medicare and Medicaid Services have authorized micro-hospitals that have dedicated emergency departments as being eligible for both 340B discounted drug pricing and the Outpatient Prospective Payment System, we expect micro-hospitals will prove increasingly popular with providers and patients alike.

How can new design features offer better solutions to efficiently accommodate cognitively impaired patients as opposed to older construction types?

Carney: Between the impacts of the national opioid abuse crisis and the rising awareness of mental health conditions, we’re seeing more and more hospitals–such as Connecticut’s Waterbury Hospital and Newport Hospital in Rhode Island–reconfigure their emergency departments (ED) to accommodate cognitively impaired patients more effectively and more sensitively. A big part of this is simply creating spaces for cognitively impaired people that are thoughtfully segregated from areas serving trauma victims or cardiac arrest patients, places where they can receive a behavioral health or addiction management intervention with compassion and dignity.
Spatial arrangements and interior design elements that improve a patient’s understanding and awareness of their environment while working to reduce anxiety are important components of this design. Also, because patients with cognitive impairment and behavioral issues often require longer stays than the general ED population, a definite emerging best design practice is adding features for them such as bathroom showers, places to securely store belongings and access to decompression space.

What can the health-care industry learn from the hospitality sector in terms of design trends?

Carney: We see many hospitals embracing the trend of removing outpatient services from traditional, larger hospitals and moving them into more consumer-friendly, hospitality-influenced environments, like new medical buildings near shopping malls or transportation nodes. These aren’t just spaces that feel more hospitality than hospital—they create operational efficiencies, improve clinical outcomes and reduce readmission rates. There’s also a growing recognition that larger parts of the inpatient hospital experience can be accommodated in less hospital-like environments, which patients prefer.

Could you give us an example of such a project?

Carney: A great example is E4H’s recent work with a New York hospital to create a long-term space for immunocompromised patients going through a procedure such as a bone-marrow transplant (BMT). The first phase of a BMT—surgery and initial recuperation—obviously must take place in an inpatient hospital setting. But in later phases, when patients are recovering and need mainly to be monitored closely for infections or complications, they don’t require a standard inpatient hospital room and can enjoy a much better, less costly experience in a specially designed, hotel-like space.
For our client, we created a space for this “in-between” population that has private, suite-style rooms; specialized water filtration systems to protect immune-suppressed patients; and more of a hotel aesthetic. Patients are served by a concierge instead of a charge-desk nurse. If any of them develop complications, of course, they are quickly detected and patients can rapidly be brought back into the hospital for treatment. But if their recovery proceeds without incident, they can enjoy the equivalent of a long-term hotel stay, instead of long-term hospitalization, after their BMT.

How will telehealth affect the industry in 2018?

Carney: Numbers we’ve seen from the health-care consulting firm Sg2 project that just in the next two years, the volume of virtual health-care patients will rise 7 percent and in-home health-care services will rise 13 percent. Ever-more-sophisticated patient monitors and ever-more-robust communications platforms are allowing more and more patients to enjoy telehealth consults with physicians and care-team professionals. Increasingly, we see telehealth being used to consult with specialists like dermatologists, radiologists, psychiatrists and others without patients having to schedule a second appointment or hospital visit.

How does it impact the actual design of a facility?

Carney: Telehealth is absolutely continuing to grow, and health-care facilities need to be thinking about how to incorporate more of it in their master facility plans. That can mean everything from configuring treatment rooms to accommodate remote consultation and providing infrastructure for broadband video links to heightened attention to the lighting, aesthetics and privacy of rooms in which telehealth consultations will occur.
Telehealth technology is also transforming lobbies, common spaces and admissions areas. Increasingly, these areas are being designed to include accessible areas for kiosks or tablets from which patients can register, view their records or videoconference with a provider. As telehealth continues to expand, we will see changes to staffing models and reduction of provider support space at care locations.

What about augmented reality?

Carney: As we look even further into the future, the use of augmented reality will change the way that patients interact with providers and how providers collaborate, research and plan their delivery of care.

What can we expect beyond 2018 in terms of trends and challenges in health care?

Carney: Pressures to manage costs, accommodate continued medical and technological breakthroughs and meet the preferences and desires of health-care consumers and practitioners will only grow. New developments in approaches such as gene therapy and bioprinting will drive a greater need for specialized laboratory functions as a component of treatment. Further miniaturization of robotic systems will mean changes in surgery and the way that operating rooms are configured, with a growing emphasis on support for technology-assisted procedures.
Source: CPE

Nicklaus Children’s Hospital just paid $88 million for the Miami Medical Center campus near Miami International Airport, property records show.
HC 5959 NW 7th Street LLC, an affiliate of the Carter Validus Mission Critical REIT, sold the property at 5959 Northwest Seventh Street to Variety Children’s Hospital, an entity of Nicklaus Children’s Hospital.
The deal included a 6,336-square-foot office building, a 5.15-acre parking lot and four single-family homes just south of the hospital. Nicklaus will keep the facility closed until it determines plans for the hospital campus, according to a spokesperson.
A for-profit investment arm of Nicklaus, Children’s Health Ventures, was a minority investor in Miami Medical Center. Additional investors included Nueterra, a health care management company based in Kansas.
Records show Tampa-based Carter Validus paid nearly $47 million for the property in 2014. Despite some major renovations, the hospital closed its doors in October. It had been seeking capital and was even considering a sale prior to shutting down, according to published reports.
The hospital included 67 private rooms and 12 operating rooms. It was founded in 1963 by exiled Cuban doctors, and was formerly known as Pan American Hospital.
Source: The Real Deal

UF Health North nearly doubled the size of its campus with the opening of its new 168,000-square-foot bed tower last May. The latest addition to the North Jacksonville medical campus on Max Leggett Parkway, just a few miles from Jacksonville International Airport, is the 92-bed hospital with all-private patient rooms on four floors of the fivestory building.
The second floor has 20 beds for women’s services, including 12 large delivery suites that serve as the location for labor, delivery, recovery and postpartum care — allowing mothers, babies and loved ones to stay in one room until discharge. A 24-bed intensive care unit is located on the third floor, and the fourth and fifth floors each have 24 medical and surgical suites.
The $85 million expansion, along with the existing medical office complex, provides residents in Northeast Florida and Southeast Georgia greater access to much-needed health care services.

“The success of UF Health North and the enthusiasm that the community has shown have exceeded even our highest expectations,” said Leon L. Haley Jr., MD, MHSA, CPE, FACEP, chief executive officer of UF Health Jacksonville and dean of the UF College of Medicine – Jacksonville. “We knew that this rapidly growing area of Jacksonville needed a health care facility of its own, a place that offers the very best possible medical care, and we’re incredibly proud of the way we have been accepted.”

UF Health North opened its medical office building in February 2015. The six-story building includes a full-service 24/7 emergency room, outpatient surgery suites, imaging and other diagnostic services, a midwife-led birth center and four floors of physician offices. The operation has already earned a 5-star rating for patient satisfaction in emergency room and outpatient surgery care by Professional Research Consultants, a national health care research group.

“It’s not just our physicians and other medical providers who make this campus special. It’s the incredible attitude and compassion that everyone who works here brings every day, recognizing that patients are at the heart of everything we do,” said Wayne Marshall, vice president of UF Health North. “This is an incredible resource. I couldn’t be more excited for this community and for the future of our organization.”

University of Florida Health Science Center’s Jacksonville Campus

Just north of Downtown Jacksonville lies the regional campus of the University of Florida — the UF Health Science Center Jacksonville. Its facilities intertwined within UF Health Jacksonville’s hospital and outpatient buildings, the Health Science Center includes the UF colleges of Medicine, Nursing and Pharmacy. Similar to its sibling campus in Gainesville, the Health Science Center in Jacksonville also includes a full UF library, dedicated clinical research facilities and a medical simulation laboratory.
About 450 faculty members and 16 clinical departments comprise the UF College of Medicine – Jacksonville. More than 370 UF medical residents and fellows train in Jacksonville in one of 44 medical specialty or subspecialty programs. Residencies and fellowships are the final stages of a physician’s training before going into practice.
In addition, third- and fourth-year medical students from UF’s main campus in Gainesville complete rotations at UF Health facilities in Jacksonville. Under the supervision of a physician, this allows medical students to have hands-on training in the fundamentals of patient care through multiple medical specialties, helping students select their future fields of practice.

RESEARCH

In addition to patient care and education, research is the third pillar of academic medicine. Physicians and residents at the UF Health Science Center Jacksonville have completed more than 550 clinical research studies, with community-based, patient-centered projects often a major focus. The campus received $21.5 million in research funding in 2016, with 72 percent of that money from federal sources like the National Institutes of Health. Over the past four years, total external funding has increased by 40 percent.

COLLEGE OF NURSING

The Jacksonville campus of the UF College of Nursing offers an accelerated Bachelor of Science in Nursing for people who already hold a bachelor’s degree in another field. While the college has Jacksonville faculty, it also employs modern communications technology to offer interactive teleconferenced seminars from the Gainesville campus. Differentiating the college from other nursing schools in the area, UF nursing students regularly work alongside pharmacy students and medical residents in simulation scenarios aimed at optimizing patient outcomes by improving communication and interprofessional teamwork skills.

COLLEGE OF PHARMACY

The UF College of Pharmacy is ranked as the No. 1 pharmacy college in the state by U.S. News & World Report. The college features preeminent researchers who are leading major medical breakthroughs in areas such as drug discovery and development, pharmacometrics and systems pharmacology, and precision medicine.
In 2017, the college welcomed 271 students into the professional PharmD program. Of that group, 51 enrolled at the Jacksonville campus. Students enjoy small class sizes that allow them to build quality relationships with professors and classmates, as well as take advantage of leadership opportunities.

“We are fortunate to have renowned faculty physicians and research experts among the hundreds of dedicated personnel on our campus,” said Leon L. Haley Jr., MD, MHSA, CPE, FACEP, dean of the UF College of Medicine – Jacksonville. “While providing exceptional patient care and forging new discovery, they help ensure our trainees and students receive all the support and resources they need and ultimately have an educational experience that is second to none.”

Source: Florida Trend

Primary care providers and other medical tenants are moving in ever-increasing numbers from medical office buildings into retail properties. Family practitioners, internists, allergists, dermatologists and other specialists often find that space in a neighborhood shopping center can be an excellent venue for performing common procedures in an office setting, closer to patient populations and with more convenient accessibility and parking.

This shift from traditional medical office space to retail poses special considerations for medical tenants, however, and that can create unpleasant surprises for tenants who are unfamiliar with retail leasing.

Here are just a few examples of the differences medical users encounter when exploring retail real estate for the first time.

Improvement allowances often fall short.

The buildout cost to create a typical retail showroom is a fraction of the sums some healthcare providers must pay to finish out their spaces, often involving the installation of heavy diagnostic equipment, surgical rooms and other specialized enclosures. Given that the landlord’s contribution will be in line with the more modest cost of building out a store, medical tenants should be prepared to pay the additional up-front cost to complete their space.

Expect fewer services.

A shopping center may provide parking lot lighting and landscape maintenance, but a retail tenant is usually responsible for other services they may have grown accustomed to receiving in an office property. The tenant must make its own arrangements for regular housekeeping and cleaning up the occasional spill, for example. In most cases, the tenant is also responsible for any repairs required within its four walls, including plumbing, mechanical and electrical fixes. Expect little or no security from the landlord; that is usually left to the tenant to provide.

Consider neighboring tenants.

Medical office building leases usually restrict tenancy to healthcare providers and may preclude leases to healthcare systems that would compete with existing tenants for patients. Because building occupants share a focus on patient care, most of those properties also preserve a professional atmosphere.

By contrast, the retail environment can run the gamut from sedate to chaotic, depending on the stores and clientele on the property. For example, the noise from a children’s event center, an apparel store with loud music or a lively restaurant with outdoor seating next to the healthcare provider may disturb ill or infirm patients as they navigate the parking lot and common areas. Because retail tenants have few protections or control regarding the tenant mix, it is important to select a property with an atmosphere conducive to a medical practice.

Deciphering leases may be complicated.

The variety of lease structures used in retail can be confusing and difficult to compare without expertise. And while most leases include some method of conveying building operating expenses to tenants in addition to the base rent, the way those expenses are calculated and passed through can vary significantly.

Source: GlobeSt.