Health Systems To Build Microhospitals To Fill Community Gaps

Despite their small physical size, microhospitals are fast becoming a big thing in health care design.
Historically, hospital construction has been based on the premise of “build it and they will come,” says David Argueta, president and CEO of CHI St. Luke’s Health — The Woodlands, Lakeside and Springwoods Village hospitals. Inpatient beds have in large part defined a hospital or health system. “When we talk about health care systems and hospitals, part of the statistic is how many beds we have,” Argueta says.
Today, priorities are shifting toward “driving the cost of health care down and building ambulatory access points that are focused on who we serve — really focused on the patient experience and their journey through health care. Finding a way to do that in a lower-cost environment — that’s what everyone’s trying to do,” he says.
Microhospitals can be distributed throughout a region to support a network of care; they also can be designed to be scalable, to grow along with a burgeoning community. According to Argueta, microhospitals are an innovative solution to delivering hospital care where it’s needed, to meet a health care organization’s strategic goals and its mission as a care provider.

In short, efficient, well-placed microhospitals can achieve the health care trifecta of “best value, high quality, lower cost,” he says.

Convenient and Accessible

Microhospitals generally fall between 15,000 and 25,000 square feet, though they can be upward of 50,000 or 60,000 square feet in size, says Kevin Harney, principal at architecture firm ESa in Nashville, Tenn. They typically include eight to 10 inpatient beds, eight to 10 emergency department treatment bays, a small imaging and diagnostic suite and support functions like dietary services, environmental services and materials management.
These facilities perform essentially the same functions as standard-sized hospitals but are scaled to respond to the needs of lower-acuity patients, explains Rod Booze, partner in the Texas office of health care architecture firm E4H.
Besides size, the primary difference between a microhospital and a larger community or tertiary care hospital is that microhospitals do not provide services like intensive care.

“Microhospitals cater toward the noncritical patients,” Harney says. “If a patient’s going to be there more than 48 hours, the provider will transfer [him or her] to a larger hospital. They’re trying to take the less-acute patient who needs a hospital stay and needs to be cared for but who doesn’t need to go to the larger tertiary hospital.”

PhiloWilke Partnership in Houston has designed approximately 25 microhospital facilities in the last eight years, with 20 more on the books, according to Kevin TenBrook, a partner at the firm. “It’s definitely expanding at the moment,” he says of microhospital design and construction.
TenBrook describes PhiloWilke’s typical microhospital as less than 20,000 square feet, with a full-service ED. These buildings are generally in suburban areas, 30 minutes or less from a primary hospital campus, so patients who require high-acuity care can be transferred quickly to a setting appropriate to their needs.

“The microhospitals we do are very much portal-type facilities, meaning they’re a way to get the hospital service out where the people live, out in the communities,” TenBrook explains. He adds that most projects include medical office space for physicians who practice at the hospital or are related to the health system.

Microhospitals tend to be on highly visible sites in their communities.

“From a project location or siting point of view, these are retail facilities,” TenBrook says. “One of our clients once said, ‘We expect a typical future patient to have driven by one of our facilities 100 times before they walk in the door.’”

With microhospitals, providers are “trying to create something convenient and accessible,” Harney adds.

Scalable Design

Springwoods Village Hospital is a microhospital designed by ESa for CHI St. Luke’s as part of the new Springwoods Village master-planned community in Spring, Texas, within the extraterritorial jurisdiction of Houston. The facility comprises 50,000 square feet of hospital space and 100,000 square feet of medical office space.

“It becomes almost a one-stop shop for health care, when you think of primary care and multispecialty groups and dentistry alongside our hospital services. That’s what we were trying to create,” says Argueta.

The hospital portion of the facility includes four inpatient beds, four operating rooms, two endoscopy suites with associated preoperative staging and post-anesthesia care areas, a full diagnostic imaging suite with computed tomography, radiology, magnetic resonance imaging and nuclear medicine capabilities, and a 10-bed ED.
The microhospital, on a 26-acre site, is master-planned to expand over time into a 200- to 300-bed tertiary care hospital. The scalable design is meant to serve the immediate and long-term needs of the community, Argueta says. By starting with a microhospital, “you’re able to grow intelligently. You don’t have 100 or 200 beds to start out with. You may have four to 12 beds and concentrate on more procedural areas,” he says.
This type of phased development makes efficient use of resources and gives local residents the comfort and convenience of having access to both nearby health care services and a larger network of care, he notes.
Argueta explains that CHI St. Luke’s, which historically has been inpatient-focused, recently has concentrated on developing facilities to serve patients along the entire continuum of care. The health system now has nearly 50 access points and almost 100 physicians in the North Houston area.

“We consider [Springwoods Village Hospital] a part of the continuum,” he says. While the microhospital can handle most patient needs, The Woodlands Hospital, CHI St. Luke’s flagship facility in North Houston, is a comprehensive stroke center that can provide higher-acuity care for patients who require it. The health system’s facilities are complementary, Argueta says.

Neighborhood Hospitals

Dignity Health–St. Rose Dominican health system has been working with Houston-based microhospital developer Emerus and other partners to implement a microhospital strategy in Las Vegas. The health system has opened three microhospitals so far this year, and another is in the works.
The first floor of each Dignity Health–St. Rose Dominican microhospital, designed by PhiloWilke, includes eight inpatient beds and a similar number of emergency treatment and triage rooms, along with computed tomography, laboratory, X-ray, ultrasound, pharmacy and dietary services.
“Each location has either one or two additional floors that are purposed for Dignity Health–St. Rose Dominican’s other clinical services,” says Vic Schmerbeck, executive vice president of strategy and business development for Emerus. These include primary care, wellness centers and other specialty clinical services.

The microhospitals are located on sites that range from 3 to 7 acres. “They are highly visible and accessible for patients,” Schmerbeck says. “All of them sit on hard corners in retail-centric locations, to provide great access for patient care in areas we believe have needs in the marketplace.”

“We’re calling them neighborhood hospitals. They are fully licensed, Centers for Medicare & Medicaid Services-certified facilities capable of providing a continuum of care, albeit at a lower acuity level than some of our larger, more complex facilities,” says Peggy Sanborn, vice president, partnership integration, Dignity Health. “They’re generally distributed to better serve the overall population in Las Vegas, particularly as we migrate as an organization to value-based contracts and at-risk contracts.”

Population health management was a key factor in the health system’s decision to deploy microhospitals in this manner, Sanborn says. “First of all, we’re able to provide access to care that’s most commonly accessed at hospitals, which is predominantly outpatient-oriented, through this lower-cost model. So it preserves on capital and expenses as it relates to creating access points for patients.”
Additional access points help to prevent bottlenecks to care.

“Many times in communities that are under-resourced, you have long waits for emergency services,” notes Sanborn.

The neighborhood hospitals will provide needed services and allow Dignity Health–St. Rose Dominican to keep patients in network as the health system moves forward with some of its more narrow-network or value-based population health-oriented contracts, she says.
According to Sanborn, co-locating outpatient diagnostics and physician services on the microhospital sites creates “minimedical campuses” where local residents can receive primary care, outpatient care, emergency treatment or a short-stay, acute care inpatient admission.
She says that Dignity Health–St. Rose Dominican has developed resources to transfer patients with more complex medical needs in a timely and effective manner to hospitals within the system that provide higher levels of care, and for the system’s medical staff and management team to coordinate care for patients across the entire network.

Health Care Evolution

“What we’re trying to do is evolve our health care thinking and make it much more community-facing, so that patients feel [as though] we’re delivering the product to them,” Sanborn says. “We’re starting to look at how you address the way patients want to access care.”

Millennials want convenience and immediacy in care resolution, she notes. “We want to be evolving or thinking about health care delivery in a similar way,” she says.
Microhospitals enable health care organizations to provide “great care in a patient-friendly and convenient manner, while remaining disciplined on capital and operational efficiency,” Schmerbeck adds.
Source: H&HN
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Project Management: The Treatment Protocol For Healthcare Development

Developing a hospital, diagnostic laboratory or other healthcare facility involves stringent building standards and an array of overlapping regulations. But the reality is, few hospital systems retain builders on staff. Moreover, few builders deal exclusively in the medical field and understand the patient outcome and regulatory performance goals that caregivers must meet in the completed facility.
What the owner of a planned hospital or clinic needs is a project manager, a trusted advisor who brings to the team a deep understanding of current best practices in both the building and healthcare sectors. Whether this cross-industry expert is on staff or a third-party partner, the project manager’s role is to add value on several fronts while representing the owner.

On time…

Wasted time is the bane of every building project, from a residential addition to a downtown skyscraper. When foul weather, zoning or permitting delays, building supply back-orders or any number of other difficulties occur, owners who haven’t made plans to deal with those contingencies may see work slow or grind to a halt.
In the healthcare industry, delays can be especially costly. The services provided to patients at a large hospital can easily amount to $1 million or more per day. In that light, each week that a hospital project overruns its planned completion date represents substantial lost income.
The flip side of that reasoning suggests that shaving a few weeks off the four to five years required to build a typical hospital may enable the operator to generate millions of dollars in additional revenue, simply by moving up the opening date and starting to schedule and see patients sooner.
A project manager that has experience with medical properties will know the application process for approvals and the expected time required to complete each task throughout the various development phases. Communicating realistic expectations helps the client set and adhere to a workable budget and delivery schedule.

…and on budget.

The project manager’s expertise enables the client to make informed decisions in selecting design elements and building materials, explaining the cost implications of various options. Hospital administrators need to know, for example, that the elevated standards in place for hospitals come with a higher price tag than for most other property types.
If the average cost to build conventional office space is $100 per square foot, hospital space in the same market may run $450 to $600 per square foot, while medical laboratory research space requires as much as $1,300 per square foot to construct. For example, a hospital bathroom renovation may cost $30,000 to $50,000, or three to four times the cost of renovating a residential bathroom.
Ensuring that the owner’s cost expectations reflect market realities also helps to keep the project on schedule as bills come due, preventing sticker shock and subsequent, time-consuming disputes with the contractor.
In addition to assisting with planning, budgeting and quarterbacking the development, the project manager is often a translator, conveying the hospital or healthcare organization’s needs to the project team and explaining progress and challenges in terms understandable to hospital decision makers.
When healthcare providers consider the potential costs of avoidable delays and unnecessary expenditures that plague many inexperienced property owners, many will deem a project manager to be a worthwhile investment.

Commentary provided by Peter Stojkovic, Managing Director of project services at Transwestern.

Source: GlobeSt.
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NSU Obtains Preliminary OK For New Medical School, Enrollment Date Set

Nova Southeastern University has received preliminary accreditation for its College of Allopathic Medicine, meaning that medical students can start enrolling for the August 2018 semester.
The approval from the Liaison Committee on Medical Education would create the eighth M.D. program in Florida. NSU currently offers DO degrees through its College of Osteopathic Medicine, which will continue.
Florida has a shortage of physicians that is expected to grow as the state’s population of elderly residents increases.

“The accreditation decision is a transformational moment in the history of NSU which brings the university another step closer toward NSU’s Vision 2020, and its goal of becoming a nationally recognized, top-tier university of teaching, research, service, and learning,” said NSU President George Hanbury.

Health care is a major focus at NSU. It already has schools of pharmacy, dentistry and nursing, plus medical research programs. It recently completed the 215,000-square foot Center of Collaborative Research on its Davie campus to host research companies. HCA plans to break ground on a 200-bed teaching and research hospital at NSU.
NSU plans to build a 200,000-square-foot interdisciplinary medical education building to house its health profession programs and medical offices.
The curriculum of NSU’s new MD school would focus on research, technology and innovation while collaborating in small groups. The students will take clinical rotations at HCA East Florida hospitals and West Palm Beach VA Medical Center.

“NSU has made remarkable commitments to medical education, research and patient care, building a strong foundation for an innovative, research-intensive medical program,” said Dr. Johannes W. Vieweg, founding dean of the college. “As a new medical college, we are in a unique positon to leverage institutional resources and external partnerships to create a new educational model that will transform the delivery of health care in our community and beyond.”

Source: SFBJ
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New Adult Medical Care Model Expands To Sarasota

For many older adults, making the rounds to various doctors’ offices to address multiple health issues can amount to a full-time job — one that comes with cascades of paperwork.
But at a new medical practice that opened Friday in Sarasota, the patient’s user experience has been conceived to feel more like a casual drop-in at an Apple computer store in the mall. Walk into the just-completed EliteHealth location in Midtown Plaza, and instead of a receptionist handing you a clipboard through a tiny window, you’ll encounter a soaring, white-walled space reminiscent of an airport VIP lounge, punctuated by vibrant splashes of purple, teal and spring green.
The use of this “Apple palette,” said Steve Schnur, a Miami cardiologist and CEO of EliteHealth Medical Centers (elitehealth.com), has been found to transform a newcomer who might be feeling unwell and hesitant into a welcome guest who’s smiling and calm.

“The way we’re doing it — I don’t really understand why it hasn’t been done before — is about trying to take away the pain points that older patients experience,” Schnur explained. “The first thing that we did in our model was get rid of the waiting room.”

Patients are escorted instead into “intake pods,” then proceed into adjacent examining rooms where large touch screens help doctors give visually enhanced consultations. Nutritionists, wellness coaches and other members of the team come to the patient, and many procedures — including lab draws, X-rays, allergy tests and even genetic or heavy-metal screens — are done onsite. Extras like transportation, house calls and a 24-hour virtual assistant are available to members of the concierge-like “Senior VIP program.”

“We’re really a pioneer in the world of artificial intelligence,” Schnur said, adding that Elite’s data processing and billing are outsourced to the Dominican Republic to save costs. “The only thing done onsite is customer experience. There are no phones ringing, no papers thrown around. We’re paid by insurance companies, so our incentive is to practice more prevention and wellness. We don’t get paid extra to do a test; we get paid extra if the patient stays well.”

Expansion Planned

Primary care physicians have long looked for ways to keep adult patients functional instead of merely responding to each medical crisis as it erupts. But aside from the small sector of concierge practices that cater to patients who can afford annual retainers, the business model for wellness practices has remained fragile. EliteHealth, which owns six medical centers and manages 20 more, got a boost last year when Humana Inc. added its South Florida locations to the insurer’s Medicare Advantage Plan network.
Sarasota is the first expansion site for Humana MA patients outside the Miami-Dade area, and those members will provide the foundation for the start-up here. But EliteHealth is open to anyone over 18, at any stage of health, and accepts most insurance plans. A Venice location is due to open soon, and a second Sarasota office is “in the pipeline,” according to Nema Runyan, a physician overseeing the local launch.
Another obvious departure from the standard doctor’s office is a large, glass-enclosed activity room, designed to host wellness education sessions and fitness classes that range from gentle stretching to Zumba. It’s right up front and visible as you enter, an inescapable message that you’ve come to a place where constant encouragement to get and stay healthier will be part of the care package.
Schnur said between 30 and 40 percent of visitors to his South Florida sites come for the wellness programs and not to see a doctor.

“As we get older it’s important that we know that our choices still matter,” Runyan said passionately. “We’re not too old, we’re not too fat, we’re not too thin, and every little bit helps. Activity doesn’t mean running a marathon or scaling Mount Everest; it means doing a little less sitting, at your own pace.”

A common criticism about medical care for America’s costliest patients — those with multiple complications like diabetes, heart conditions or obesity — is that specialists and hospitals tend to attack each problem separately. Health policy analysts have long encouraged the medical profession to create a more patient-friendly system, but aside from geriatric centers that rely on federal grants or medical schools, the elder care business model has been tough to crack.

Changing Model

A federal pilot program known as PACE — Programs of All-inclusive Care for the Elderly — has expanded since 2015 to serve more than 42,000 patients in 31 states, most of whom are “dual eligibles” — elders who qualify for both Medicare benefits and Medicaid, the health coverage for Americans with limited income. The nearest PACE center to this region is in St. Petersburg, but a new growth initiative by the John A. Hartford Foundation was announced this month, aimed at reaching five times the number of elders.
The PACE program targets very frail populations with almost no assets, with the goal of keeping them independent and saving on nursing home costs. That leaves large numbers of Medicare recipients who could also benefit from a less “siloed” approach to disease management. If successful, the EliteHealth concept could provide a for-profit model that both doctors and patients prefer.

“People were like, ‘It can’t be done; Steve, you’re spending all this money,‘” Schnur said. “I would always bring up the movie ‘Field of Dreams’: If you build it, they will come.”

Runyan, who took a break after closing her internal medicine practice in St. Petersburg, said she was convinced to come out of retirement by seeing the EliteHealth center in Miami.

“We were compensated very well for putting people in the hospital,” she said, talking about the old fee-for-service Medicare model. Unwilling to return to that life, she jumped at the chance to practice preventive care and disease management.

“I like to say that a smart person can deal with the problem, but an intelligent person prevents the problem,” Runyan said. “Now what they’re figuring out – the business people — is that actually it works, and it saves money.”

Source: Herald-Tribune
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Bringing Former Hospitals Back To Life

When Juana Monroy moved into Hollenbeck Terrace in 2015, she learned that the towering senior apartment building was once a busy hospital that had appeared in dozens of movies and television shows.
Then she heard the rumors that the old Linda Vista Community Hospital building was haunted. “I was a little scared,” said Monroy, 60.
But she hasn’t seen a ghost yet, and now she loves living in a building with such history. “It’s gorgeous,” she said.
Across the country, hospitals that have shut their doors are coming back to life in various ways: affordable senior housing in Los Angeles, luxurious multimillion-dollar condominiums in New York’s Greenwich Village, a historical hotel in Santa Fe, N.M. In the Capitol Hill neighborhood of Washington, D.C., a hospital that opened in 1905 to care for the poor was remodeled and reopened this summer with 139 apartment units, a rooftop deck and an indoor dog wash.
Such conversions can pull at the heartstrings of communities in which residents often have an emotional attachment to hospitals where family members were born, cured or died. Nevertheless, the changeovers can also be welcome, particularly when hospitals have been long closed, their buildings left empty and dilapidated.
Closing a hospital and converting it to another use is not exactly like renovating an old Howard Johnson’s, said Jeff Goldsmith, a health industry consultant in Charlottesville, Va. “A hospital in a lot of places defines a community — that’s why it’s so hard to close them,” Goldsmith said.
In Charlottesville, he noted, Martha Jefferson Hospital closed its downtown facility in 2009 to move closer to the interstate highway, and an apartment building recently took its place.
The trend of converting hospitals to condos and apartments comes as real estate values have soared in many U.S. cities, and demand for inpatient hospital care is on the decline. Surgery and other health services are being moved increasingly to freestanding outpatient centers, and the average number of days patients stay in hospitals has dropped significantly.
Against this backdrop, the hospital industry is consolidating, and many institutions are shutting their doors. The number of hospitals in the U.S. has declined by 21 percent over the past four decades, from 7,156 in 1975 to 5,627 in 2014, according to the latest federal data.
In addition, many older hospitals are too outmoded to be renovated for today’s medical needs, which include large operating room suites and private rooms, said David Friend, chief transformation officer at the consulting firm BDO in Boston.
Real estate investors say the location of many older hospitals — often in city centers near rail and bus lines — makes them attractive for redevelopment. The buildings, with their wide hallways and high ceilings, are often easy to remake as apartments.
Some of the changes have elicited controversy, however — particularly in New York, where many hospitals have been converted to residential housing in recent years.

St. Vincent’s Transformation

St. Vincent’s Hospital in New York, which traditionally cared for the poor and treated survivors of the Titanic’s sinking in 1912, the first AIDS patients in the 1980s and victims of the 9/11 terrorist attacks in 2001, went bankrupt and closed seven years ago. Developer Rudin Management bought it for $260 million and transformed it into a high-end condo complex, which opened in 2014. Earlier this year, former Starbucks CEO Howard Schultz reportedly bought one of the condos for $40 million. The shift from a place that cared for the poor to a home for the rich upset many residents in Greenwich Village.
Jen van de Meer, an assistant professor at the Parsons School for Design in New York, who lives four blocks from the former St. Vincent’s, said people in her neighborhood were sorry to see the hospital close for more than just sentimental reasons. “Now, if you are in cardiac arrest, the nearest hospital could be an hour drive in a taxi or 20 minutes in an ambulance across the city,” van de Meer said.
St. Vincent’s is one of at least 10 former hospitals in New York City that have been turned into residential housing over the past 20 years.

Spurring Development

In some circumstances, a conversion provides a much needed lift for the community. New York Cancer Hospital, which opened on Central Park West in 1887 and closed in 1976, was an abandoned and partially burned-out hulk by the time it was restored as a condo complex in 2005. Developer MCL Companies paid $24 million for the property, branded 455 Central Park West.

“The building itself is fantastic and a landmark in every sense of the word,” said Alex Herrera, director of technical services at the New York Landmarks Conservancy. He noted that it retained some of its original 19th-century architecture.

Friend, who was on the management team that tried to revive St. Vincent’s financially after it filed for bankruptcy in 2005, noted that real estate is one of the most valuable assets a hospital has. “A hospital could be worth more dead than alive,” he said.
Repurposing them does not come without friction, however.
Nicky Cymrot, president of the Capitol Hill Community Foundation in Washington, D.C., a neighborhood group, said that when Specialty Hospital Capitol Hill sold off a little-used 100,000-square-foot wing of its facility to developers who planned to build apartments, neighbors weighed in with concerns about aesthetics and traffic. But the builders of 700 Constitution — the hospital-turned-apartment house a few blocks from the U.S. Capitol — preserved the old architecture, which pleased residents.

“They did a beautiful job,” Cymrot said of the three developers of the building — Urban Structures, Borger Management and Ronald D. Paul Co.

The renovation cost $40 million and took nearly nearly five years to complete in part because of delays building an underground parking garage. At 700 Constitution, one-bedroom apartments rent for nearly $2,600 per month.
It’s not the first hospital in the district to make such a conversion. Columbia Hospital for Women, which had delivered more than 250,000 babies since it opened shortly after the Civil War, closed in 2002 and reopened in 2006 as condos with a rooftop swimming pool in the city’s fashionable West End. The developer, Trammell Crow Co., paid over $30 million for the property.
Some former hospitals are used for purposes other than housing. In San Diego, Point Loma’s Cabrillo Hospital closed in 2007 and was transformed into a language school nine years later, providing economic stimulus for nearby businesses.
In Santa Fe, N.M., St. Vincent Hospital moved into a new facility in 1977 and the old structure downtown was reborn as a state office building. Later, it was abandoned and locals listed it as one of the spookiest places in town. In 2014, the building reopened yet again as the 141-room Drury Plaza Hotel.

‘A Building With Tremendous History’

Linda Vista Community Hospital, which overlooks a park in L.A.’s Boyle Heights neighborhood, opened in 1905 to serve railroad employees. Budget problems and declining patient rolls led to its closure 86 years later, and the abandoned six-story building fell into disrepair.
But the empty patient rooms, discarded medical equipment and aging corridors soon attracted film crews, who shot scenes for movies such as “Pearl Harbor” and “Outbreak.” The hospital also attracted trespassers looking for ghosts and groups such as the Boyle Heights Paranormal Project, said Francis Kortekaas, assistant superintendent at Amcal Multi-Housing Inc., which bought the property in 2011 and redeveloped it.
The company turned patient rooms into affordable senior apartments and renovated everything from the intensive care unit to the medical library. Amcal retained many of the building’s original features, including mailboxes, dumbwaiters, windows and stainless-steel doors.

“They really rescued a building with tremendous history … while providing really needed low-income senior housing,” said Linda Dishman, CEO of the Los Angeles Conservancy, a group dedicated to preserving and revitalizing historic structures. “It is such an iconic building in the neighborhood.”

Source: California Healthline
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