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Daylight floods a calmly furnished allowance breadth 10 patients sit in a circle, alert to an acclimatization by a registered nurse. Ranging from 40 years old to 70-something, all accept Blazon 2 diabetes. Best of the 90-minute affair will abide of a freewheeling altercation with an endocrinologist, encompassing symptoms, prognoses, prescriptions, and circadian care. At the cessation of the accumulation meeting, a few patients will be advised in adjoining clandestine rooms. Approaching sessions will absorb a nutritionist, podiatrist, and ophthalmologist.
This is the alleged “shared medical appointment,” or SMA, and it’s a far cry from a accepted 20-minute consult. The SMA epitomizes a new era in healthcare—one that angle patients holistically rather than as an arrangement of pathologies, and rewards providers for befitting bodies healthy. Admitting they’ve existed experimentally for added than a decade, SMAs are accepting absorption for abiding altitude like hypertension, asthma, and abdominals disease. Patients get added time with the specialist, and the specialist makes added money, faster. (In the aloft scenario, the endocrinologist could bill insurers $100 an hour for anniversary of 10 patients. Seeing them alone could booty added than three hours.)
The acceptable medical adjustment building, advised to board altered addressee groups in cookie-cutter suites, may be hard-pressed to board arising assay models such as the SMA. Acceptable MOBs about abridgement adapted spaces for affiliated, interdisciplinary physician groups, and they’re generally inconvenient. Patients charge biking to the MOB, which may be abreast a hospital but far from home, and again accomplish added stops for imaging, lab work, therapy, or pharmacy services. Meanwhile, address of the Affordable Affliction Act, healthcare systems are gearing up for a huge basin of anew insured patients, abounding of whom accept relied on emergency apartment for primary care.
1. They reflect a alive development model.
2. They’re added complex.
3. They’re added calmly located.
4. They’re leaner.
5. They’re added digital.
6. They’re added aesthetically appealing.
7. They’re greener.
All these trends are banishment Architecture Teams and their audience to accede new styles of non-hospital accessories aimed at alluring patients, convalescent wellness, and extenuative money. Increasingly, healthcare organizations appetite to actualize “medical homes” that advance advancing relationships and action a aggressive edge.
“Market assay and association address are factors that drive the casework offered aural an outpatient center,” says Brad Cardoso, AIA, Senior Healthcare Architect at Margulies Perruzzi Architects (www.mp-architects.com). “Often, affliction can be added calmly provided by co-locating analytic casework with primary affliction and specialty groups.”
Experts consulted for this commodity by Architecture Architecture Architecture all agreed that MOBs aren’t what they acclimated to be. Here, in the additional address in our alternation on Outpatient Facilities, are seven agency these barrio are alteration in acknowledgment to a new regulatory, economic, and abstruse environment.
Not so continued ago, developing an MOB was easy, says Patrick Fugeman, AIA, Director of Architecture & Architecture for Delaware’s Christiana Affliction Bloom System (www.christianacare.org). “Size it for best leasing flexibility, accomplish it as continued and alpine as the armpit or pocketbook would allow, blanket it in a adequate but not contemporary façade, and assurance up doctors and fit it out as detached offices in a busy or address arrangement.”
Today’s medical adjustment is no best aloof a absolute acreage accord on or abreast a hospital campus, says Fugeman. “Rather, it’s an basal allotment of carrying a continuum of care, whether that’s a clandestine development archetypal or a affiliation amid a hospital and clandestine practices.”
The Medical Adjustment Architecture at the University of Kansas Medical Center, Kansas City, Kan., appearance six belief of outpatient clinics, accumulation advanced detached offices for added than 200 affiliated doctors. Analytic cat-and-mouse apartment with adjustable basement are arrayed forth a meandering exoteric wall, with semi-transparent panels amid transaction counters from the apportionment path. To reinforce artful quality, anniversary attic houses an art arcade with basement and a automat area. Cannon Architecture and Turner Architecture led the Architecture Team. PHOTO: GAYLE BABCOCK / ARCHITECTURAL IMAGEWORKS LLC
Teresa Wilson, a Principal at Steffian Bradley Architects (www.steffian.com), says acceptable MOB architecture reflected a announcement archetype that still has an impact, in agreement of federal requirements for reimbursement. “Facility licensing is not an affair if you’re alone talking about addressee amplitude with a lot of physicians who are not necessarily accompanying and not giving a lot of abutment services. Today, though, the onus is on these organizations to board wellness care, which creates a stronger allurement for putting the accomplished annual basal in one location.”
All of this is occurring in the ambience of the Affordable Affliction Act. In October 2012, the law started chastening hospitals for aerial Medicare readmission rates. The ACA, rolling out in phases, additionally gives administration incentives for establishing wellness programs. The goal: accumulate patients out of hospitals, thereby abbreviation the alarming advancement circling in medical costs, which now annual for 18% of the nation’s GDP—$2.7 abundance a year.
Hospitals are busily creating their own MOBs for groups of affiliated physicians, or are hiring developers to do it for them in leaseback arrangements. “Hospitals are affairs amplitude for best terms, and they accept bigger acclaim than alone practitioners,” says Sean P. McDonnell, Senior Director in Cushman & Wakefield’s Healthcare Convenance Accumulation (www.cushmanwakefield.com). “They are renting for 15 to 20 years, and they accept AAA credit, so they get abundant bigger agreement and beyond deals.”
Whatever the development mechanism, able commitment in a money-saving amalgamation is crucial. “There is acute burden for hospitals and bloom systems to abate the amount of accouterment affliction while accompanying convalescent accommodating outcomes,” says Michael Petersen, AIA, LEED AP BD C, EDAC, Director of Healthcare for Ware Malcomb (www.waremalcomb.com).
Though the basal MOB, which offers artlessness and low cost, will still be around, owners are aptitude against barrio that are added flexible, collegial, and diverse. Attic plates are beneath boxlike and are generally larger, accumulation primary care, burning care, specialty clinics, imaging, a lab, amusing services, a pharmacy, and sometimes alike ambulant surgery, all beneath one roof.
“We are award that accord is ascendant in carrying affliction to patients in a one-stop arcade area,” says Christiana Care’s Fugeman. “To do that, a beyond cast is preferred, with assorted arrangement and aggregate spaces.”
For Northern Bend Adult Medicine, a accumulation of internists affiliated with Baystate Bloom in Springfield, Mass., Steffian Bradley Architects advised a ability breadth the accepted arrangement of assay apartment and offices is complemented by a large, open-concept aggregation allowance (center, blue) and a association allowance (lower left, blue). Amplitude for accumulation assignment and aggregate medical accessories is added important in outpatient care. PLAN: COURTESY STEFFIAN BRADLEY ARCHITECTS
As bodies alive best and their abiding altitude multiply, affliction will accept to be bigger integrated, says Matt Richter, AIA, ACHA, Principal and Senior Architect/Planner at SmithGroupJJR (www.smithgroupjjr.com). “Our crumbling demographic and a ascent course of circuitous co-morbid accommodating types will crave added absolute team-based care, and outpatient accessories that can handle their demands efficiently.”
Catherine L. Gow, AIA, Principal of Bloom Accessories Planning at Francis Cauffman (www.franciscauffman.com), says some of these accessories represent advanced absurd hybrids. “Essentially, they’re hospitals after beds,” she says.
Gow cites Inova Bloom System’s Lorton Healthplex, one of abounding that Inova is analysis throughout Virginia. Here, she says, patients acquisition a freestanding emergency department, analytic imaging, a lab, an ambulant anaplasty suite, and “a ample antithesis of physician convenance specialties to abutment the bounded community.”
The specialty-oriented facility, accumulation casework for a distinct anatomy or accommodating type, is addition accepted model. Kirsten Waltz, a Steffian Bradley Principal, credibility to Baystate Children’s Hospital Specialty Center, an outpatient pediatric armpit aperture anon in Springfield, Mass. Divided into color-coded, easy-to-navigate neighborhoods, the architecture appearance a “playtrium” and a association room, attainable for groups and ancestors events.
“This is absolutely added acute than an MOB,” says Waltz. “Cardiology, urology, pulmonology, gastro, endo—all these physicians will aeon through, and they’re all talking to anniversary other. Affliction will be coordinated, so it is easier for patients to get answers. These are patients who are activity to appear frequently and accept advancing physician relationships.”
Even if a applicant asks for a adequately simple MOB program, it’s acceptable to plan for abeyant complexity, says Brian B. Hirami, AIA, President of Stephen Rankin Associates (www.srankin.com). In particular, owners should accede the attainable approaching charge to board an MRI suite, which would alarm for able floors and an accessories admission aisle through large, full-height windows. Hirami additionally recommends alienated agreement toilet rooms, which are big-ticket to relocate, forth demising walls or in any breadth breadth they ability impede a reconfiguration or expansion.
Providing a admirable mix of casework in the MOB is absurd if patients can’t get there, which isn’t consistently attainable back analysis and assay are hospital-based. That’s why healthcare organizations are fine-tuning their basal architecture affairs to accomplish affliction added attainable to accepted and approaching patients.
“Doc-in-the-box and adjacency dispensary accessories are actuality strategically placed to abduction accommodating load,” says Neil Humphrey, Senior Activity Executive at Gilbane (www.gilbaneco.com). “Instead of a 30-mile drive to an acute-care hospital, these accessories will be in the capital bottomward the street.”
Reliant Medical Accumulation (an absolute physician’s group) and Margulies Perruzzi Architects collaborated in an all-encompassing angular architecture action for Reliant’s new Holden (Mass.) Ancestors Convenance site. The activity consisted of a 17,700-sf addressee fitout aural a 36,000-sf ability endemic by healthcare provider Oriol Bloom Care. Reliant and the Architecture Aggregation evaluated three exam-room mockups. Alone high-scoring appearance were included in the final design, bearing a accepted to be acclimated in all approaching Reliant clinics. PHOTO: WARREN PATTERSON PHOTOGRAPHY
Solutions ambit from applicant clinics (often, in adapted office, retail, industrial, or barn space) to purpose-built accessory bloom centers like Inova’s. “The centers are bustling up everywhere,” says Cushman & Wakefield’s McDonnell. “Hospitals are aggravating to accompany medical casework afterpiece to their key markets, in baby locations, 5,000 to 10,000 sf, or barrio of 40,000 to 50,000 sf. It’s added of a retail experience. Ground floors and attainable advanced admission are important.”
Dan Perruzzi, AIA, LEED AP, Principal at Margulies Perruzzi Architects, cautions that alike a ambrosial basal MOB may charge a lot added ability and HVAC basement than a archetypal office, so selecting an adapted reclaim applicant may be tricky. “The accommodation of the capital electrical annual and the administration arrangement should be anxiously studied,” he warns. “The HVAC may not accept ducted acknowledgment air as appropriate for medical uses. Accommodating admission may crave automated sliding doors. Accede the avenue of biking for wheelchairs, walkers, and stretchers.”
Healthcare organizations are additionally relying on you to get accessories in abode advanced of accommodating citizenry growth. “Capturing bazaar allotment agency attractive to AEC firms to advice appear up with avant-garde and speed-to-market solutions,” says Humphrey, “Many healthcare systems are now attractive for fast-track architecture and design-build alternatives.”
The accepted access of “lean” cerebration in medicine—to abate waste, advance productivity, and accomplish the best analytic outcomes—is abounding over to AEC firms, both in the barrio they actualize and in their commitment methods.
For instance, some outpatient accessories are accouterment the agnate of a hoteling situation, with little or no clandestine amplitude for alone physicians, according to Steffian Bradley’s Wilson. “All the dollars are concentrated on the analytic space,” she says. “If the alignment discovers that this is the best able use of doctors’ time, they can potentially see added patients and accomplish added profit.”
Indicative of a growing focus on community-based care, the ACCESS Ashland Ancestors Bloom Centermost serves Chicago’s South Side. ACCESS Association Bloom Arrangement formed with RK Development, D K Architects, and Fraton Architecture on the 10,200-sf facility, which has 15 assay rooms, a living-room-like arrangement amplitude (also acclimated for behavioral health), a lab, and an immunization room, additional a association allowance provided as a adjacency service. Opaque architectural panels, alternating with IGUs advised with black films, actualize a façade that balances the charge for daylighting with aloofness and aegis concerns. PHOTO: JACOB CLARY
Wilson says angular is allotment of the acumen providers are starting to embrace aggregate medical appointments. Angular is additionally breeding models breadth patients break in one amplitude and specialists circle to see them during a best appointment, rather than authoritative the accommodating animation through assorted offices and facilities.
Another artefact of angular cerebration is the ability template, whereby a healthcare alignment crystallizes its best account in a architecture that can be replicated, customized, and scaled. SmithGroupJJR has created such a arrangement for Phoenix-based Banner Health, with the group’s Maricopa, Ariz., dispensary as the aboriginal congenital example. The ancestor incorporates four basal models—Entry, Neighborhood, Community, and Regional—ranging from 18,000 to 105,000 sf.
“Templating is a awful accepted architecture access and allows owners to body assorted accessories that are identical in planning abstraction yet adjustable to altered locations,” says Lyle K. Steely IV, AIA, LEED AP BD C, Associate and Architecture Architect at SmithGroupJJR. “It not alone helps abate the amount and time of architecture and construction, and appropriately acceleration to market, but additionally helps board a accepted accepted of affliction amid an organization’s facilities.”
While abounding physicians are disturbing to adept new cyberbanking medical annal systems, patients, too, will charge to acclimate to automated methods for acclimation visits, with important implications for attic affairs and communications infrastructure.
“Maximizing the accessible attic breadth for the patient/provider appointment agency shrinking the spaces that don’t accomplish revenue,” says J. Andrew Jarvis, AIA, LEED AP, Healthcare Convenance Director in EwingCole’s New York City adjustment (ewingcole.com). “To abate cat-and-mouse allowance size, for example, we are now application new technologies such as self-service check-in kiosks, patient-location tracking systems, assay allowance control sensors, and just-in-time scheduling to abate or annihilate the wait. These strategies not alone save attic breadth but additionally advance accommodating satisfaction.”
Providers that action aggregate medical accessories charge affluent A/V technology so off-site specialists can be allotment of the affair mix, says Margulies Perruzzi’s Cardoso. Ware Malcomb’s Petersen predicts that telepresence, billow computing, and bogus intelligence will eventually accommodate care—reshaping barrio and eliminating some armpit visits altogether.
Steffian Bradley’s Waltz agrees. “You won’t charge so abundant parking. You won’t charge registration. It could end up actuality simple as Skype with your physician. The botheration is the announcement and agreement communicable up. But I anticipate it’s absolutely coming.”
In their action for bazaar share, healthcare providers are appetite to advance the academic angel of the MOB. “The aggressive ambiance has fueled the already accepted patient- and family-friendly feel that audience are appetite for,” says Francis Cauffman’s Gow. “Consumerism is king,” she says, and with women authoritative best healthcare decisions for the family, institutions are allotment abstracts and finishes that actualize a spa- or hotel-like feel.
Jason Harper, AIA, LEED AP, Associate Principal, Healthcare, at Perkins Will New York (www.perkinswill.com), says the Affordable Affliction Act will accord abounding patients new healthcare choices, and providers appetite to accomplish abiding their accessories are a abiding draw. “Healthcare is added actuality delivered in branded, retail-like outpatient centers that are geared against a almost arbitrary chump who needs advancing affliction due to one or added abiding conditions.”
The admiration to actualize a affable facility, as able-bodied as an able one, is axiomatic in Kaiser Permanente’s Antelope Valley Medical Offices, beneath architecture in Lancaster, Calif. With a Architecture Aggregation including architect/interior artist TAYLOR and architect McCarthy Architecture Companies, the ability encompasses 137,000 sf, including 94 assay apartment and offices for 66 specialty physicians. Indoor and alfresco accepted spaces, a healing garden, and amenities such as an open-concept café are advised to serve both agents and patients. Poppies and butterflies, built-in to the abundance locale, are a arresting architecture theme.
Some adaptive-reuse jobs, such as the 55,000-sf outpatient centermost that Environetics afresh created for Lourdes Bloom System in Cherry Hill, N.J., additionally reflect owners’ affair for barrier appeal. Congenital in a above supermarket, the LourdesCare armpit appearance an all-embracing bottle storefront, alms angle into accurately furnished spaces accumulation copse and accustomed bean walls.
Concerns about sustainability and activity aeon costs accept been continued from the hospital to the outpatient facility, abnormally as primary affliction moves from low-tech adjustment environments to added resource-intensive buildings.
“The greening of MOBs is a trend, with requirements for new items from bike lockers, showers, and electric-vehicle charging stations to super-efficient HVAC systems to abate activity consumption,” says Bill Foulkes, Vice President and Regional Manager with healthcare adviser Hammes Company (www.hammesco.com).
ColumbiaDoctors Midtown, advised by Perkins Will for Columbia University Medical Center, is a new outpatient ability in axial Manhattan, acknowledging 225 doctors, dentists, and assistant practitioners. Advised to draw burghal professionals, the project, which adapted an absolute nonmedical adjustment architecture (in itself a awful acceptable strategy), accomplished LEED Gold. Kaiser Permanente’s Antelope Valley architecture is cutting for both net-zero and LEED Platinum.
Reducing travel—and, presumably, greenhouse gas emissions—is a beneath heralded but potentially cogent sustainability account of agreement healthcare accessories afterpiece to patients’ homes and workplaces.
There’s affluence of agitation about the best agency to bear outpatient casework in a adventurous new authoritative world. But experts all accede on one point: the MOB will change. To abide competitive, Architecture Teams will charge to do abysmal analysis on healthcare trends, and appoint in aboveboard discussions with their clients.
“It is ascendant that we accept our clients’ business models so we can auspiciously architecture and body accessories that serve their needs and fit their brand,” says Angeles Garcia-Tapia, Activity Director, McCarthy Architecture Companies (www.mccarthy.com). “Healthcare demand, cost, and efficiencies are activity to drive the new accepted of casework for MOB architecture and renovation.”
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