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EVOLVING MODELS OF CARE SPOTLIGHT ON MAINTENANCE David Ennis, senior vice president (retired), Kaufman Hall Associates Ultimately, to make healthcare affordable in our country, it will be essential to lower the historic rate of growth in expenditures for care. The pressure to reduce growth and lower costs will be seen in lower payment rates to healthcare providers. As payment rates decline, so must the cost structure. Jay Grinney, CEO, HealthSouth There are several things facility managers can do to enhance a company's bottom line: ensure all hospitals are maintained to all applicable regulatory standards; transition from a "reactive" to a "pro-active" approach for facility maintenance and upgrades; operate each hospital as cost-effectively as possible and collaborate with operations to identify ways to drive operational improvement through facility design. Mark Herzog, CEO, Holy Family Memorial Health Historically, healthcare providers have striven to provide services in a passive manner, being ready when patients seek care. Increasingly, we must focus on providing services outside the hospital's historical core that help community members achieve healthier lives. In doing so, healthcare must move from an inpatient-centric model to an outpatient and outreach structure as articulated in the AHA White Paper Hospitals and Care Systems of the Future (Fall 2011). Rick Mace, CEO, Adventist Bolingbrook Hospital Across the continuum of care services spectrum, acute care facilities (hospitals) will become a cost center. Hospitals will be going through a metamorphosis of understanding where they fit into the continuum of care. Patients may not be instructed to go to hospital campuses in the future. We'll want to educate the patient to go to the physician office for healthcare, not the hospital. This may require the passing of an entire generation to teach the patient population how to navigate the new health system. Jay Grinney, CEO, HealthSouth From a post-acute perspective, I anticipate our facilities will become more multipurpose as the healthcare industry evolves. The facility needs of today's postacute providers are dictated by Medicare reimbursement policies; Medicare has created post-acute silos through rules and regulations that exist solely to determine how Medicare will pay particular post-acute providers. This has created a fragmented and inefficient post-acute industry where the needs of the patient are subservient to the needs of the payor. In an accountable-care environment, the needs of patients, hopefully, will prevail. From a facility perspective this means flexible, multi-purpose post-acute buildings that can accommodate a broad spectrum of patients. Steve Driggers, M.D., chief medical officer, Holy Family Memorial Health At Holy Family, in addition to establishing medical home physician practices in local nursing homes, we are developing the concept of inpatient home where caregiver teams (a set of staff plus 1-2 hospitalists) provide patient care, thus bringing a pool of patients the continuity of a single provider team as opposed to an everchanging chain of caregivers. Facilities need to reflect this. Ken Lukhard, south market president, Advocate Health Care Historically, hospitals and health systems have been caught between funding inpatient expansion projects and addition of private beds, infrastructure demands and the high cost of clinical technology. Continuous preventive maintenance programs competed for shrinking capital as reimbursement has fallen. With the growing demand for broader outpatient platforms and multiple sites of care along with aging physical plants, staying on top of infrastructure needs will remain a challenge. It will be difficult to meet all of those demands. ADDITIONAL THOUGHTS Jeff Glassroth, M.D., dean of clinical affairs, University of Chicago The current architectural arms race and the architectural wow factor that is expected is going to have to change. A better balance between architectural/artistic high-end hotel-like environments and the mission must be achieved. There must be a balance between healing environments, technical needs and cost. Kevin Larkin, CFO, Presence Mercy Medical Center To be successful in the future, it will be critical for providers to achieve a robust margin, including contributions from Medicare and Medicaid. The formula for success involves eliminating unnecessary costs and process steps, while ensuring favorable patient outcomes, wowing patients and striving to be the best-of-class performers. Key cost controls include risk sharing, managing by exception, optimizing productivity, staffing to daily census/volumes, including support services, avoiding nice-to-haves and simply being great stewards of business resources. Doug Silverstein, president, NorthShore University HealthSystem Evanston Hospital The industry has experienced anywhere from a 5-15 percent decrease in inpatient business. Yet in an increasingly competitive consumer-driven environment, inpatient facilities need to be stateof-the-art. Flexibility is incredibly important. We must be prepared and positioned for moving in many directions. Strategies are also needed that will take costs out of our construction/capital budgets. "Can do" healthcare provider cultures are required where committed and talented people can make a difference. Editor's Note: Health Care Institute survey results and interviews were conducted by Constance Nestor, FACHE, EDAC, LEAN, Health Care Institute vice president for research and Gary Collins, AIA, NCARB, principal of PFB Architects and Health Care Institute vice president. The second part of this article will appear in the January/February issue of MCD. For more information, visit http://hci.ifma.org. www.mcdmag.com November/December 2013 | Medical Construction & Design 25