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MCDM AG.COM | M A RCH /A PR IL 2017 | Medical Construction & Design 19 news, awards, etc. Industry access points for a continuum of care." The panelists said they're seeing a grow- ing trend in healthcare facilities of using space more effi ciently and cost eff ectively, such as off ering evening wellness classes, nighttime pediatric clinics, ambulatory settings for behavioral health and more. Site selection, demand & capital fl ow The panelists discussed the Medicare Ac- cess and CHIP Reauthorization Act, which is transferring value-based purchasing from strictly Part A to Part B reimbursement from Medicare. Physicians will have new risk-based contracts in which they have the potential to lose money if they don't meet specifi c goals regarding healthcare quality, resource use, advancing care information and clinical practice improvement. The new rules begin with a reporting period in this year and the changes in Medicare reimbursements will take eff ect in 2019. The panelists said they expect this will result in more consolidations and expansions of physician practices to spread out the risk. Stark of Duke Realty noted, "I think that a large percentage of the independent physician practices with less than 25 or 50 members will either go out of busi- ness or be acquired by a health system. Over the last fi ve to 10 years, we've seen a big increase in health systems acquir- ing physician practices but then it's leveled off a little. Now I think we're in for a whole new era of acquisitions." Other panelists said MACRA will result in health systems seeking new capital partners or third parties to handle imple- mentation and assume and manage risk. One panelist said this will likely result in a shift to more virtual primary care, home care and community care networks. Many said they expect health systems will need larger healthcare facilities to house the consolidated organizations or to serve as a medical call center rather than a clinic. The panel also discussed changes in the Center for Medicare and Medicaid Services' site-neutral payment rule. This rule stipulates that reimbursement for services provided by off -campus hospital outpatient departments will be reimbursed at the same (lower) rate as on-campus hospital-based outpatient departments. Changes in this rule are reducing payments for new HOPDs to align with the physician practice fee schedule versus hospital rates. It was mentioned that there's a growing trend of health systems building micro- hospitals and freestanding emergency departments, which enables them to bill at traditional hospital rates. They said they anticipate CMS may continue to closely scrutinize these arrangements. The panel was asked if they think the results of the presidential election will have a major, minor or no eff ect on the healthcare law. Some said it remains to be seen what the eff ect will be, and others said the new administration will signifi - cantly aff ect PPACA but that it may take several years. The panelists said the hottest trends in the healthcare real estate sector are employed physicians and consolida- tion. The panelists all agreed that the mar- ket fundamentals are strong to very strong. TODAY, IT'S CRITICAL FOR EVERYONE TO PERFORM SEAMLESSLY, INCLUDING THE FLOOR. In here, there's no room for error, which is why more hospitals rely on the proven performance of Sika. With exceptional durability, low maintenance and fast return to service, Sika's hygienic floor systems are as dependable as they are beautiful. ASK THE EXPERTS Call 800.933.7452 or visit www.SikaFloorUSA.com to learn which resinous floor system is best for your unique environment. For more details, visit dukerealty.com/healthcare.