Physician Turf Wars Complicate Facility Planning

Often unknown to the general public, physicians in the U.S. continuously struggle to defend and expand their increasingly overlapping empires. Hospitals, freestanding healthcare centers, and other venues are their battlegrounds and facility planners are often in the crossfire. As medical technology continues to evolve ― and reimbursement diminishes ― the traditional boundary lines separating specialties have become blurred and facility planning can be contentious.

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Rethinking Parking Lots and Structures

When it comes to parking, hospitals seem to never have enough. At the same time, customers ― whether patients, staff, or visitors ― always want to park as close to the their designated entrance as possible. Innovations in design, technology, and financing, along with careful planning, can mitigate shortages and improve customer convenience. Because easy and convenient access is a prime indicator of hospital customer satisfaction, more U.S. hospitals are rethinking the expansive asphalt parking lot and dreary concrete parking structure.

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Reverse Migration of Outpatient Services to the Hospital Campus (An Update)

Many medical services are provided both in hospital and community settings, such as physician offices and freestanding imaging or ambulatory surgical centers (ASCs). Services commonly provided in both settings include laboratory tests, physical therapy, outpatient surgery, routine and advanced imaging, physician visits, and noninvasive and invasive procedures, such as endoscopy or cardiac catheterization. When the Centers for Medicare & Medicaid Services (CMS) originally developed the hospital outpatient department (HOPD) designation to establish a higher reimbursement rate for hospital-based outpatient services, hospitals started purchasing physician practices, freestanding imaging centers, and ambulatory surgery centers and rebranding them as hospital outpatient departments to collect the higher Medicare payments. Now CMS is considering site-neutral payments which may result in another 180 degree shift from an on-campus to an off-campus location.

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The Hospital Pharmacy — Now a Sophisticated Manufacturing Plant

Automation — with the barcode as the foundation — has transformed the hospital pharmacy into a high-tech manufacturing plant that allows pharmacists to focus on direct patient care. Although automation in the pharmacy requires a significant capital investment, it reduces labor costs, lowers the risk of dispensing errors, optimizes inventory control, and provides better security, among other benefits.

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Fluctuating Demand for Hospital Beds

Starting in the 1980s, healthcare strategists and policy experts encouraged hospitals to reduce their surplus inpatient bed capacity in response to declining admissions, use rates, and lengths of stay — as a result of the advent of Medicare’s diagnosis related groups (DRG) payment methodology in the public sector and managed care in the private sector. Hospitals responded to changes in demand by shifting their resources. Between 1980 and 2003, community hospitals in the United States took 175,000 inpatient beds out of service — an 18 percent reduction — through downsizings, consolidations, and closures. At the same time, skilled nursing and subacute care facilities were developed to provide a less expensive and less resource-intensive alternative for patients requiring a lengthy recuperation. Home health agencies also proliferated. Since 2003, the number of hospital beds has declined less dramatically — a reduction of another 12,700 beds. Although, nationally, inpatient admissions rose from 1992 to 2012, both the rate of inpatient admissions per 1,000 population and the average length of stay have declined to an all time low — resulting in an overall decline in the demand for inpatient beds.

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Rethinking the Intensive Care Unit

Many hospitals feel that they never have enough intensive care beds and are constantly pressured to expand existing units or create new units. Historically, intensive care units (ICUs) have provided intensive observation and treatment of patients in unstable condition. Because of the high-tech requirements and highly skilled staff, these units are expensive to build and operate. Insufficient intensive care beds also affects the ED, as high-acuity patients waiting to be admitted backup in the ED when the ICUs are full.

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