Physician offices and outpatient clinics typically consists of a patient intake area with space for reception, check-in/check-out, and waiting; exam/treatment space with a number of identical exam rooms, several office/consultation rooms, and one or more special procedure rooms; and associated clinical and administrative support space. Physician office space may be located in a medical office building (either freestanding or connected to a hospital), co-located with diagnostic and treatment services in a comprehensive ambulatory care center, or part of an institute or center organized along a specific service line — such as a Sports Medicine Center, Heart Center, or Cancer Center. Planning space for physician offices (also referred to as physician practice space) and outpatient clinics begins with determining how many exam rooms are needed and two different approaches are commonly used.
TWO DIFFERENT APPROACHES
Planners typically use one of two different approaches to determine how many exam rooms are needed — a physician-driven approach or a workload-driven approach. The need for other patient treatment space, such as procedure rooms, will depend on the specific medical or surgical specialties seeing patients at the facility. However, the sizing of patient intake, administrative, and support space is generally based on the number of exam rooms.
Physician-driven approach. When planning space for a private practice or when the anticipated schedule and staffing pattern have been firmly established, you can estimate the number of exam rooms simply by assuming a ratio of exam rooms per physician (or other care provider) during the peak weekday shift or clinic session. Two exam rooms per provider are typically planned although high-volume, quick turnaround specialties ― such as dermatology or surgery follow-up visits ― may effectively use three exam rooms per provider.
Workload-driven approach. Exam rooms were traditionally assigned to specific physicians regardless of the hours per week that they were present. In larger clinics, the number of exam rooms was typically driven by the demand on the peak half-day during the week. Because of the competing responsibilities of most physicians ― seeing inpatients, performing surgery and other procedures, seeing outpatients in other locations, attending conferences ― only a portion of the total physicians may use their allocated exam rooms at a given time. This results in significant variance in utilization of the exam rooms during the week. The variance between peak- and low-volume days is even more pronounced in academic medical centers where medical faculty also have teaching and research responsibilities that further reduce (and affect the scheduling of) their time in outpatient clinics.
INCREASED FOCUS ON UTILIZATION
With today’s emphasis on reducing capital and operational costs, most organizations strive to increase the utilization of exam rooms and minimize the overall footprint of the space. This has led to increased scrutiny of exam room throughput and the development of more efficient operational models. By co-locating groups of exam and consultation rooms, they can be used by other provider teams during periods of low utilization.
Interest in “time-share” clinics is growing ― where physicians schedule exam/treatment rooms only when needed and share staff and support services rather than “owning” their space.
An analysis of the utilization of an existing physician practice or outpatient clinic begins with collecting data on the annual number of visits and weekly hours of operation. You can divide the annual physician visits by 50 weeks per year (allowing for holidays) to derive the average weekly visits. Based on weekly hours of operation, the portion of workload expected to occur evenings and weekends can be subtracted for space planning purposes. You can then calculate the average daily visits per exam room by dividing the average weekly visits occurring during the primary weekday shift by the number of exam rooms.
For example, 400 visits per week (Monday through Friday, 8:00 a.m. to 5:00 p.m.) with 24 exam rooms results in an average of 3.3 visits per exam room per day. If patients are typically scheduled two per hour with a break for lunch, a utilization factor of only 21 percent results. In this case, changing the schedule should be considered (i.e., so that fewer half-day clinic sessions per week are scheduled) resulting in the potential reassignment of the exam rooms to another provider team during other times of the week.
It should be noted that there may be other care providers in addition to the physician ― such as physician assistants and nurse practitioners ― who see patients independently in an exam or consult room. Providers typically schedule a range of one to four patients per hour depending on the specialty and the proportion of new patient visits (which take longer) versus return or follow-up visits.
You can assume an exam room utilization factor as high as 90 percent for private practitioners who do not have a high number of no-show patients. In teaching clinics, care is provided primarily by residents supervised by experienced physicians who together spend a longer time with each patient. Along with a large number of no-shows, teaching clinics typically see the fewest number of patients per provider. In this case, you may need to use an exam room utilization factor of 70 percent for planning purposes.
IMPACT OF TELEMEDICINE
Telemedicine use surged at the peak of the COVID-19 pandemic as patients and providers sought ways to safely access and deliver healthcare services. In April 2020, telemedicine utilization for office visits and outpatient care was 78 times higher than the previous month. This rapid shift, borne out of necessity, was enabled by increased patient and provider willingness to use telemedicine and regulatory changes enabling greater access and reimbursement. Concurrently, an effort was made to expand the telecommunication infrastructure and ensure patients have internet access. During this spike, it is estimated that on average one-third of office and outpatient visits occurred via telemedicine. Since that time, telemedicine utilization has stabilized and varies by specialty.
SUMMARY
When planning physician office space and outpatient clinics, it is important to understand the relationship between workload, visit times, and staffing. With the rapid growth in telemedicine over the past several years, an analysis of where the workload is occurring is also required. However, a single flexible exam/treatment space can accommodate a wide range of patient visits with careful planning.
This article is an update of a previous post.