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Page 12 — Health Care Properties Quarterly — January 2018
Break the mold.
revolutionize the experience.
build what matters.
A significant trend in the
health care industry is the
migration of hospital ser-
vice lines from inpatient to
outpatient facilities, which
is creating a churn in demand for
outpatient facilities.
Several key factors, including
reimbursement requirements, reg-
ulatory requirements and design
influences, will affect costs and
leasable rates for these facilities
and should be considered in the
decision-making process when
acquiring an existing building or
constructing a new facility.
• Reimbursement from Centers for
Medicare and Medicaid Services.
If a tenant is licensed through the
hospital and receiving reimburse-
ment from CMS,
it is possible for
that to drive up
the cost to build
or renovate an
outpatient center.
Recent rulings
from CMS and
The National Fire
Protection Agency
should be taken
into account.
• Freestanding
emergency depart-
ments and ambula-
tory surgery cen-
ters. The increased
patient acuity in
freestanding EDs and ASCs drive
stricter health care and building
code require-
ments. This, in
turn, affects the
type of construc-
tion and structural
system that may
be used for the
building. Retrofit-
ting an existing
multistory medi-
cal office build-
ing for these uses
adds challenges
and expense
with the required
upgrades, regula-
tory requirements
and separation
from nonreimbursed-based ten-
ants.
• Retail centers. Vacant retail
centers and big-box stores are a
great opportunity for hospitals
to relocate outpatient services.
They are frequently located close
to the patients they are trying to
attract, and the large, open floor
plans allow for flexible, multidisci-
plinary centers. One caution is that
mechanical, electrical and plumb-
ing requirements may require
upgrades to these systems.
• “Right-sized” design. Today’s
outpatient facilities have what is
known as a “sweet spot” for size
and height that enables the build-
ing to attract and keep reimbursed
licensed hospital-based tenants.
With the current inpatient to out-
patient migration trend, we have
seen or likely will see the following
services migrate out: ambulatory
surgery, oncology, digestive health,
sports performance and cardiovas-
cular services.
Several of these services will alle-
viate the current inpatient burden
on hospitals, which in turn will
create a more cost-effective model
for hospitals when done in an
outpatient setting. CMS has final-
ized an increase in payments for
hospital outpatient services and
the trend is for hospitals to see an
uptick in payment rates for outpa-
tient services that are imaging ser-
vices and nondrug related.
Additional design considerations
for efficient and effective outpa-
tient facility design include:
• Floor-to-floor height. Floor-to-
floor heights are highly critical
for many reimbursed licensed
hospital-based practices, as well
as nonreimbursed practices, such
as imaging departments and free-
standing emergency departments.
Renovated multistory buildings
may not be able to meet these
required heights, which may drive
large hospital tenants to new con-
struction or former retail settings.
• Tenant square footage. As hospi-
tals move to provide an integrated
model of outpatient care, their
space requirements within a single
lease can easily exceed 10,000
to 15,000 sf. The larger footprint
allows for an improved patient
experience by offering a mixture of
services and a one-stop-shop for
patients outside of the hospital.
Smaller, less flexible spaces may go
unleased for long periods of time
or cause frequent turnover.
• Depth of space. Depth of space
and common areas should be
designed to create the best square
Design
Tina L. Du Mond,
AIA, ACHA,
EDAC, LEED GA
Senior health care
architect, Hord
Coplan Macht,
Denver
The trend of hospital services lines migrating from inpatient to outpatient settings con-
tinues to impact demand for outpatient facilities.
Jim Albert,
AIA, ACHA,
EDAC
Principal, Hord
Coplan Macht,
Denver