Medical design operational efficiency seminar.ppt

HEALTHCARE Realty & Development Services

Building Foundations for the Future



Discussion topics for today:

1. Physical Environment and Operational Efficiency

2. Cost implications in selecting space3. Costs and tax implications of

construction or renovation


Your practice is your patient manufacturing “plant.” It requires:

●Accessible location●Physical plant●Demographics (patients)●Skilled labor●Value added services

Your office takes patients, applies labor and value added services to produce healthy individuals


Let’s talk first about “Operations”!

Operations is the driving force behind location and physical plant

Operations determines the demographic criteria you seek in selecting a location

Operations determines the layout and functionality of your “plant”


How do a bunch “… of pimply faced teenagers run a billion dollar corporation”

One word:

“SYSTEMS”


By maximizing operational efficiency, we will:

Show you how to utilize your physical environment to maximize income

Enhance the patient experience for better outcomes


How can you increase income?

See more patients (increase productivity)

Charge more money per patient

Add more labor / providers

Add more billable services

Lower costs

“Fix” patients the first time (manage returns)


See more patients


Charge more money per patient


Add more labor / providers


Add more billable services


Lower costs


“Fix” patients the first time No Returns!


How can we enhance productivity?

There are four primary ways to increase productivity:

Efficient Space Design

Comfort for Patients and Staff

Technology

Utilize a Systems Approach


Let’s consider this design:


Or this design:


Staff

RecordsPatients

This design failed to properly address the three necessary flows in a medical practice:


Additional design issues:

Crowding in corridors or at check out

Improper placement of Staff areas

Poorly designed exam rooms

Improperly designed door swings (exposes

patient)

Placement of fixtures results in poor sound

control

Poor staff control over certain patient areas


Compare to this suite layout:


This is a self replicating module:


Let’s examine “exam” rooms:


What’s wrong with these “exam” rooms?

● Door swings/privacy● Back to back plumbing & electrical outlets create holes for sound transmission● Dr. must go completely around patient in exam 2● Dr. has difficult access to cabinets/supplies in Exam 1● Dr. is blocked in when seated● Chairs have arms


An efficient exam room:


Multiple efficient exam rooms:


We know this is better because of “Evidence Based Design”

Evidence Based Design is achieved by applying scientific and engineering principles, such as time-motion studies, to healthcare design.

“EBD” results in more patients seen, less stress, better infection control, fewer errors, greater comfort, better privacy and better control over traffic and access to services.


Monetary benefit of good design:

What is the value of two extra patient visits per day?

2 patients x $75 /ea x 240 days/yr

= $36,000 / yr


Part 2- Enhancing Productivity through “Therapeutic Environments”

Healthcare facilities are designed not only to support and facilitate state-of-the-art medicine and technology, patient safety, and quality patient care, but to also embrace the patient, family, and caregivers in a psycho-socially supportive therapeutic environment. The characteristics of the physical environment in which a patient receives care affects patient outcomes, patient satisfaction, patient safety, staff efficiency, staff satisfaction, and organizational outcomes. The effects can be positive or negative. No environment is neutral.

~National Institute of Building Sciences


A healthcare environment is therapeutic when it does all of the following:

Supports clinical excellence in the treatment

of the physical body

Supports the psycho-social and spiritual

needs of the patient, family, and staff

Produces measurable positive effects on

patients' clinical outcomes and staff

effectiveness


Key components of “therapeutic environments”

Reduce / eliminate environmental stressors

Provide positive distractions

Enable social support

Provide patients and staff a sense of control


How can we reduce stressors?

● Calming art● Reduce paperwork● Reduce wait times● Noise reduction ● Eliminate crowding● Odor control● Natural light● Privacy control● Positive distractions● Indoor air quality● Temperature● Aesthetic design and colors●Cleanliness


How to provide positive distractions:

Access to outdoors

Natural views

Educational materials

TV loop

Music

Art


How can we enable social support and provide a sense of control?

Provide adequate space for caregiversProvide culturally appropriate environmentArea seating, quiet rooms, conference rooms for larger gatheringsLighting and temperature controlSchedulingData entryPayment options


Benefits of a “Therapeutic Environment?”

In reality, everyone benefits! Patient satisfaction is much greater Patient outcomes are much better Staff satisfaction is much higher Absenteeism is greatly reduced Staff turnover is reduced Errors are minimized


Our “plant” is now in order!

We have created a plant such that patients, staff and records flow smoothly and our facility provides a therapeutic environment. Now what?


How can we Increase Revenues?

Creating systems using technology

Add extenders (PA / NP)

Add billable services

Value added services


Let’s talk about systems and technology!

Systems make the world go around. Typical medical systems include:●Communications● Billing●Treatment●Marketing●Human Resources


Web based scheduling


Benefits to web based scheduling

Patients benefit by working around their schedulesPatients find it easy to useCapture patient data electronicallyVerify insurance easily and in advanceCapture payment informationPossible to reduce staffing needsCAPTURE SYMPTOMS & PROTOCOLS


Web based diagnosis!


Benefits to web based diagnosis

Reduces calls and interruptions from patients seeking advicePatients find it easy to useCapture patient symptom dataProvide staff with possible diagnosisAlert staff to potential emergenciesWhen combined with online scheduling it ALLOWS STAFF TO BATCH PATIENTS


Electronic Health Records!

The implementation of EHR’s provides a platform for many technical AND treatment improvements in your practice “systems!”


UCF has a research arm that can help you select the appropriate Electronic Health Records system for you.


A Benefit of Electronic Health Records - it creates useable space!


Space that can be used to:

Add staff, particularly nurse practitioners or PA’s


Benefits of adding extenders:

●Lowers wait times●Adds more billable hours●Allows physicians to select preferred procedures●Provide coverage and backup●Assist in clinical research



Add services such as lab and x-ray


Benefits of adding lab and/or x-ray:

Patient convenience

Practice convenience

Increases income

Provides quicker results

Results in better coordination

of care

Better patient outcomes



Add services such as Pharmacy


Benefits of adding Pharmacy:

●Patient convenience●Practice convenience●Increases income●Results in better patient outcomes (approximately 35% of patients do not fill prescriptions)


How to add a Pharmacy:

Register as dispensing physician ($150 +/-)Select only 10 – 12 most commonly used drugsSelect generics where possible and under $10Select a system that takes minimal space & staff timeWork with manufacturer, not a distributorPrice at around co-payDo not bill insurance

20 Rx/day x $5/Rx = $100/day - $500/wk - $26,000/yr



Add services such as a Sleep Laboratory


Example: adding a Sleep Lab:

Patient conveniencePatient retentionPractice convenienceIncreases incomeBetter coordination of careResults in better patient outcomes


Example: Additional revenues - Sleep Lab:

Convert exam rooms to sleep rooms (easy)Lab must be accredited or physician must be boarded in sleep medicine (usually C, P, N)

Select management company to start (provides equipment & tech support)

Sleep labs can also generate significant additional revenues in patient visits and titration studies

3 P/N x $700/P = $2,100/N - $1,350/N (mf) = $750/N ($195,000/yr)


Space that can be used for telemedicine!

Example: One physician has contracted with 24 day care centers to provide medical services!


What is telemedicine?

Telemedicine - delivery of health care by a physician to a patient using some type of interactive video technologyVirtually any medical service can be provided via telemedicine for follow-up or consultation purposes

Requires a secure videoconference system with high-speed internet connection and peripheral devices, such as electronic stethoscopes or otoscopes are commonly employed.

Most insurance providers cover interactive telemedicine consultations including Medicare, Medicaid, and most private insurance companies. Patients may still be responsible for a co-pay or deductible, the same as a traditional in-person visit.


Add services such as E-commerce:

Benefits:Enhances patient communicationEasy for patient and staffTargeted to service lines (diabetes, oncology, etc.)Increases incomeProvides portal for enhancing relationshipA means to providing better outcomes


E-commerce – how does it work?

Physician discusses product(s)Book: “Yoga for sore backs”Saw Palmetto supplements

Staff reviews recommendations with patient and indicates on tablet.Order sent to e-commerce store.

E-store receives recommendations and sends e-mail to patient. Patient can review cart and checkout.


Space that can be used for durable medical equipment

Advances in equipment design and size now allow for many common services to be available in-house


Space that can be used by other providers!

Space in your facility can be used by many different providers who may, or may not provide service to your patients. For example:

Space leased on off days or after hours to specialists

Space leased to labs (under investigation)

Space provided for group sessions/therapy

Space provided for patient education

Space provided for value added services


Finally - what can fast food restaurants teach us about efficiency?

Batch patients to streamline operations and maximize income!


Example: Diabetes

Set aside specific times for these patients

Scheduling and Diagnosing programs limits patient access

to these times

Set up in advance for all tasks necessary for this group of

patient’s particular needs

Maximize revenue/patient (orthotics, patient education,

cognitive studies, etc.)

A system can be created for each type of condition


The final category – savings!

We have already reduced absenteeism and turnover through our therapeutic environment – two huge barriers to efficient practice operations.We have reduced clerical staff through web based services, standardized systems, and EHR. Where else can we save money?


Energy & Utilities:

Energy saving methods:

●Energy efficient windows●Lighting & Daylighting●Low flush toilets●Water saving faucets●Maintenance●Added insulation●Highly reflective roof●Landscaping & Irrigation


Non Traditional Savings

Less understood savings

Energy Star

Tax credits

Property tax adjustments

Depreciation


For more information

Frank RicciHealthcare Realty & Development Services

300 N. New York Avenue, #2802Winter Park, Fl 32789

Ph: 407-947-5074Email: [email protected]

Medical design operational efficiency seminar.ppt

Health & Medicine

Transcript of Medical design operational efficiency seminar.ppt