Healthcare Realty & Development Services Guide to Operational Efficiency

HEALTHCARE Realty & Development Services
Building Foundations for the Future

HEALTHCARE Realty & Development
Discussion topics for today:
1. Physical Environment and Operational
Efficiency
2. Cost implications in selecting space
3. 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 caregivers
Provide culturally appropriate environment
Area seating, quiet rooms, conference
rooms for larger gatherings
Lighting and temperature control
Scheduling
Data entry
Payment 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
schedules
Patients find it easy to use
Capture patient data electronically
Verify insurance easily and in advance
Capture payment information
Possible to reduce staffing needs
CAPTURE SYMPTOMS & PROTOCOLS

Web based diagnosis!

Benefits to web based diagnosis
Reduces calls and interruptions from patients
seeking advice
Patients find it easy to use
Capture patient symptom data
Provide staff with possible diagnosis
Alert staff to potential emergencies
When 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 drugs
Select generics where possible and under $10
Select a system that takes minimal space & staff time
Work with manufacturer, not a distributor
Price at around co-pay
Do 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 convenience
Patient retention
Practice convenience
Increases income
Better coordination of care
Results 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 technology
Virtually 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 communication
Easy for patient and staff
Targeted to service lines
(diabetes, oncology, etc.)
Increases income
Provides portal for enhancing
relationship
A 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 Ricci
Healthcare Realty & Development Services
300 N. New York Avenue, #2802
Winter Park, Fl 32789
Ph: 407-947-5074
Email: HealthcareRealtyServices@gmail.com

Healthcare Realty & Development Services Guide to Operational Efficiency

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