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Seattle Healthcare Growth Focuses On Community-Based Care

The movement of patient care away from larger hospitals into smaller facilities is a well-developed trend, the speakers at our Seattle Healthcare Forum said, but it's really only just beginning. The goal, which is fundamentally affecting healthcare property development, is full integration of healthcare into the community.

The shift to ambulatory care—and the development of many smaller, non-acute facilities in recent years—continues for a number of reasons, our speakers said. For one thing, it's less expensive to build. Also, there are fewer regulations and it's easier to standardize the developments. But a more fundamental shift in healthcare is at work, with its movement away from large facilities into communities.

Shown: PAE Engineers principal Dave Williams, Perkins+Will managing principal Brad Hinthrone, University Mechanical Contractors director Steve Brooks.

As the focus in healthcare is shifting to wellness, healthcare designs are changing to be more patient-centric, the speakers said. Even so, the main challenge in designing new facilities is it's something of a matter of guesswork as to what medical facilities will need to be like even in five years. The potential for change, in medical tech and government policy on reimbursement, is too great to predict effectively.

One growing possibility is personalized medicine delivered in an outpatient facility, but supported by highly sophisticated biotech facilities that patients never see. Sustainable design is also increasingly important, since hospitals are tremendous users of energy. Creating systems and infrastructure to reach green goals isn't easy, especially in operational buildings, but the savings can be considerable.

Here are Wilsonart healthcare manager Mark Krejchi, CollinsWoerman principal Phil Giuntoli and Abbott Construction project executive Kyle Raschkow.

The movement away from acute care to community-based care is changing existing acute care space, our speakers noted. Hospital systems are moving lab and some other functions from hospitals to other facilities, and are looking to fill space with well-established, reimbursable activities, such as imaging. 

Really sick patients are still in hospitals, so it's more important than ever to design acute care right. Yet "acute care" it itself shifting as the definition of outpatient has changed—more complex procedures are now classified as outpatient. "You can have your hip replaced over your lunch hour," as one panelist put it, with only some exaggeration.

Cairncross & Hempelmann attorney Nancy Bainbridge Rogers, on the left, moderated.

The event included a panel of local hospital execs: Seattle Pacific Realty partner Jeffrey Rosen, who moderated, Virginia Mason Health System CEO Gary Kaplan and CHI Franciscan Health innovation officer Thomas Kruse.

The executives said payment reform is driving most change in the healthcare industry. For every dollar that goes in, only two and a half cents go to the bottom line. So healthcare is a high dollar, low margin business, and thus very sensitive to changes in payment models. Also, consumerism in healthcare in increasing, since patients are paying for more of their healthcare, making them more aware of their spending. The shift to ambulatory care and Obamacare are driving change.

The move from volume to value is just getting underway. Even today, fee-for-service is the rule. Many hospital systems want to see the movement to value accelerated, especially those that pride themselves on their high quality. Appropriate care is an essential component of quality care.