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Revista
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Attendee Comments

     
 

"Good variety of speakers, topics"


"Expertise of the speakers"
 

"The variety of relevant topics that were covered. There is something relevant for everyone- designers, CM, healthcare clients, real estate owners, trend setters, challenges, etc"

"The IoT Panel and FGI"

"Inside" information"

"Thank you for a stimulating conference"

"Ability to connect and network"

"Up to date information on a variety of healthcare issues"

"FGI changes, and the What's Next for NYC Real Estate sessions"

"Informative, easily accessed location. Thank you"

"The Joint Commission speaker"
"How organized and efficient the sessions were"

"It was very well thought out - not much room for improvement"

 

 
     
     
    New York 2017 - Post Summit Recap
 
 

 

 

 

Key Takeaway Messages

 
  Reported by Theresa Walsh Giarrusso, freelance writer & contributing editor to The McMorrow Reports for Facilities Design and Management (www.mcmorrowreports.com)
   
 
  Where is Healthcare Going?
  Alan Whitson, President of Corporate Realty, Design & Management Institute
 

TAKEAWAY MESSAGES

  • The shift to outpatient care facilities is accelerating.

  • Outpatient Facilities = Hospital level; Hospitals = ICUs

  • Increases in 65+ population will result in more physician visits and higher demand for healthcare.

  • Economics are changing as Baby Boomers move from private insurance to Medicare. Private Insurers pay 144% of costs, while Medicare pays 88% of costs of services

  • Over 80% of patient visits involve two or more people. The physician visit is an ineffective use of both patients and physician’s time.

  • Only 16% of a patient’s time during the average visit is with doctor, and this has a disproportionally negative impact on the poor and elderly.

 
  How EHR, Big Data, IoT, and new Medical Technologies are Reshaping Healthcare Facilities
  Daniel Barchi, Senior VP and Chief Information Officer at New York-Presbyterian:
 
 

TAKEAWAY MESSAGES

  • New York-Presbyterian has two primary data centers in New Jersey, but more often data is going to the cloud. “I really don’t want to be in the data center business.”

  • NY-Presbyterian’s big push is into telemedicine. “We’re more and more keeping people out of the hospital,” he says. “We would prefer that people not even come.”

  • New York-Presbyterian had 10,000 telemedicine visits this year, and has set its goal for next year at 100,000 visits. Ultimately, their goal is to have 15 percent of all hospital visits through telemedicine.

Dusty Majumdar, VP and Chief Marketing Officer for IBM Watson Healthcare:
 
  • Big data can help with false positives. For example, normally if someone has a CT scan where the size of a tumor is inconclusive the patient would be sent back for CT and PET scans every few months, and eventually have a biopsy with possible complications. But what if the scanner could use analytics to compare the nodule to others and determine with a high probability whether it is malignant or benign? You could add a regular blood draw to search for signatures of cancer in the blood, and have a pretty conclusive, low-cost, low-invasive diagnosis.

  • The company is also working on using data to predict major episodes for patients with diabetes and heart conditions. By monitoring patients and uploading data, they can better predict problems.

 
  Your Health is in the Walls
 

Left to right:

Alfred Ojukwu, Technology Solutions Microsoft

Tracy Nichols, Regional Healthcare Manager, Steelcase Health

Elke Merz, Architectural Solutions Consultant, Steelcase Health

 
 

TAKEAWAY MESSAGES

  • Using Steelcase’s modular construction and Microsoft’s Surface, the companies are offering healthcare facilities a different way to build and interact with patients.

  • For example:

    • Palmetto Health has 1,835 beds in eight hospitals, and more than 1,000 physicians that handle over a million patient visits a year. To improve productivity, employees needed to mitigate the extra time required to login at each workstation and gain access to full EMR apps, not reduced function read-only apps.

    • The solution? Palmetto has equipped physicians with Surface 3-in-1 devices so employees have easy access to a tablet, laptop, and desktop experience with productivity-boosting implements including pen, voice, touch, keyboard, and mouse. Now employees are able to run Cerner Millennium EHR in virtualization, keeping them efficient no matter where they are.

 
  Never-Ending Compliance Challenges - Facility Guidelines Institute
  David B. Uhaze, RA, chairman-elect of the 2022 Health Guidelines Revision Committee (HGRC), and vice chair of the 2018 Guidelines
 

TAKEAWAY MESSAGES

  • The FGI Guidelines specifies minimum design standards for everything from room sizes to lighting, finishes, ventilation, etc.

  • The 2014 edition is now in use, and the 2018 edition is in final publishing stage.

  • The 2018 Guidelines Colloquium Recommendation was to split the standard into two parts:

    1. Fundamental Requirements – Minimum/Baseline standards that can be adopted as code by AHJs. Further divided into books addressing: Hospitals, Residential and Outpatient.

    2. Beyond Fundamentals – Emerging practices that exceed basic requirements.
       

  • Hot Topics for 2018 Include:

    • Design / clearances to accommodate patients of size

    • Pre-and post-procedure patient care areas – flexibility to combine areas and correct ratios

    • Procedure and operating room sizes that reflect space requirements for Anesthesia team and equipment requirements

    • Definition of “invasive procedure”

    • Guidance for when exam/treatment, procedure, and operating rooms are needed

      • Clearances and spatial relationships

      • Locations for procedure types

    • Classification system for imaging rooms

  • Sign up for the Guidelines newsletter at fgiguidelines.org

 
  Ten Must-Know Points About NFPA 101 & NFPA 99 2012 Editions to Keep Your Facility Safe and CMS-Compliant
  Eric R. Rosenbaum, PE, Vice President/Mid Atlantic Region, Jensen Hughes
 
      TAKEAWAY MESSAGES
  • NFPA 101, 2012 edition, replaces 2000 (four revisions of NFPA 101)

  • NFPA 99, 2012 edition, is the version directly referenced by CMS (with exclusions)

  • Be aware of these changes:

    • Risk assessment required

    • Retrofit sprinklers/existing high-rise hospitals using FSES may not pass

    • Explicit criteria applicable to rehabilitation projects (Chapter 43)

    • Inspection, testing and maintenance criteria changed

    • Suite criteria changed

    • Corridor/stair width criteria changed

    • Door locking arrangements clarified

    • Special hazard clarifications

    • Sliding and powered door added

    • Unoccupied service area criteria provided

 
  Most Frequently Cited Violations in Hospitals & Outpatient Care
  Larry F. Rubin, M.Ed., CHFM, CHSP, CEP, CEM, CHC; Life Safety Code Surveyor, The Joint Commission
 

TAKEAWAY MESSAGES

  • Get ready for change: In 2018, facilities are going to lose their accreditation.

  • If we see it, we cite it. Even though you fix it, inspectors still have to write it down. No more A or C categories.

  • TJC is trying to do away with Hospital Clarifications. If you don’t have it now, it’s not done.

  • They are also doing away with incorrect findings. The inspectors will call in to make sure they are marking the right categories.

  • Extensions are gone!

  • No more plan for improvement. Inspectors will NOT consider them—although they are good to have.

  • Use the pre-survey checklist. It’s exactly what the inspectors use. This is an open-book exam. Prepare your documentation this way as well.

 
  Construction Management and Infection Control
  Andrew Streifel, Hospital Environment Specialist at Carlson School of Management, University of Minnesota
 

      TAKEAWAY MESSAGES

  • Objectives for infection control during construction in healthcare facilities:

    • Be respectful of patients

    • Control aerosols

    • Maintain a clean environment

    • Prevent water damage

    • Respond to emergencies

    • Provide documentation

    • Ensure contractors, supervisors and workforce are trained and able to communicate

  • You do not want untrained workers in your facility. Streifel trusts the Carpenters Union with his projects. “The guys are trained and have the proper documentation to come into our facility. They are accountable.”

  • Good resources include “Best Practices in Healthcare Construction” from the United Brotherhood of Carpenters, and the “Guidelines for Design and Construction of Hospitals and Healthcare Facilities” from The Joint Commission.

  • Some of the problem prevention strategies are just construction management being proactive, such as: Provide bathrooms for the workers so they don’t urinate on the sheetrock. Provide break areas and trash cans so they don’t store food and wrappers in walls as they close them up. Have floor mats leading from projects so debris doesn’t spread. Have workers cleaning up as you go along so things don’t spread.
 
  Tips, Tricks & Hidden Traps to Avoid from In-the-Field Experts
 
  TAKEAWAY MESSAGES
 

Left to right:

Balazs Boldog, Cambridge Sound Management:

  • The question “How quiet was your space?” on the HCAHPS exit survey is often the lowest rated question by patients. Sound masking can increase your HCAHPS score by as much as 30 percent.

  • Sound masking is placed where you have unintended listeners, not where the conversation takes place. You don’t put it in the conference rooms, you put it outside the conference room.

Joshua Esposito, nora systems, inc.:

  • Get the technical reps involved early. Ours all have at least 30 years installation experience.

  • What’s going on beneath your flooring? A lot of people assume a skim coat is good enough but consider what equipment is going over it. Your floor will only be as good as your substrate.

Phil Russell, Planon:

  • Have a comprehensive database that keeps all compliance info in one place.

  • Universities and hospitals need to have all their data in one place and accessible on dashboards by students or patients.

  • For hospitals buying other hospitals, make sure you are buying their data as well.

Mark Izsa, Specified Technologies:

  • Identify where your overfill cable sleeves are. They are noncompliant once they start reaching 48 percent.

  • You do not want to add or remove putty or sealant from your firestop openings.

 
 
 
 
 
  The Outlook for Medical Real Estate
 

Left to Right:

Vicki Match Suna, Vice Dean & SVP, Real Estate Development & Facilities, NYU Langone Medical Center

Thomas Ahn, Vice President, Real Estate Division, Mount Sinai Health

Hilda Flower Martin, Principal, Revista

 
   
 

TAKEAWAY MESSAGES

  • Size of the Industry

    • Hospitals: 5,407 properties; 1.7B square feet; $605B total value

    • Medical Office Buildings: 33,387 properties; 1.4B square feet; $363B total value

    • Grand Total: 38,794 properties; 3.0B square feet; $968B total value

  • Top five owners in healthcare: Kaiser Foundation Hospitals (Oakland, Calif.); Welltower; Ventas, Inc.; Ascension Health Alliance (St. Louis), Hospital Corp. of America (Nashville, Tenn.)

  • Continued strong transaction volume

  • Private equity is now a net buyer

  • MOB Cap rates continue to compress, hospitals stable

  • Outpatient sector is largely user-owned

  • Outpatient building occupancy is stable long term

  • Construction pipeline is strong

  • Outpatient deliveries increasing (although with an odd dip in 2016 starts)

  • Off-campus development accelerating

  • Suna says they are creating certain facilities with specialties, such as women’s, men’s and cancer centers, but then creating ambulatory centers that are multidisciplinary. Ahn says he sees the same building trends.

  • When asked what is keeping them up at night, Ahn replies he’s concerned with maintaining his facilities through natural disasters and emergency planning. He mentioned the terrible events in Las Vegas and says we must be prepared. Suna agrees, saying, “We lived through Sandy. It had a devastating impact on our campus.” She says they have made huge progress and are comfortable with the work that they’ve done to protect that campus.

  • Suna says she is always looking for space. The top things she is looking for with space include:

    • Space they can own. If they can’t own, they prefer long-term leasing.

    • Ability to finance their own construction.

    • Proper due diligence on infrastructure.

    • Facilities that work with their brand.

  • Ahn says they only want to own and invest in land if it’s on their campus. They do not want to invest their capital in ambulatory facilities. He does work hard to find the right landlord. “A long-term lease is kind of like a marriage. We will walk away from a building if the landlord is not good,” he says.

 
  Connecting the Dots
 

Left to Right:

Tony Caputo, Principal, Practice Leader - Design, ARRAY Architects
Christina DeRose, Director Real Estate & Space Management, Weill Cornell Medical College
Louis Della-Peruta, Senior Project Manager, LF Driscoll Healthcare

 

TAKEAWAY MESSAGES

  • Caputo says it is invaluable to assemble your design team, build team and owner early in the process. “Even at the feasibility stage before it becomes a real project, it can be invaluable.”

  • Della-Peruta says that getting the construction team on board early can help you with due diligence on the space. They can look at the design and budget, helping you go through your project with live updates and value engineering while you’re putting your program together.

  • DeRose says Cornell University prefers to use its capital investment on campus so most of the off-campus space for doctors is leased. She says, “We’ll spend that money to make sure we fit in a medical space.” They make sure the end user is known and test fit the space while simultaneously negotiating the lease. Since doctors see patients at night and on the weekends, she always makes sure the buildings can meet their power and cooling needs at odd times.

 
  Job Order Contracting: A Remedy for Cost & Time Challenges in Healthcare
  Douglas Gayden, Director of Healthcare, The Gordian Group
 

TAKEAWAY MESSAGES

  • Only 2.5% of all global projects are delivered on time and on budget

  • Only 25% of projects are completed within 10% of the original schedule

  • Only 31% are completed within 10% of the original budget (Source: PricewaterhouseCoopers)

  • Job order contracting allows:

    • Indefinite delivery/indefinite quantity process (IDIQ)

    • Contractors to complete a substantial number of individual projects with a single bid

    • Tasks to be based on competitively bid, preset prices

  • From one competitively awarded contract, you can procure an indefinite number of projects.