Planning Neighborhood Hospitals

Wednesday, January 2, 2019
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Neighborhood hospitals, often referred to as micro-hospitals, are popping up in many areas of the country as health care systems strive to grow and add value for patients. When planned and designed appropriately, neighborhood hospitals can be an economically efficient way to improve access to care and provide essential health services to the surrounding community.

Q&A: Strategically Planning and Designing Neighborhood Hospitals
ASHE recently interviewed Phil DeBruzzi, FACHE, to discuss neighborhood hospitals and some of the planning and design considerations essential for this unique type of facility. DeBruzzi is a managing director at Ankura and has been consulting and advising health system executives for 25 years. DeBruzzi’s forward-thinking view of a health system’s objectives aids his operational planning and strategy work, helping executives develop facility strategies that will support growth and success into the future.

Q: What is a neighborhood hospital?
A: (DeBruzzi) A neighborhood hospital is a small platform hospital that has some key components: an emergency department, 10 to 12 inpatient beds, diagnostic services and, often, procedural services such as surgery. Sometimes a neighborhood hospital will have complementary outpatient services such as a wellness center or clinics. Neighborhood hospitals are typically 20,000 to 40,000 sq. ft. and between $15 to $30 million facilities.

Q: Where are neighborhood hospitals popping up?
A: (DeBruzzi) We are mainly seeing neighborhood hospitals in the western half of the United States in non-CON states. However, many health care systems across the country are considering them.

Q: What are the benefits of neighborhood hospitals?
A: (DeBruzzi) Neighborhood hospitals benefit patients by providing accessible, intuitive, and close-to-home care. Neighborhood hospitals benefit health systems because they are capitally efficient and quick-to-market facilities. They can effectively help large systems fill in market gaps where they don’t have a presence.

Q: What makes a neighborhood hospital successful?
A: (DeBruzzi) The most successful neighborhood hospitals are the ones that can effectively leverage the larger health system’s resources and infrastructure while remaining extremely consumer friendly. They act as an extension of the health system, not as a separate entity that duplicates clinical and support services.

Q: What are the top planning and design considerations for neighborhood hospitals?
A: (DeBruzzi) The top three [considerations] in my opinion are:

  1. Ensuring that you have an effective planning team that can think appropriately and strategically about what a neighborhood hospital should be,
  2. Leveraging virtual medicine/telemedicine capabilities to take advantage of the larger health system’s resources, and
  3. Creating a sound business plan.

Q: What has changed in regard to neighborhood hospitals in recent years? What trends are emerging?
A: (DeBruzzi) Regulatory requirements continue to evolve. There are more clear definitions around what it means to be a neighborhood hospital and the conditions one must meet to receive Medicare reimbursement. For example, to participate in the Medicare program, facilities must meet the “Conditions of Participation” and must be “primarily engaged” in providing inpatient care.

In terms of trends, more neighborhood hospitals are including wellness or community space within their facility. They are aiming to become more integrated with the community, effectively supporting population health. Additionally, technology is becoming more robust as virtual care becomes a more accepted way to access health care.

Q: What is one of the biggest mistakes a planning team can make in regard to a neighborhood hospital?
A: (DeBruzzi) Planning the same way as a traditional hospital is a mistake. The two hospitals are very different and if you plan them the same way or utilize a similar thought process, the neighborhood hospital will end up with a lot of components that aren’t needed. There’s a risk it will be oversized and operationally inefficient.

Q: What are some innovations a planning team should consider?
A: (DeBruzzi) One of the most innovative things a neighborhood hospital can do is design to be expandable. If a facility is planned correctly, it may start as one thing (such as an ED) but can effectively phase into a neighborhood hospital as the market conditions warrant.

The design should also allow for efficient staffing models. If certain departmental relationships can be established, staff can be shared as patient care demand increases or decreases.

Q: What stakeholders should be involved in planning a neighborhood hospital?
A: (DeBruzzi) The planning team should be multi-disciplinary and should include strategic planners, an architect, a contractor that is in the market, a health care facility manager, and the key administrative executives from the health care system. The planning team should always include a certified Six Sigma member who can make sure the plan is efficient.

A: (DeBruzzi)

Q: What can attendees expect from your session at the 2019 PDC Summit, Neighborhood Hospitals 2.0: Whats Changed from a Regulatory and Planning Perspective?
A: (DeBruzzi) I will be co-presenting with Rod Booze, AIA, NCARB, ACHA, partner at E4H Environments for Health Architecture. Attendees can expect a dynamic and engaging conversation around neighborhood hospitals, key operational areas, and clinical innovations. Our session is extremely comprehensive and not just about the design aspect. Attendees will be able to apply the lessons learned to any type of project, not just a neighborhood hospital.

Attend DeBruzzi and Boozes session and network with more than 3,500 like-minded peers at the 2019 PDC Summit. The theme, “Connect the Dots. Collaboration in Health Care Planning, Design & Construction,’ will allow you and your team to develop skills and discover strategies to push your facility forward.