Worcester Business Journal

www.wbjournal.com August 17, 2015 • Worcester Business Journal 11 These risks are far less in an outpatient setting, where the stays are shorter and the patient base is, overall, healthier. Also, for the last four years, Medicare has been assessing readmission penalties on hospitals. This year, those penalties are expected to total $420 million nationwide, according to Kaiser Health News. Nearly 2,600 hospitals will receive lower payments based on their readmis- sion statistics, including three-quarters of Massachusetts hospitals, Kaiser reported. Hospitals across the spectrum contend that older or sicker patients skew their performance numbers and that should be taken into consideration in assessing readmission statistics. All this, plus the push to pay health- care providers based on medical out- comes rather than treatment of condi- tions, make it more lucrative for health care systems to establish and build their own satellite facilities. For example, UMass Memorial Health Care Inc. will build a $31 million, 40,000-square-foot ambulatory care center with nine oper- ating rooms in Shrewsbury to capture more of the same-day surgery patient base. It's being proposed as a joint ven- ture with Quincy-based Shields Health Care Group, which already has a work- ing relationship with UMass Memorial through two new urgent care centers in Worcester — a third is under construc- tion in Northborough and scheduled to open in October — that provide x-rays, MRIs and other services. The center's opening would result in the closure of 11 of its 51 licensed operating rooms in Worcester, but would not cause any staff reductions, UMass Memorial told the Telegram & Gazette earlier this year. Maugel Architects, in Harvard, has been working with hospitals and medi- cal facilities for 20 years. Among its current proj- ects are a 20,000-square- foot physicians' office in Harvard and a similarly sized outpatient facility in Sudbury, a satellite of Emerson Hospital in Concord. "There is a move away from centralized services, based at large academic medical centers, to a dis- tributed model where health care is being deliv- ered at the neighborhood level," says Jonathan Cocker, of Maugel, who manages the firm's health care busi- ness segment. "The hospitals are expanding into the primary-care market by setting up urgent care facilities and/or primary care facilities that are feeders to hospital services." Insurers' use of a preventive model, in which primary care doctors, rather than emergency rooms, deliver care, is also contributing to the economic viability of freestanding facilities, according to Cocker. That's because of the high cost of acute-care health services. "Massachusetts has the most expensive hospitals in the country," Cocker says. In response, hospitals are starting to own, or are being closely affiliated with, primary-care practices and urgent care facilities. "The hospitals handle the logistics of running the facilities and the doctors have more time to take care of patients," Cocker says. Brian Hamilton, a project executive who specializes in health-care building projects with Milford-based Consigli Construction, thinks it's all about the service. "Freestanding outpatient build- ings allow health care systems to move out of hospital things that don't require services the hospital provides," he says, resulting in a more cost-effective build- ing. He adds, "It's where people want to get the service. Outpatient service build- ings are situated in convenient places." Consigli's renovation project at Lowell Community Health Center is an exam- ple. Consolidating several workspaces in a 19th-century mill building into one created a 100,000-square-foot clinic, a cost-effective way to provide service to patients who had been without access to good health care. The clinic offers pedi- atrics, eye care and primary care func- tions that a hospital doesn't provide. Cancer centers are another example. Dana-Farber Cancer Institute, which has the brand and the treatment regimens, has spread that service west of its Boston base by establishing an affili- ate at Milford Regional Medical Center. That's a C onsigli project, designed by Steffian Bradley Architects, based in Boston. The trend had been to provide same-day sur- gery in an existing hos- pital building. But acute-care hospital buildings are expensive, due to the stringent building and fire-safety codes required by the federal Centers for Medicare & Medicaid Services, recognizing a hospi- tal patient base that cannot be easily removed from the building. Ambulatory facilities don't have to meet the same criteria since their safety standards fall between those of an acute-care hospital and a traditional office building. Another incentive that favors free- standing facilities: They don't require a more elaborate Determination of Need certificate, as do acute-care hospitals. Says Maugel's Cocker: "The hospitals make the decision whether or not to build based on market demand. If their analysis predicts that they can make money, they'll build." n Outpatient services may be just around the corner >> Continued from Page 1 MBA l MSA l MSOL YOUR FUTURE IS WAITING. WE'LL INTRODUCE YOU. GRADUATE & PROFESSIONAL STUDIES gps.nichols.edu | 800-243-3844 NIC150802_GPS_9x6_FINAL.indd 1 8/6/15 3:03 PM UMass Memorial Medical Group's outpatient facility in Harvard. P H O T O / C O U R T E S Y M A U G E L A R C H I T E C T S I N C .

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