Healthcare industry veterans shared their perspectives on the state of the local healthcare market and healthcare facilities at MWM’s 2020 Healthcare Summit on Wednesday, March 11 at the headquarters of event host, JE Dunn Construction.

Panelists Doug Weltner, executive vice president at Colliers International, Matt Jennings, architect and regional director at BSA LifeStructures, Lynette Wheeler, chief operating officer at Truman Medical Centers-Lakewood and David Feess, president and CEO at Liberty Hospital, discussed topics ranging from behavioral health initiatives, patient satisfaction scores, health and wellness programs and the use of technology to deliver healthcare services. Shelly Koehler, vice president and healthcare group manager at JE Dunn Construction, moderated the panel.

THE STATE OF THE LOCAL HEALTHCARE MARKET

Shelly Koehler: Last year at the [Healthcare] Summit, we talked about the trend toward hospitals having outpatient facilities and moving more toward urgent care facilities. This year, we’re seeing hospital partnerships and mergers. We’re seeing some metropolitan hospitals set up clinics and more patient care in some of the suburban areas, and we’re also seeing some larger healthcare projects popping up that we haven’t seen in quite awhile.

Doug Weltner: When we did Mission Farms, initially we had 180,000 square feet of retail. That all went down the tube with the ‘08 recession, and we’re now down to 50,000 square feet of retail. Fortunately, the new retail for us became the health systems and health care. It’s kind of slowed down a little bit, the whole medical office thing, because of the consolidation of health systems and physician owned practices. From our standpoint, we’re not dealing with the individual doctors, but we’re dealing with the health systems and how they are going to supply their system and their physicians with spaces in the future.

Shelly Koehler: Fifty percent of doctors are now employed by a healthcare system.

David Feess: Patients want convenience, so that’s really why you’re seeing the trend to more and more outpatient facilities. You go into a large hospital, it’s hard to find things and it’s complicated; so convenience is very important to a patient. As far as physicians, (when) you talk to most physicians coming out of training or medical school, they do not want to go into a private practice - they want to be employed. Most of them have large loans and they don’t want to buy into a practice, so they are really looking at what can they do to affiliate with a larger health system or a larger practice.

Matt Jennings: We’re seeing an awful lot of clinic work. We don’t see much private physician practice anymore. It’s all associated with the systems they work for. It has to do with convenience, It has to do with being out where the folks are. That’s where we’re building.

HEALTH SYSTEM CHALLENGES

David Feess: Workforce is a huge challenge as we look for clinical staff, nurses and physicians, across the board. The good thing about healthcare is that it’s not going to go away. It’s going to be driven by the payment system and how healthcare is delivered. Access to capital is always going to be a challenge for health systems. Health systems generally run with a very, very small margin—one or two percent—and many times, you may be losing money in a particular year.

Lynette Wheeler: We have a 188 licensed bed long-term care facility and our biggest challenge right now is (staffing) certified nursing assistants. One of our other biggest challenges is capital. Because we are a safety net hospital, last year we were running about $143 million gap in what our cost of care is versus what we get reimbursed. That gap has to be paid by us.

David Feess: I really can’t think of a more complex, regulated, constantly-changing business than what is happening in healthcare. Every four years [with the election], we have to plan for change.

IMPACT OF DEMAND BY CONSUMERS

Lynette Wheeler: The electronic health records [of healthcare systems] are on different platforms. But if we were all on the same platform, then people could go from one place to another and that health record would follow them. Right now we’re not all on the same platform so we can’t share data as easy as we’d like to. The consumers are going to demand it because they are going to want to be close to home. If they need a specialty service that might be miles away, they want that record to follow them. It’s going to be complicated. Reimbursement is difficult, but I see consumers driving.

DEMAND FOR BEHAVIORAL HEALTH SERVICES

Shelly Koehler: We’ve seen quite a demand for behavioral health facilities. We’ve seen it shoved aside for 15 or 20 years. Yet even as we see these facilities increase, the need for them has increased greatly. Yet, we’re still lacking on reimbursement to get people help when they need it.

Lynette Wheeler: There’s a crisis. There really is. Trying to get reimbursed for simple things like depression, let alone complicated schizophrenia or PTSD. There are very few behavioral health inpatient beds in this community. Try finding a psychiatrist. There is a shortage in this country of psychiatrists. Why do you think that is? Because of a lack of reimbursement.

PATIENT SATISFACTION SCORES

Shelly Koehler: The Affordable Health Care Act links patient scores to reimbursement.

Lynette Wheeler: It’s all about choice. Consumers have choice and if they don’t like what they got with A, they are going to go to B and they’re going to go to C, especially if they have insurance because that affords them to go anyplace they want. So we really spend a lot of time looking at the feedback, whether they are inpatient or outpatient. We monitor feedback of all patients that come into the facility, through whatever door they came in. We then develop plans based on what that patient population is telling us. How can we react to improve our services and be able to provide the coverage and the services they need to be healthy?

Matt Jennings: From the design side, most of the information we get from the [patient satisfaction] scores has to do with how patients are treated and their perception of how their healthcare is. One of the questions the patients are asked is whether the place is clean. We work closely with the facilities to understand how they clean it. So material selection is the obvious choice. Maybe one that’s not as obvious are the questions patients are asked about how they are cared for. We’re seeing a lot of time being spent on the design side to take care of the caregiver. If the caregiver is in a facility that is conducive to them being healthy, energetic, awake - the scores are better.

Doug Weltner: I think the one thing you see in all the newer hospitals or surgery centers that are being done by the health systems is almost a concierge approach. They’ve almost become more of a hospitality industry, especially with the short-term surgeries. Also, the maternity wards at these hospitals are incredible. It’s all about service, and you do really feel it now.

David Feess: It is really all about consumerism. I can remember when I started in healthcare, you had four patients in a room. Can you imagine anyone wanting to go into that room?

TREND TOWARD HEALTH AND WELLNESS

Davd Feess: We started an initiative called Norterre that was opened about two years ago. It has a 55,000 square-ft health and wellness facility and currently has about 5,500 members. So there is certainly a demand for that. It is a tough business from making sure you meet the customers’ needs at an affordable price point, but it is part of what we need to do as a health system. At the end of the day, it’s going to be how well do we keep people well, as opposed to treating chronic illnesses. The more we can do to encourage people to live a healthier lifestyle, so much the better for the collective.

Lynette Wheeler: Prevention is critical, but we’re reimbursed for illness. The system is rigged. You don’t get paid to keep people well; you get paid to treat the sick. We use all the tools available to keep us well and healthy and prevent illness even though we’re not paid as well for prevention. But, we don’t want you to be sick. We want to keep you healthy. You’ll live a lot longer.

Matt Jennings: We are seeing a lot of preventive stuff. We do see a lot of genome stuff. We do see a lot of stuff with precision medicines targeted toward you, and specifically to you based on simple tests they can do - or are beginning to do - that identifies a predisposition to a certain illness. It’s more than just eat better. Medicine is changing to handle wellness.

TECHNOLOGY TRENDS IN HEALTHCARE

Matt Jennings: From the design side, the hospital is becoming less and less the center of the universe, and the individual is becoming the center of the universe. Most of you are wearing fitness trackers. That kind of technology is centered on the person instead of the facility. We certainly have wearables now. I see stuff that’s implanted in you, stuff that they can scan. Wherever you are is your healthcare facility in the future.

Lynette Wheeler: One of the things is tele-health. We could have done it a long time ago because the technology is there. We didn’t get reimbursed for it. We could not figure out a way of how to pay the physician who was on the other side. But, that’s coming available now. You might be visiting with the physician that’s not even in the same city where you are located. You’re going to see more and more of that.

David Feess: I think tele-health will really be driven by the lack of providers. If you look at the rural areas, you have a lot of communities that don’t have physicians and healthcare providers so telemedicine becomes an attractive alternative to driving into the city. Probably the areas I see the greatest potential going forward is with genetic counseling. (For)A woman dealing with breast cancer, we have a genetic counselor that works with the woman and her siblings and children. We also use artificial intelligence to look at some of the aspects of breast cancer because there are so many different types of breast cancer so people don’t realize the complexities and how we can use technology to treat some of these diseases. I think that really holds a lot of promise in the future. It is expensive, but there are a lot of things that we weren’t able to do years ago.

Lynette Wheeler: The other big technology advancement is not brand new, but it’s the robot to do surgery. The surgeon might not be in the same city where you are, but that’s how far it’s going to go. The robot allows surgeons to sit at a control booth and they are directing the robot what to do. Once they’ve figured out reimbursement, you’ll have surgeons doing surgery in a different state, especially complicated, specialty kinds of surgery, and the robot will allow that to happen. Your length of stay is less. There’s less trauma to your body when they use the robot. It’s in and out. Incisions are small.

SENIOR LIVING FACILITIES AND THE COST CHALLENGE

Doug Weltner: It’s a hot industry right now, and it’s very profitable for the real estate developers and the operators. The biggest problem is that as the baby boomer population starts to move into senior facilities, it’s the cost to the tenant. You have independent living which is really just a fancy apartment complex, with food service and some transportation service. That’s $3,000 per month. Then you have the assisted living, that’s a minimum of $4,500 per month. Then you have skilled nursing and that’s a minimum of $7,500 per month. Then you have memory care, that’s $10,000 per month. There is nobody paying for this except the person that is occupying that space. Not everyone can afford that. It’s going to be a problem going forward. That’s going to have to be subsidized by somebody.

Matt Jennings: We’re starting to see as a national firm that as baby boomers are retiring, they’re healthier as a group, and some of them are healthy and have the funds to stay home. They want to stay home. We’re starting to see some very initial work on the design side renovating houses with a little bit of a healthcare bend—bathtubs, slip and fall stuff, no stairs, elevators, that kind of stuff.