Explore This IssueNovember 2015
Does it matter? Actually, it does.
“Good design is good business,” said Dan Greenfield, the founder of Health Space Design, a medical interior design firm based in Austin, Texas. “How does the overall function of your office impact the form?”
Having an updated medical office space can do several things for your practice. It can help you stay compliant with laws pertaining to privacy and accessibility, as well as allow for effective and efficient patient flow. Such elements can go a long way in helping your practice attract and retain patients. It can also improve staff morale, which can help streamline office operations and maintain good practices.
While patient care isn’t directly related to how modern a medical office is, physicians who pay close attention to their business’ bottom line may be thinking more about how the office looks, said Greenfield.
“In this day of declining reimbursements, doctors are under more pressure to be more business-minded,” said Greenfield. The look and feel of a doctor’s office may make a difference to some patients in terms of whether they return for a follow-up visit.
When it comes to office renovations, “many physicians think ‘I didn’t go to medical school to learn about blueprints,’” said Greenfield. “They are extremely educated and smart, but there are a lot of things they may not be aware of, such as the need to start a renovation project early by talking to a designer, and to have the right amount of space for current and future needs.”
Linking Decoration to Dollars
In the Affordable Care Act era, physicians are subject to the Centers for Medicare and Medicaid Services’ value-based payment modifier program, under which a differential payment is made to a physician or physician group based on whether quality care standards were met compared with the cost of care. In the past, reimbursements were made to physicians regardless of patient outcomes.
Some builders are seeing a trend in the use of higher-quality building materials, particularly in waiting areas, said Robert Titzer, executive vice president in the Corporate Real Estate Services and PrimeCare divisions of HSA PrimeCare, a real estate and healthcare firm based in Chicago. “Higher-level finishes make it more comfortable for people in some offices, with nicer artwork and small water features to dress up the waiting areas.”
Putting patients at ease is one way to help them move through the office efficiently, which helps physicians make more money from their space, because they can see more patients every day.
“If [physicians] can design the office so that a patient spends a comfortable, but not inordinate, amount of time in the waiting room, and then goes to the exam room, and then is checked out efficiently, the patients are stacked as they go through the flow,” said Titzer. “A doctor can go through and see one patient, and then the next, and not be waiting for someone to check out or check in. It’s designed to the extent that doctors can set up their offices for the most efficiency.”
“I don’t think I’ve ever done an office where it hasn’t been the case that business has improved after a renovation,” said Bruce Puffer, president of the design firm Professional Interiors in Plymouth, Mass. His company has worked on medical office renovations since 1995. “We ask our clients, and many report a 10% [to] 20% increase in patient flow.”
Designing for Law and Order
With passage of the Americans with Disabilities Act (ADA) in 1990 and the Health Insurance Portability and Accountability Act (HIPAA), first passed in 1996 and later fully modified to cover patient privacy in 2002, medical offices must consider legal standards before undergoing renovations. “Making things HIPAA compliant is a reason to renovate in itself,” said Puffer. “A lot of it is how people feel they are received and treated while they are at the practice.”
Maintaining patient privacy is important, and reception areas should be designed to give patients a sense of confidentiality. “With a multi-group practice, there can be maybe 100 patients an hour coming through, with multiple people standing around waiting to be checked in,” said Puffer. “You want to have more than just a check-in area to give a sense of privacy, and a place where more sensitive conversations can happen out of earshot of the waiting room, such as an area inside the reception area, called a check-out area, where you can interview somebody.”
There are HIPAA guidelines that specify how much space should separate waiting area seating from check-in areas and also address maintaining privacy in exam rooms so that conversations within them can’t be overheard elsewhere, said Greenfield.
To be fully ADA compliant, offices must have adequate space for people in wheelchairs to maneuver freely and must have bathrooms equipped with grab bars and larger toilet stalls for wheelchair-bound patients. Widening hallways and ensuring there is enough space to accommodate wheelchairs when doors swing open is also a consideration. Reception desks and check-out areas also need to have access that enables someone sitting down to be seen at the right height, said Puffer.
Modernizing and Morale
Making the office space easy to navigate helps not only patients, but also office workers. Puffer said he remembers when corridors were three feet wide in the 1970s, then widened to four feet six inches to help make them more accessible to those in wheelchairs. Today, he designs hallways up to six feet wide if they are for a multi-physician practice.
“The ADA rules are one thing, but you also have to take into consideration the size of the practice and the number of bodies moving through the space.” Such updates can also help boost staff morale, noted Greenfield. “It’s important to be vigilant that your office space is a place you will feel confident in,” both for the physicians and other medical office staff.
Otolaryngology practices may have to incorporate space for specialized equipment, such as an audiology booth or dedicated space for selling hearing aids, either within or adjacent to the medical office. For patients who may have equilibrium problems, soothing colors and textures rather than vertical lines or jarring patterns can be helpful, said Puffer.
Making both the clinical staff and administrative employees happy can help physicians run an efficient and effective business, while encouraging patients to feel that they are in the right place for their medical care.
“Ultimately, a physician’s office is a place to heal people, but it is also a place of business,” said Greenfield. “You want to get referrals and positive ratings online, which are becoming elements that people use to make decisions about their care. Patients are becoming increasingly more consumerist in their care.”
Cheryl Alkon is a freelance medical writer based in Massachusetts.