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How Outpatient Care Environments are Impacting Healthcare Construction

Welcome to the second installment in my series of healthcare articles focusing on the changes in healthcare regulations and how they’re affecting the delivery of care and construction of medical facilities.

In my first post, I outlined the big picture of the shift in construction for healthcare and the three trends impacting the industry.  To recap, the trends are:

  • Shift to wellness care
  • Changing payment models
  • Rise of the hub and spoke delivery model

In this segment, I will discuss the growth of outpatient care environments, and we'll take a look at free standing emergency departments (FSEDs) and micro hospitals, which are a couple specific examples of the second ring of the hub and spoke model, and how they fit into the delivery of care. But first, let's review the three rings of the hub and spoke model in more detail.

Rise of the Hub and Spoke Delivery Model

As healthcare regulations have evolved, so too has the delivery of care and the facilities that are being constructed to provide it. Healthcare services range from complex, acute care operations for serious illnesses and long-term care to quick, convenient care for minor illnesses such as a cold or a routine immunization.

The more complex services and facilities make up the central ring of the hub and spoke model, and they branch out to outpatient care environments for specialized services, and finally to quick care environments for the least complex care. 

1st Ring (Hub):  Complex and Long-Term Care

  • Services and Care:  general hospitals, specialty hospitals, education, rehabilitation centers, teaching facilities, hospitality, retail, food, diagnostic and treatment centers, spiritual spaces, open space, courtyards, community-based wellness centers, and clinics
  • Facility Types:  multi-specialty hospitals, campuses, and healthcare villages

2nd Ring:  Outpatient Care Environments

  • Services and Care:  primary care, secondary care, urgent care, emergent care, micro hospital services, and complex multi-specialty care
  • Facility Types:  free standing emergency departments, ambulatory surgery centers, urgent care centers, community care centers, micro hospitals, medical office buildings, and multi-specialty centers

3rd Ring:  Quick Care

  • Services and Care:  physicals, immunizations, cold and flu clinics
  • Facility Types:  private practice offices, retail stores, drugstores, and grocery stores


Healthcare Hub and Spoke Model

As the delivery of healthcare becomes more decentralized, we're seeing an increase in the second and third rings of the model. Outpatient care environments in particular are experiencing the most rapid growth. One reason is that there are so many different types offering such a broad range of services - just look at the examples above.

These environments range from medical office buildings to urgent care centers to micro hospitals, which all vary in complexity, so understanding them can be very confusing! However, if we understand that their growth is due to a shifted focus to wellness care with easier access, it all starts to make sense.   

Shift to Wellness Care and the Increase in Community-Based Care Facilities

The shift to wellness care has brought on the emergence of community-based care facilities with the intent to deliver care closer to the incident. Two examples of such facilities are free standing emergency departments and micro hospitals. Although these types of facilities are not perceived as direct wellness care, they are directly linked as they bring the point of delivery of care much closer to home.


Free standing emergency departments and micro hospitals are typically located in populated urban and suburban environments. This allows communities to have several care centers near people’s homes rather than relying on a central hospital, or hub.

These healthcare facilities are popping up in neighborhoods all over the the country, and you can identify them easily by many of their unique building characteristics, such as:

  • Signage designating the type of care the facility provides (emergency care, urgent care, community hospital, etc.), as required by most states
  • Signage, as required by ACA and CMS rules, that says “Emergency” and other such designators like “24-7 Care” or “ER”
  • Covered emergency ambulance entrance
  • Drive around building access for fire department and ambulances, to comply with health and regulatory codes
  • Presence of on-site backup generators

Micro and community hospitals share many of the same characteristics with FSEDs. In addition, they are often two story buildings containing 20-24 beds and may include a surgery center entrance.

Many of these types of buildings are developer-led and funded with private money and then sold or leased back to a health system organization. For example, the FSED below was built by a developer and was sold to the University of Colorado health system. It is now being staffed, licensed, and operated under them.


Growth of Outpatient Care Environments in Healthcare Delivery

It’s apparent that the second ring of the hub and spoke model is where the activity is today. We can see this in the shift to wellness-based care and community care centers such as free standing emergency departments, ambulatory surgery centers, and community hospitals. We expect this to continue to be the area with the greatest level of activity for the next 3 to 5 years.

Over a three year reporting period from 2012 to 2015, the percent share for projects of this type went up 15%. Dependent upon whose statistics are cited, we can confidently report that the vast majority of all surgical procedures in the U.S. are now being done within the outpatient environment.

And, as evident in the examples we’ve discussed, you’ll see how these procedures are being “captured” closer to the initial point of care – closer to our collective rooftops. This reflects the activity shift from the hub (centralized hospital campus) to the second and third rings of the model of services.

These facilities are being financed, planned and built with greater frequency. But this is all new, and we have yet to see if they can be financially viable in this new economic model, particularly with downward reimbursement trending by CMS (Centers for Medicare & Medicaid Services).

In the near future, we'll cover this very important question. In the meantime, subscribe to our blog today to be sure you don't miss this or any other essential upcoming building solutions content.


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