One of the most recent and greatest impacts under the Affordable Care Act, now includes the massive expansion of the Medicaid program. As a result, millions of Americans who were previously uninsured are now being provided with medical coverage. Simultaneously, with the significant increase in the Medicaid program, Healthcare providers have had to adjust to substantial reductions in their reimbursement structures. This shift, has driven more consumers to pay a larger portion of the cost of their medical care. With more consumers gaining greater access to care everyday – hospitals are faced with a dilemma of providing care to more patients, while simultaneously improving quality, and doing so at a lower overall cost for the consumer.

The consequence of this dilemma now forces a shift from the focus on a volume of care-based outcomes to a quality of care-based on outcomes. With the increased prominence and demand on patient outcomes, Evidenced-based Design (EBD) solutions should now be incorporated into all planning and design decisions. The EBD process will use credible research to impact design choices which clearly express those findings to enhance a wide range of outcomes. Without question, the ACA will impact the healthcare design landscape and it will alter the way a design team develops appropriate solutions. Much like the healthcare provider community, design teams will need to provide unique solutions that will result in providing more with less.

Doing More With Less
By incorporating Evidence-based Design principals, architects, engineers and interior designers can provide important design solutions which will help improve a Healthcare Facility. We all recognize that Ambulatory Care will continue to take on a much larger role in the delivery of healthcare. This will only increase as medical technologies continue to advance, which will only make it easier access for patients to interact with physicians through the use of phone apps and wearable technologies. Additionally, physicians will continue to migrate from a Private Practice setting, to a Group Practice setting, and even to Hospital based employment.

Ambulatory Care Facilities will provide a valuable alternative to cost-effective care, which will play a significant role in helping hospitals achieve their financial goals. Hospitals will be looking for facilities that are efficient to operate, convenient for the patients and provide an environment for high-quality care. The level of acuity being treated in Ambulatory facilities has been expanded tremendously, and the Facility Guidelines Institute for Hospitals and Outpatient Facilities are constantly being updated to reflect lower constraints in Ambulatory settings.

Combining the growing need to attract high-quality talent, will lead to hospitals to look more and more to physicians for input on state-of-the-art facility design features. Ambulatory facilities will continue to perform more complicated procedures, which will require design teams to understand this need during the design process. As a result physicians will look for opportunities to collaborate in an Ambulatory Clinic model. The trend will continue to decentralize away from larger hospital based care in support of Ambulatory Care Buildings. These type of facilities will incorporate community based primary care and immediate care, include imaging centers which incorporate MRI technologies. Medical and radiation oncology treatments along with rehabilitation services including retail pharmacies will be a high area of use.

What to Expect
The Affordable Care Act will continue to affect everyone in some way. As a result healthcare design will continue to undergo significant changes. Forced budget cuts coupled with the increase in the newly insured Medicaid population, will require healthcare systems to rethink how they will conduct business. Mergers and partnerships are here to stay, which will force facilities to continue moving from a hospital-centric model, to a patient-centric model, and ultimately to a remote-centric model in order to deliver quality care at a lower cost to the consumer. A renewed emphasis will be placed on integrating technology with Evidenced-based Design solutions, where Ambulatory care buildings will provide the alternative solution for the delivery of patient care.

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