The Center for Health Design Blog

CMS Reimbursement Policy Changes Looming

In October, the Centers for Medicare and Medicaid Services (CMS) will no longer provide reimbursement over and above the typical Inpatient Prospective Payment System rate for care required to battle several types of healthcare-associated infections, including:

1. Foreign object retained after surgery
2. Air embolism
3. Blood incompatibility
4. Stage iii and iv pressure ulcers
5. Falls and trauma
6. Catheter-associated urinary tract infection
7. Vascular catheter-associated infection
8. Surgical site infection-mediastinitis after coronary artery bypass graft
9. Surgical-site infections following certain orthopedic and bariatric surgeries
10. Certain manifestations of poor control of blood sugar levels
11. Deep-vein thrombosis or pulmonary embolism following total knee and hip replacements

Not reimbursing for this mix of hospital-acquired infections and National Quality Forum-endorsed “never events” are expected to save Medicare about $20 million a year.

I suppose that’s good news for us taxpayers, but not so good news for hospitals who are struggling with quality issues and those who serve a lot of Medicare patients. Not that hospitals shouldn’t be trying to do better (they should!), but improvement doesn’t always come easy. It takes hard work and commitment.

Of all these conditions, there is good evidence to support that the design of the built environment can help reduce falls and trauma by providing good views of the patient, better pathways to the toilet, etc. Creating less noisy, less cluttered workspaces also reduces stress on staff and can help eliminate errors during surgery or other routine procedures that are in the list. The evidence linking these outcomes to the design of the built environment is not quite as strong, but doesn’t it make sense for hospitals to consider everything that can be done to improve quality? And everything includes the built environment.

Most Powerful People in Healthcare

Modern Healthcare (MHC) came out with its “100 Most Powerful People in Healthcare” rankings last week. Readers voted Steve Case, co-founder of America Online and founder, chairman, and chief executive officer of Revolution Health Group, #1.

MHC reporter Jennifer Lubell wrote that “Case–whose primary objective is to empower consumers through various IT strategies–has apparently struck a chord with an industry worn down by soaring costs as well as questions about access and quality.”

Interestingly, Eric Schmidt, chairman and CEO of Google was #2, and Microsoft co-founder Bill Gates was #3. They were followed by politicians Hillary Rodham Clinton, Barak Obama, Edward Kennedy, Arnold Schwarzenegger, George W. Bush, John McCain, Newt Gingrich, and Nancy Pelosi. IHI’s Donald Berkwick was #17; AHRQ’s Carolyn Clancy, #30; and RWJF Risa Lavizzo-Mourey, #82.

What makes a person powerful? According to Merriam-Webster’s online dictionary, it means “having great power, prestige, or influence.” Power is defined as the “ability to act or produce an effect; possession of control, authority, or influence over others.”

No doubt those individuals mentioned above are indeed powerful in healthcare. But I wouldn’t necessarily say that they are powerful in healthcare design. Who would those individuals be? Perhaps we should do our own poll and ranking. Some who come to mind are Cheryl Herbert of Dublin Methodist Hospital; Christine Malcomb of Kaiser Permanente; Joe Sprague of HDR (AIA Guidelines); Kirk Hamilton of Texas A&M; Robin Guenther of Perkins & Will; and of course, there are many more.

Who do you think is powerful in healthcare design?

Timeless Design Updated

Back in 1990, we included the Community Hospital of the Monterey Peninsula in CA as one of the tours for our Third Symposium on Health Care Interior Design (the predecessor to our current conference, HEALTHCARE DESIGN). The hospital’s architect, Edward Durell Stone, was one of America’s premier modernist architects — and one of the few of his generation who “got” what hospital design should be about. He believed in providing comfort to patients by giving them access to nature through courtyards, interior and exterior landscaping, water features, etc.

Those are ideas we’re still talking about today. Stone also wrote that a hospital is “the toughest problem in architecture. It is as if every room were either a kitchen, a bath, or a boiler room. It’s not something you can design by remote control.”

I was delighted to see feature articles on the Monterey Hospital in the August issues of Health Facilities Management (HFM) and Architectural Record magazines. Both are thoughtful explorations of a new 200,000 sq. ft. addition designed by HOK that opened in 2007. Another 90,000 sq. ft. in renovated space is expected to open in 2010.

Record writes that the “firm’s major challenge was maintaining the Zen-like peacefulness and iconic design of a complex that has become a fixture in the community while carrying out such an extensive enlargement and modernization and adhering to the incredibly strict regulations of the Office of Statewide Health Planning and Development (OSHPD).” The writer also observes that the “original building’s focus on the natural environment is not only maintained, but even enhanced” — with a healing garden, hallways with floor-to-ceiling height windows, natural finishes, and large corner common rooms.

HFM’s assessment of the new pavilion design is similar, noting that the original patient rooms (which may have been the first all-private patient rooms in the U.S.) “were clustered in groups of four, with each group sharing a balcony overlooking a wooded area.” Patient rooms in the new pavilion do not have balconies, but larger windows to simulate the look of a balcony.

It’s good to see such an exemplary facility grow as its community grows and healthcare changes, but not lose what makes it unique. Edward Durrell Stone would be proud.