Archive for month: November, 2017

Five Things To Remember When You Have A Lease Coming Up For Renewal

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201711_03

  1. Give yourself enough TIME prior to expiration.
  2. Consider several ALTERNATIVES to your current space.
  3. THINK LONG TERM as well as short term.
  4. REVIEW the LEASE DOCUMENT even if you renew.
  5. Use the renewal or relocation as a time to RETHINK OFFICE OPERATION.

 

  1. GIVE YOURSELF ENOUGH TIME PRIOR TO EXPIRATION.

Make sure that you start the process early enough so that you will have enough time to properly evaluate alternatives. Don’t short change your practice by allowing too little time. As with anything else it is always better to have more time. If you start too early you can always slow down but if you start too late the advantage goes to the Landlord which you don’t want to do. What is enough time? To figure this out in your particular situation estimate how much time each component of the process from the initial search for alternatives, to lease negotiation and finally buildout will take. In the case of a 5,000 sf lease space you should figure on 30 days to determine what options are available. It is a good idea to find five or six options which might work. Figure another 30 days to work thru those options which would included doing test fits on the top two or three options. Efficiencies differ between different buildings and floorplates.

  1. CONSIDER ALTERNATIVES TO YOUR CURRENT SPACE.

Take the time or hire a professional medical office broker to find a reasonable number of alternatives. After identifying five or six possibilities tour the buildings paying particular attention to such thing as visual appeal of the building ingress and egress to and from the building, the total number of parking spaces available in the building (4 spaces per 1,000 square feet of leased area is a minimum however ideally you would like 5 or 5 per 1,000. Parking is the silent killer of a practice. If there aren’t enough spaces patients will be late for their appointment, they will be upset at having to drive around looking for a space and upset because they were harassed by staff for being late to the appointment. Many times they won’t complain but just not come back. Once you have toured the options and made notes send out a request for proposal (RFP) to each option telling them what information you want. The idea behind an RFP is to get identical information from each option so that you can make an apples to apples comparison. Buildings will naturally try to give you information in a way that makes their property look good but if they are successful that makes the job of comparing them much more difficult. Once you receive the proposals from the options you will want to put the competing buildings on a spreadsheet and compare them both in terms of their economics and the more subjective issues such as appearance, ingress/egress and parking.

  1. THINK LONG TERM RATHER THAN JUST SHORT TERM.

Concurrently with the RFPs you will want to do test fits with the best two or three options. This will tell you how each option actually lays out and how efficient they are relative to one another. In doing a test fit and looking at a long-term design for your space you will certainly want to think about the things which currently work in your space and those things that don’t. Do you have the right number of exam rooms? Does the reception area have enough seating?  Does the office still flow efficiently? What worked well for the practice five or ten years ago may not work now. Offices are generally designed along one of two ways. The “pod concept” where the exam rooms serving a particular doctor, the doctor’s office and the doctors nurse or nurses are all bunched together in a pod. The other concept “non grouped” which seems to be regaining favor in the current changing medical environment is to have all of the exams together with the nurses station and have the doctors all together apart from the exams, using charting stations interspersed among the exam rooms. This concept allows more flexibility in assigning different numbers of exam rooms to different providers which may be a function of the patient load or how a particular provider works.

  1. REVIEW THE LEASE DOCUMENT EVEN IF YOU RENEW.

A year before your lease comes up it is a good idea to get out your lease and review it to refresh your memory on what the sequence of events will be regarding the renewal of your lease. Are there any renewal options specified in the lease? This will usually be spelled out in the Special Stipulations section of the lease. If there are options how long before renewal do you need to give notice of your intent to renew. What in addition to the ability to renew does the renewal option describe such as a specific renewal rate or other items which are specified and have been pre-negotiated. An option only grants your practice the right to renew not the obligation. You will want to look at the market to determine if the renewal option is advantageous for your practice. If the renewal option is clearly advantageous then it may make sense to look at alternative spaces and begin the process of negotiating between the options to determine the best avenue for the practice.

  1. USE THE RENEWAL AS TIME TO RETHINK OFFICE OPERATION.

During the process of considering a renewal it is a good idea to take a global look at the operation of the practice, and not just as it relates to the office space. Since a renewal may not involve additional square footage many practices just sign the renewal amendment and move on. However, a renewal marks three, five or even ten years since you have seriously looked at provisions in your lease. As you know there have been significant changes in the healthcare system which have had an effect on how your practice operates and possibly how your office space should function. Also with a renewal or relocation you should not just look how things effect your practice today but rather you should be looking at your needs 2, 3 or 5 years down the road.

In considering your long term needs you should consider such things as whether your phone system continues to be adequate for the operation of the practice. You might consider whether your computer system adequate for the demands of the practice in 2017 and beyond. There will be a range of issues which will be specific to your practice.

The bottom line on how to address an upcoming renewal is that you should begin early, take a careful look at whether your current space is adequate for your needs today thru the end of the renewal term, and use the anniversary to consider things that relate to your office space and maybe a few larger issues that relate to the practice. Good luck. If you don’t have the time to do an adequate job, consider hiring a real estate professional to take on some of the time consuming aspects.

FGI’s 2018 health care facility guidelines open for public comment

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Revisions to the guidelines include new standards for emergency preparedness, operating rooms and more

The Facility Guidelines Institute has released its proposed additions, changes and deletions for its 2018 editions, which include three books this year; Guidelines for Design and Construction of HospitalsGuidelines for Design and Construction of Outpatient Facilities, and Guidelines for Design and Construction of Residential Health, Care, and Support Facilities.

FGI’s documents, which are updated every four years to keep up with changes in the field, have provided fundamental standards for the design and construction of various health care facilities since the 1940s. Some of the major changes to this year’s books include:

  • New guidance on design of telemedicine spaces
  • New design requirements for accommodations for care of patients of size (formerly bariatric accommodations)
  • Imaging room design requirements using a classification system based on procedures performed and patient acuity
  • Identical requirements for operating rooms in outpatient surgery facilities and hospitals
  • More flexible pre- and post-procedure patient care area guidance (allowing provision of one, two or three spaces, depending on operations)
  • Two options for sterile processing area design
  • Expanded sustainability requirements regarding waste minimization, potable water and energy efficiency

The organization’s multidisciplinary 100-member Health Guidelines Revision Committee (HGRC) has also proposed revisions for its Provisions for Disaster chapter within the Guidelines for Design and Construction of Hospitals. HGRC has proposed retitling the chapter as Emergency Preparedness and Management. Proposed changes within the chapter mainly focus on hospital resiliency, or the ability to “absorb and recover from adverse events,” such as a hospital’s ability to: adapt to changing conditions, recover from disruptions, resist probable deliberate attacks, improve technical and organization capabilities, focus on reducing damage and disruptions to public health and safety.

The proposed emergency preparedness changes also touch on allocating hospital space to act as a shelter where patients, staff and visitors can go for safety, as well as having space for emergency supplies and resources.

The revisions echo some of the major points included in the Centers for Medicare & Medicaid Service’s (CMS’s) recently released emergency preparedness requirement, which has three key goals: safeguarding human resources, maintaining business continuity and protecting physical resources.

“In light of the new CMS rule, we’d like to make sure we aren’t conflicting with that,” says Douglas Erickson FASHE, CHFM, CHC, HFDP, chair of the 2018 HGRC. “So we absolutely want people to take a look at that rule and our new draft guidelines and give us feedback on the proposed changes.”

The 2018 Guidelines revision cycle will yield three documents, one for hospitals, one for outpatient facilities and another for residential health, care and support facilities. FGI developed an electronic comment system for each book, and the organization says the public can access the drafts at its website. FGI specifically is asking commenters to weigh in on the costs and benefits of any changes to the draft text, which will be reviewed by its Cost/Benefit Committee.

The public comment period closes Dec. 12 and comments are restricted to proposed changes, including deletions, revisions and new material.

“Although we are only in the middle of revising the FGI Guidelines documents, HGRC members have been putting forth a yeoman’s effort to verify the need for existing requirements and validate newly proposed language,” Erickson says. “Now we need users of the Guidelines to review the draft documents and provide comments, supportive or constructive, for consideration by the HGRC during the final stages of developing the 2018 documents.”

September 29, 2016
Jamie Morgan

The Healthcare Industry Faces Ongoing Communication Challenges

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Healthcare professionals themselves are up on the latest technology. A recent study by Spyglass Consulting Group found that 96 percent of licensed physicians in the U.S. regularly use smartphones as their primary device to communicate, manage their personal and professional workflows, get news and information, and browse the Internet for medical-related information.

Healthcare facilities, however, are not. Spyglass also found that fully one-third of the 950,000 licensed physicians in the U.S. are still required to use legacy alpha-numeric pagers for work-related communication. Even worse, that especially applies to those involved in critical and rapidly-evolving specialties such as emergency/trauma, critical care, surgery and radiology.

It’s not that anybody wants to use pagers, but at least they’re secure. According to an article in InformationWeek, Atlantic Health System found that over half its clinicians were using insecure SMS text messaging despite repeated warnings from the IT staff.

“We are blue in the face telling our clinicians and nurses, ‘You can’t do this. SMS is not safe,’” said Linda Reed, CIO at Atlantic Health. But, she added, “At the end of the day, not doing it is not practical.”

And that’s only half the problem. Nurses are often overlooked when it comes to analyzing healthcare communications. A Kansas University Medical School survey revealed that 92 percent of nurses said their most common forms of communications at work were face-to-face and telephone conversations.

This is a situation that has to change. Even as modes of treatment have undergone dramatic technological improvements, healthcare institutions have vastly under-funded upgrades to their communications technology.

That’s a costly oversight. The Joint Commission, which accredits and certifies U.S. healthcare organizations, has found that ineffective communications were the primary cause of more than 70 percent of treatment delays and unexpected deaths or injuries.

A study by the Ponemon Institute found that clinicians lost more than 45 minutes per day by relying on pagers and other outdated communications technology. The decline in efficiency cost the U.S. healthcare industry more than $5.1 billion annually, according to Ponemon.

Further, the healthcare profession is under more pressure than ever before to increase efficiency. There are some 75 million baby boomers to care for, and they are starting to reach retirement age, requiring more complex medical care from more specialists. The Affordable Care Act also adds new regulations that beg for more efficiency. Medicare and Medicaid may reduce payments to hospitals with too many patients readmitted within 30 days. There are also pay-for-performance incentives and new patient-centered care models that would benefit from better communication between patient and care provider.

Clearly, 21st Century medicine has a critical need for 21st Century communications technology.

Paul Mancini
Fall 2017

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