Effective expansion means keeping doctors happy

Key to outpatient growth — location, location

As health care systems scurry to develop networks for HMOs demanding easy and convenient access for their members, physicians relations professionals (PRPs) can serve as an important member of the expansion team by advocating sites that will bring physicians to the new facility — and keep them there.

"A well-planned ambulatory care center can be used as a recruitment tool for doctors," says Howard Gershon, principal of Lammers & Gershon Associates, health care consultants in Reston, VA. "On the other hand, if a local physician’s business is lost to a competing freestanding center, significant revenues may be at risk."

Physicians Relations Update talked with two architectural firms that specialize in designing and constructing medical facilities to find out what physicians and their patients want in an ambulatory facility.

Topping the list, both firms agree, is location.

"Thirty years ago, location wasn’t much of an issue. If people wanted to see the doctor, they’d find you," says Ron Halverson, senior vice president for sales and project development for Marshall Urdman and Associates in Madison, WI. "Not so in today’s market." (For more information on what makes patients happy, see related story, p. 18.)

The firm uses convenience as the primary benchmark for helping health care systems locate new facilities. "We assume that patients in a metro area will drive no more than 15 to 20 minutes," Halverson says.

The site also must be easy to find, he adds. "We’ve found that locations in and around interstate exchanges are popular with patients because they can follow simple directions to get there easily," Halverson notes.

A location visible from a major or secondary traffic artery also is identifiable, says Joseph Strauss, AIA, CHC, vice president, Lammers & Gershon. "You want to select sites in areas that patients will be familiar with," he says.

Although freestanding centers away from the hustle and bustle of the hospital campus provide access and parking convenience for the patient, it may not always be the best choice to recruit and retain physicians.

For example, doctors who do most of their care on an outpatient basis generally prefer separate off-campus facilities because their work will not be delayed by inpatient demands, Gershon notes. "The efficiency of their operations is generally enhanced [by a freestanding center], he says.

But it’s more difficult to predict the preferences of surgeons who see both inpatients and outpatients. "Some will not be interested in adding a third facility at which to practice — the office, the hospital, now the freestanding facility," Gershon explains. "Others may appreciate the efficiency of an outpatient facility and the fact that it will help ensure customer satisfaction."

The best of both worlds may be what Gershon terms "hospital aggregated" or "hospital separate" models of ambulatory care services. "Both place service inside or near the hospital in order to achieve convenience for doctors and efficiency of services," Gershon says.

In the "hospital aggregated" model, outpatient services are provided within the hospital itself but on a separate floor or wing. "They are physically separated and perhaps organizationally separated from inpatient services," he says.

For example, the Medical Mall at St. Joseph Health Center is Kansas City, MO, is built on the front of the hospital. "It incorporates process redesign of scheduling, registration, pre-op testing, same-day surgery, and a host of other ambulatory care clinics within a stunning physical design resembling an upscale retail mall," says Gordon Docking, CHE, administrator of the medical mall.

To solve the parking problem, the hospital instituted a free, volunteer-operated shuttle to take patients and family members to and from the parking lot.

In the "hospital separate" model, outpatient services are provided in a facility located close to — but physically separate from — the hospital. The facility may or may not be actually connected to the hospital.

For example, St. Luke’s Episcopal Hospital in Houston built a 27-floor outpatient tower attached to the main hospital with a skybridge. Patients can use valet parking or self park on one of three floors in the tower. (For more information on St. Luke’s physician amenities, see related story, p. 15.)

Which one is right for your health care system? Neither is inherently better than the other, Gershon points out. Here are four recommended steps to make the best decision possible:

1. Clearly identify your organization’s objectives.

"Decide and state the most important objective, then rank alternative location models based on that goal," Gershon says.

For example, if your objective is to improve payer mix, consider an off-campus model because it allows you to access new geographic areas and facilitates patient satisfaction.

Halverson agrees. He asks clients to develop a five-year plan to define long- and short-term goals before shopping for a building site. Five years gives the facility enough time to grow, especially if part of that time will be consumed by construction, he says.

2. Conduct thorough market research.

"If you’re in an area where there are lots of young families, you’ll need obstetricians and pediatricians. But if you have an older population, you’ll need cardiologists, urologists, and other specialists in fields related to elder care," Halverson says.

3. Become familiar with local physicians’ practices.

In addition to studying patient demographics, you’ll also need to find how likely physicians are to use the new model. "If you build a new facility for ambulatory care, will doctors come? Will they change their practice patterns? says Gershon. "The only way to find out is ask."

4. Market the program.

"When you’ve developed the perfect outpatient facility, be sure to let your customers know why it’s perfect and how they’ll benefit from it," Gershon says. And remember that customers include payers, patients — and physicians.