An expected explosion in patient demand will require health care facilities to adapt and expand. One opportunity is to reuse area retail and dark big-box locations to provide medical services.
America’s new health care legislation is expected to bring millions of new patients into the marketplace as it takes effect over the next four years. While these previously uninsured patients have used health care services sporadically, this new legislation will provide more affordable avenues for getting access to care than ever before.
Hospitals and health care complexes will need to expand and improve facilities to meet the anticipated explosion in demand—presenting an enormous business opportunity to developers, design firms, and other consultants who understand the marketplace.
Experts predict that by 2019, 95 percent of U.S. residents will be covered by health insurance, placing more than 30 million additional people under some form of insurance coverage. The number of patients served by community health centers could rise from 18.8 million in 2009 to 33.8 million by 2015, and nearly double to 36.3 million by 2019, according to a white paper analyzing the impact of the new health care bill on primary care services and the new funding scenarios, prepared at the Geiger Gibson Program in Community Health Policy at George Washington University in Washington, D.C.
Insurance companies will have to accept everyone, even those who were once declined for preexisting chronic conditions. A total of 133 million Americans, or almost half of all U.S. residents, are living with chronic health conditions, reports the Center for Disease Control and Prevention—a number projected to increase by more than 1 percent per year by 2030, bringing that population to 171 million. Those who are uninsured now will have insurance and be looking for alternatives to the health care access they have had in the past, which has been provided at emergency rooms or crowded public clinics.
In the next decade, 72 million baby boomers will become eligible for Medicare. Providers will require additional facilities and locations to serve this explosion in the number of new patients, and those patients’ wait times for health care providers will certainly increase.
This scenario presents opportunities. New hospitals are being funded and built, replacement facilities are being planned, and major acute care facilities are being expanded—but not quickly enough to handle the expected jump in the number of newly insured. As one might expect, existing hospitals will take the brunt of the new volumes and will need more service locations and space.
Health systems with limited resources now must compete with alternative providers, such as privately owned outpatient surgery centers and other competitive facilities that have the ability to change locations to be nearer patients, and to react quickly to changes in community needs and the types of services required. This has led to facilities providing more patient convenience at smaller, boutique medical facilities that have a retail feel in locations that are adaptable for building reuse.
Medical providers from coast to coast increasingly are considering locating services in existing retail and dark big-box locations—an approach that may be the most expedient for adapting to the changing demographics and new patient capacity required by the health care legislation. Also, these services can be provided in a more convenient location that meets the health care systems’ criteria for expansion of primary care and that also can serve as an outpatient center supporting primary care and some specialty physicians.
Older hospitals, though adaptable for new technologies, often are not in the best locations to serve outpatients. Often such patients must travel a long distance from home to reach a large hospital facility with poor parking and wayfinding signs, then wait for service interrupted by emergencies and inpatient service. Also, the renovation of a hospital is extraordinarily expensive and can interfere significantly with patient services.
One example of adaptive use of a large retail site is the Vanderbilt Health Care project, located at 100 Oaks Mall in Nashville. About 20 health clinics offering a full range of outpatient and physician services—including women’s health, cardiac care, and imaging—have recently moved into what was a dying mall, filling half the building’s 850,000 square feet (79,000 sq m) of space. The facility offers patients accessible parking, and shopping—as well as medical technology, including magnetic resonance imaging, computed tomography, digital radiography, and mammography.
The $99 million renovation by Vanderbilt has allowed the system to offer a new campus and a new concept—connecting services for patients to convenient locations that are branded to the system’s name. In addition, the existing shops in the mall, including retail stores, a food court, and a movie theater, have benefited from an increase in foot traffic.
The Vanderbilt facility is being used as a model for several expansion and adaptive use plans by other medical clients, including a strategic plan for the JPS Health Network in Fort Worth, which involves a hospital, a Level I trauma center, more than 50 health centers, school-based programs, and specialty clinics. The plan compares facilities use with extensive strategic and operational planning, resulting in new facility locations designed to ensure that JPS will effectively meet the needs of the community in the coming decades.
Many examples exist of health systems expanding into sites previously dedicated to retail services. The Cook Children’s Health Care System in Fort Worth offers access to 22 primary care offices and five neighborhood clinics across north Texas, many located in former retail and big-box centers. The retail centers offer neighborhood proximity and branding opportunities for the system, as well as convenient locations for a variety of services.
Genesys Health System in Grand Blanc, Michigan, offers occupational health and urgent care clinics apart from the main hospital complex. One clinic is located off a major highway at a retail big-box location that has been renovated for and dedicated to serving occupational health clients and their employees. The clinic is centrally located to provide easy access for area employers.
Somewhat surprisingly, retail and big box locations are well suited for outpatient health care services. Some minor adapting of the building can create opportunities for primary care physician offices, as well as adjacent offices for specialty physicians and outpatient service firms offering imaging, surgery, dialysis, and physical therapy, as well as pharmacies. Medical services are not the only ones provided in this model: many large health systems require information technology data centers, call centers, and business, accounting, conference, and training centers.
In general, parking, column structure, and the floor-to-floor height of big-box buildings work well for health care planning and architecture. Additions might include emergency power, a clerestory roof to provide additional light, atriums to separate windowless space, a coordinated waiting area for large physician groups, and space for branding and signs.
Speed to market is enhanced because it is faster to fit out an existing unused space to accommodate health care than it is to construct a new building. Typically, no code changes are necessary and parking requirements can be met by retail codes. But fit-outs for outpatient services will be more expensive than those for retail.
On the other hand, medical leases are generally longer and more stable than those for retail; expanding health systems are financially stable tenants with growing needs and are capable of leasing facilities for a variety of outpatient services or physicians’ offices. But location is the most important factor in the ultimate success of medical complexes.
Demographics, suburban sprawl, technology, and government intervention have created an unprecedented growth opportunity in the health care industry for developers, planners, and design firms that understand the industry, facility needs, and services.
