Designed by HOK and LBL, the Los Angeles County + USC Replacement Hospital is a 1.4-million-square-foot academic medical center in Los Angeles.

On June 28, the Supreme Court gave its blessing to the landmark Affordable Care Act (ACA). We asked a group of HOK Healthcare experts to share their thoughts on how this ruling will affect healthcare architecture and their opportunities to bring value to clients.

Chuck Siconolfi, AIA, ACHA, LEED AP BD+C, a senior principal and director of healthcare innovations, planning and design, based in HOK’s New York office:

“When we think of health care architecture, we are looking at a tool in the larger social context of healthcare delivery. When delivery of care is inefficient and expensive, with insufficiently good outcomes, or doesn’t cover all citizens, we are looking at problems that we as architects can help solve.

“The greater ability to solve problems, however, lies in the realm of policy. The Patient Protection and Affordable Care Act – to use the most important part of its full title – is America’s second big step in the policy arena. The first was 70 years ago.

When policy begins to support broad social good and our nation’s goals are aligned, our job as healthcare architects becomes clearer and more likely to succeed.”

Chuck also talked about the move toward outpatient centers that is integral to the ACA in Architectural Record’s June 28 story:

“The ambulatory facilities we see today are a different type than we would have done five years ago. These have procedural activity embedded in them. It’s part of the push toward new medical protocols that enable more efficient and safe care. It’s moving patients through in 23 hours or less. People who might have been inpatients before are now outpatients.”

William Roger, AIA, ACHA, a senior vice president and healthcare director based in HOK’s San Francisco office:

“The dysfunction of the world’s most advanced and expensive healthcare system is not sustainable. It is one of the few systems in the world that has grown up in a relatively free enterprise environment, compared to others in the world that are under central government control. Our government has served as the safety net for those who displease the insurers – the poor, non-citizens and those with pre-diagnosed health issues. The basic business model and the caregiving process are at odds. The Affordable Care Act is an attempt to align the caregiving process with the business model.

“Looking past the centerpiece of organizational change – the funding mechanism coupled with accountability – we can say that the incentives for healthcare to operate within an accountable care organization (ACO) or physician-guided member management rather than a reactive patient management business model could create the most change. Its closer to the model established by Kaiser Permanente, which has operationalized retaining more revenue by keeping its members well and actually loses money when people use their facilities.

“It is important for healthcare architects to focus on the idea that the buildings we design are tools for care. They can improve that care, support better patient outcomes and they can improve the caregiver’s business model by providing greater efficiencies. Let’s hope we can implement this new paradigm of efficiency and organize our buildings around the new methods of care before America’s first big step, that 70-year-old policy, goes bankrupt by its own demographics.”

Sheila Cahnman, AIA, ACHA, NCARB, group vice president and regional healthcare leader based in HOK’s Chicago office, as quoted in Architectural Record’s July 2 story:

“Cahnman says the health care industry can proceed with more certainty. Still, she notes, ‘health systems are still unsure of their projected revenues,’ and they predict those revenues will decline, regardless of the new law. In turn, ‘they will continue to push for improvements to lean their operations and increase their bottom lines,’ she says.”

“She hopes health care clients will start to look at improving their infrastructure, ‘including upgrading existing chassis so they can support lean operations or improved patient satisfaction. She also foresees an increased emphasis on outpatient facilities.”

Sheila had more to say in Healthcare Design Magazine’s article on the reaction to the Supreme Court’s decision on the ACA:

“Long term, we will continue to see more development of ambulatory care facilities that support an accountable care mission of reaching patients early and easily. Public hospitals will need to improve their facilities to become more competitive in the market place. The new market realities will continue to require healthcare designers to do more with less, just like our clients.”

David Chambers, R.A., a director in the Healthcare Consulting group based in HOK’s Seattle office:

“I see a healthcare system that has become bloated and grossly inefficient, with outcomes poorer than others that pay far less than we do. So I see the Affordable Care Act as a social/political solution to an industry that no longer provides value commensurate with costs. We brought this upon ourselves.

“The landmark ruling by the Supreme Court upholding the constitutionality of the Affordable Care Act gives us the opportunity to finally define the problem that needs to be solved. Ultimately, the act calls upon all of us to invent a healthcare system that is affordable, focused on quality and that leaves no American behind.

“Healthcare systems are already pursuing early value-based initiatives that offer promise. This includes accountable care organizations that focus on payment for quality and lean initiatives that remove waste and seek to redefine the relationship of value to cost that has been so tenuous until now. Perhaps without the intense pressure that has resulted from the ACA, we would not have been so focused on the innovations that will harken a new age of greatness for our country and prosperity for our people.”

Henry Chao, AIA, NCARB, a healthcare design director based in HOK’s New York office:

“We need healthcare environments to do more than treat our health problems and react to what has happened. We can design environments to actively participate in helping our society get healthier. This creates a whole generation of healthy people as healthcare facilities become a hub for disseminating healthy knowledge, information, experience and fun. This would transform the market. I think it is the only way to fundamentally reduce healthcare costs.”

Anthony Roesch, AIA, senior medical planner based in HOK’s Chicago office:

“The Affordable Care Act for the healthcare industry will improve the quality of care through greater integration of technology, expertise, information and accountability – all under an umbrella of shared risk and reward. This will change the landscape of healthcare from one built around sickness to one centered around health.”