by John Fowler
The Margulies Perruzzi Healthcare Studio is seeing the impacts of COVID-19 on space planning and design that will continue post-pandemic in several areas. In addition to considerations for being better prepared for a future pandemic, clients are evaluating the use of practices and workflows that were born out of necessity over the past year. The rapid adaptation of telehealth is one example that can lead to better healthcare delivery and patient satisfaction while also providing an operational advantage to healthcare organizations in certain circumstances.
According to the COVID-19 Healthcare Coalition Survey, Massachusetts saw a staggering 9000% increase in telehealth visits from September 2019 to September 2020. Of those surveyed, 60% of physicians stated that telehealth improved the health of their patients, 50% stated it will improve the financial health of their practice, and 55% said that it improved the satisfaction of their work. Even as we return to the new normal, patients will expect more virtual care options.
Anecdotally we are hearing that healthcare organizations expect 20-40% of their patient visits will be conducted virtually depending on the specialty, as certain visit types will have a greater need for physical evaluation or testing for the foreseeable future. The two biggest potential obstacles to virtual visits when deemed appropriate are reimbursement and patient’s access to technology.
The Centers for Medicare & Medicaid Services granted waivers during the pandemic that allowed for the increased use of virtual visits at the same reimbursement as in-person visits. The rules and reimbursement rates for those visits will play a large role in the extent of its utilization going forward. During the spike in use of telehealth visits, the majority of providers were conducting some from their own homes. In the future, those visits may not be allowed outside of a licensed clinic or hospital or may be reimbursed at a lower rate, due to the decreased costs to the providers.
The patient’s access to technology can vary dramatically by region and demographics, and ensuring equitable access is a key consideration. Meg Barron, the AMA’s vice president of digital health, outlined four key areas that need attention: device access, connectivity, digital literacy, and design relevance. Expanding broadband access and creating ways for those with audio, visual or motor impairment to have better access to telehealth are among the specific needs that must be addressed.
When evaluating the impact of telehealth on space planning needs, we are considering several operational scenarios. If physician at-home visits are allowed and reimbursement is financially viable, will they be able to schedule visits for certain days of the week that are virtual only? If physicians are on site at a clinic or hospital, do they need to be in the same area as their in-person visits or can they utilize space that is more remote from the highly valuable patient care zones? And if physicians do not have a dedicated office appropriate for virtual visits, is it advantageous to create virtual visit exam rooms that require less space and infrastructure than a traditional exam? With each of these scenarios we see opportunities for our clients to increase their patient volume capacity or lower the real estate footprint required due to the decreased number of traditional exam rooms required.
Although there may still be more questions than answers regarding telehealth, there appears to be a consensus that it is here to stay and will continue to provide patients with a more convenient option for their healthcare while creating flexibility for their providers to better deliver care.
John Fowler, AIA, EDAC, LEED AP, is associate principal and associate partner at Margulies Perruzzi.