Health care reform has hospitals rethinking how and when they build new facilities. It’s also influencing how developers and architects approach new projects.

Mark Henderson, new director of health care at architecture firm HOK, spoke with the Chronicle’s Purva Patel about changes he’s seeing locally and nationally.

Following are edited excerpts:

Q: How is health care reform influencing medical facilities?

A: Anytime the federal government gets involved, it creates a high level of uncertainty. What that tends to do to the health care-architecture market is everything just stops because you don’t want to build a facility that might not fit the new regulations. Our clients’ business is driven by how services are going to be paid for, how their services are reimbursed, and that’s changing. The general intent is to streamline the reimbursement of services, for instance, to reduce readmittance in a number of cases, especially higher-acuity cases like cardiology cases. Those patients, once they leave a facility, are more likely to be back one, two, maybe three times. Health care reform is trying to determine if that could be avoided because reimbursing each of those episodes is expensive. What that has done is, first of all, there are very few building projects going on right now. Instead, we’re seeing a lot of master-plan and strategic-planning work.

Q: How has planning changed?

A: Historically, master planning meant looking at an entire campus. There was a time when we would take a 15- or 20-year look at how a campus could grow, and that would result in additional buildings that would follow a pattern of growth in an organized and thoughtful process to support a strategy. What’s changed is we are now very focused on the strategy and business ideas. How can we utilize the building better than we already are? Can we locate certain services more closely so we are optimizing efficiencies through shared services such as radiology? For example, diagnostic imaging involves very expensive equipment. Can we co-locate all of those services that depend on diagnostic imaging so we don’t have three or four or five CAT scan or MRI machines?

Q: How is technology influencing the design of medical buildings?

A: Many times, the capability of a facility to accommodate new technology is determining if that building should be utilized over the next 10 years. We used to do master plans for 15 or 20 years, but we don’t do those anymore because five years is really the new horizon. There may be some loose ideas that go out past five years, but given the rate of change now driven by advances in technology, it is crazy to go beyond five years. When we look at existing buildings, the first thing we want to understand is the physical nature. Is it capable of lasting another 10 or 15 years, or five years? In the design of new buildings, flexibility is an important component. Where the stairs and elevators are located is not random. We organize them so a big empty floor can be multiple things in the future.

Q: Lots of local hospitals have expanded to the suburbs over the past 15 or so years. Do you think Houston is overbuilt?

A: It’s hard to say it is overbuilt yet. I think many organizations are asking that question right now: What’s the inventory on the market? But what is happening is you’re seeing more partnerships. For instance, out of The Woodlands, St. Luke’s built a medical center, and also within that center is a component for M.D. Anderson and Texas Children’s. By creating those partnerships, you are building fewer buildings but extending your services in other markets.

We’re also seeing a lot of mergers, not so much in Texas, but nationally. For those who have built out and can’t sustain facilities, larger health care organizations are coming and buying them. We’re even seeing some facilities close.

Q: Could that happen in Houston?

A: I think the Houston market is unique because it continues to grow, and the economy is good comparatively. I don’t think there’s a danger that they overbuilt here because the population is continuing to grow in the areas where they have built. But what it has done is, we’re building less now, and we’re seeing very few large medical centers of 500,000 square feet or more since health-care reform is putting the focus on primary care.


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