Merged Hospitals, Increased Outpatient Focus and Aging Facilities Examined During Panel

NEW YORK, N.Y. — Glenn Grube, director for the Faithful+Gould’s Healthcare Sector, moderated a recent panel held in New York City, speaking with representatives from some of the area’s largest healthcare systems about their real estate and facilities strategies. Merged hospitals, increased outpatient focus and aging facilities are some of the issues facing the New York metro-area healthcare industry, according to the panel.

The panelists represented New York-Presbyterian Hospital, Mount Sinai Health System and North Shore L.I.J. Health System—all multi-campus organizations with thousands of beds and facilities budgets in the hundreds of millions. Also participating was Scott Mason from Cushman and Wakefield, one of the world’s largest private real estate services companies, who presented a larger national perspective on healthcare facilities planning.

“What’s interesting to me is the intensity of focus on the healthcare real estate sector here in New York,” said Grube, who came to Faithful+Gould in 2012 after serving as the director of strategic engineering at New York-Presbyterian. “There’s a great deal of curiosity, and some fear, about the implications of the Affordable Care Act and its current and pending implementation. How are institutions reacting and how does it translate into their actual facilities-related strategy and decision-making?”

Mergers, Consolidations & Acquisitions
Grube noted mergers, consolidations and acquisitions are key trends among hospital systems, particularly in the New York metro-area. Driven by competition for patients and the change to a fee-for-performance model, healthcare networks are realigning to create new facilities standards—including cost-effective ambulatory care centers combined with “destination” hospitals for patients whose insurance offers them more choice. All three of the healthcare systems on the panel are experiencing these changes. A fundamental challenge for them is maintaining growth despite an anticipated decrease in funding, explained Grube.

New York-Presbyterian’s Senior Vice President for Facilities Development and Engineering Sharon Greenberg said the organization’s $3-billion master plan is about “new development, renovation, ongoing maintenance, infrastructure investments and, most of all, balance between growth of assets and protection from risk. The master plan, now in its third year, included the recent acquisition of New York Downtown Hospital.

Mount Sinai, which recently merged with Continuum Health Partners to become New York City’s largest hospital system, is learning to manage its now 17-million square feet of facility space. “We are very pleased with the facilities we now have across the system,” said Tom Ahn, Mount Sinai’s vice president of real estate. “We’re finding there are some great synergies across our systems where we can take advantage of opportunities, coordinate some outpatient facilities and cooperative functions and get some cost savings, but we are going slowly and cautiously.”

L.I.J. recently acquired Manhattan’s Lenox Hill Hospital, expanding its mainly Long Island-based operations. According to John Gupta, North Shore L.I.J.’s executive director for the Manhattan Eye, Ear, and Throat Hospital, acquiring Lenox Hill brought the new challenge of updating its infrastructure to be on par with the existing facilities portfolio. “The system has to ensure the best patient care, but we need to find the right strategic real estate assets and use them,” he said.

National vs. Local Healthcare System Trends
Scott Mason pointed out that while national issues facing healthcare tend to be the similar across the U.S., in New York they are exacerbated by a more difficult regulatory environment, limited real estate and older building stock. “In many cases, the current inventory was assembled without a lot of rationale—it was opportunistic, and designed by and for the hospital systems of a different time,” he said.

Mason also spoke of the national trend of healthcare systems moving away from large inpatient centers and toward “medical malls”—full-service ambulatory care centers with open space, integrated registration and shared waiting areas. “The inventory of assets is going to undergo a dramatic change, and that is a slow, difficult process,” he said. “It demands to be viewed as a portfolio, and managed fairly aggressively to make those assets a lot more productive and lower in cost.”

Following the discussion, Grube summarized a common theme expressed by the panelists: within the highly competitive New York market, each institution must ensure the readiness of its facilities and campuses to accommodate the changing delivery of patient care with a combination of existing and new facilities. Large healthcare institutions face the added challenge of managing aging and outdated buildings and infrastructure in the face of decreasing capital budgets.