Question

• How do federal, state, and local regulations influence facility design? Provide an example.  
• How do public laws, such as the Health Information Portability and Accountability Act, and the Patient Protection and Affordable Care Act apply to or impact new facility design or renovations?

175-275 words please

Answer 1

The Federal, State, and Local Regulations:

Meeting standards and regulations, particularly in health care facilities, plays a primary role in maintaining safety in physical structures and with the systems that support them. This focus feature provides a brief introduction to the types of standards and regulations that will be part of most health care facility building projects. Patient safety is the reason for all of the regulations, codes, standards, etc., and to that end they do serve a good purpose.

Evidence-based design principles and outcomes dictate that better design is possible, practical, and safer. As the design community attempts to apply new technology and techniques to healthcare design, many are prohibited by regulations that do not prescribe to the new concepts. The better and more innovative way may have to be abandoned to accommodate the regulations.

Codes and regulations are adopted by federal, state, and local governments, which, by their nature, are slow and cautious to react and change. However, technology is changing at an ever faster rate.

HIPPA:Health Insurance Portability and Accountability Act of 1996 is now most-associated with the privacy of patient healthcare information. Under HIPAA, the Department of Health and Human Services (HHS) establishes boundaries on the use and release of health records. It also outlines safeguards to protect patients’ information.

The law applies not only to hospitals and medical practices, but also to chiropractors, dentists, nursing homes, pharmacies, and psychologists. In addition, the law governs the activity of business associates such as third-party administrators, pharmacy benefit managers for health plans, billing and transcription companies, and professionals performing legal, accounting, or administrative work.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge.

MACRA: The Medicare Access & CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015 addresses payment for doctors as well as cost controls for Medicare Part B.

Part of an overall shift to value-based reimbursement, MACRA moves away from the Sustainable Growth Rate (SGR) payment formula and toward a treatment model based on quality of care and use of EHRs by the medical practice or facility.

Patient Protection and Affordable Care Act

The law provides numerous rights and protections that make health coverage more fair and easy to understand, along with subsidies (through “premium tax credits” and “cost-sharing reductions”) to make it more affordable.

The law also expands the Medicaid program to cover more people with low incomes.

A wide variety of physical conditions will determine the viability of renovation, including the following:

• Amount and type of space available for renovation

• Mechanical and electrical system limitations

• Ability to work within the existing building’s boundaries

• Location of structural columns and walls

• Location of vertical penetrations (such as mechanical shafts, elevators, and fire stairs)

• Location of staging area (either close in proximity or some distance away from the site)

• Temporary parking for staff and contractors

• Abatement of hazards (such as asbestos in older buildings)

Patient care involves access to care, continuity of care, assessment, and care provision. Patient flow is a primary consideration related to patient care that must be addressed during design of building projects. Efficient patient flow through a health care facility reduces potentially harmful delays in patient care. Patient flow applies from the moment an individual wants access to the facility, all the way through his or her entire experience there, until transport back home. External and internal wayfinding, direct visualization, areas for assessment, and care spaces that meet the population’s needs are just a few of the design elements that support good care processes and timely patient flow.