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1997 construction & design survey.

Managed care might seem to be putting a damper on healthcare construction, but in fact it's one of several industry changes creating opportunities for architectural and design firms. One example of a trend toward making surroundings as pleasant as possible is the west campus expansion at East Texas Medical Center in Tyler (left). Designed and built by Ellerbe Becket and completed in 1995, the project, including a nine-story medical office building, features artwork and rooftop gardens.

Architecture↗

Clinical observation units help manage costs and care.

Clinical observation units were created to avoid questionable admissions and short inpatient stays that were likely to result in Medicare payment denials. With the rise of managed care, these units also can contribute to ensuring optimal reimbursement by helping manage patient flow. Hermann Hospital, a facility affiliated with the University of Texas, Houston, initially opened an improved observation unit in 1992, but recorded a 13 percent Medicare payment denial rate and operating losses of as much as $20,000 per month during the first five months of the unit's operation. A multidisciplinary team was formed to address the observation unit's low utilization and payment denial problems. The problems identified included missed opportunities for admissions, inappropriate admissions, and extended stays. The facility took corrective measures based on the quality team's assessment and corrective measures developed by the utilization management committee and quality teams. The clinical observation unit now sustains a zero denial rate and steady revenue increases resulting from improved utilization of the unit.

Cost Savings↗

How does your CEO spell "relief"? Leadership survey shows how execs are dealing with change.

As a health care trustee, you volunteer your time, exhaust yourself trying to keep up with the ins and outs of the industry and do your best to provide an objective sounding board for the chief executive. But your job might make more sense and be a lot more valuable if you could put yourself in your CEO's shoes and understand what gets him up in the morning and keeps him awake at night. And how does that differ among leaders of hospitals, HMOs, and medical group practices? To give you the insights you need, here are the results from a Hospitals & Health Networks leadership survey (see "Who, What, Where, How, When?" page 10).

Chief Executive Officers, Hospital↗