CONSEQUENCES OF THE AFFORDABLE CARE ACT by Bill Eide

July 12th, 2012 by Scott No comments »

Well, the suspense is over, the last shoe has dropped with the Supreme Court upholding the majority of the Affordable Care Act. Now it is time to begin implementing the various aspects of the new law.

Throughout the last half of the 20th century the U.S. healthcare industry has been impacted, directed and increasingly regulated by the federal government.  Regulation, from the Hill-Burton Act of 1946, Medicare in 1965, Community Planning and it’s reliance on the Certificate of Need to regulate the supply of healthcare of the 1970s, to DRG’s in 1983 and the Balanced Budget Act of the mid 90s  - all have driven capital facility responses.  Every act has had it consequences.

The Affordable Care Act may be another and perhaps the first real serious step to controlling healthcare cost. Or it may be just another set of rules to be gamed by very smart healthcare, medical and insurance administrators.  Regardless, there are drivers that will have significant impact on the programming, planning, design and construction of healthcare facilities.  Two factors will drive the development of facilities:

1)   Tens of millions of Americans will have access to healthcare insurance.

2)   Reimbursement rates will go down.

These two factors more than anything else will become the challenge for facility design and construction – to support the institution in its efforts to maintain their economic viability and healthcare mission.

In my opinion, the most likely facility responses will include the demand for greater staff efficiency, the optimization of productive care and higher utilization rates.

Staff Efficiency

We’re going to hear a lot more about staff efficiency, which is having the right expertise, in the right place, at the right time and with the necessary tools at hand to support the care.  Every moment will count; it may not be life-supporting but it could make the difference in having a profitable operation and therefore having healthcare available.  Look for highly specialized medical treatment centers to develop around a specific medical need or procedure.  Efficiency will drive the further specialization (assuming the volume is there) to reduce the cost of the treatment.

Productive Medicine

Productive care will require that patients receive the least amount of care at the point that it does the greatest good.  Preventive and early intervention care will drive the need for more outpatient and physician support care centers. (Better to get a pneumonia vaccination before you get sick than a shot of penicillin when you get sick or spend a week in an intensive care unit fighting pneumonia).  Look for the development of more immediate care or walk-in care centers; the development of community, neighborhood and school-based clinics will lead the way to keep people out of the hospital.  Long term, the need for hospital beds should begin to decline as productive use of medicine drives down the demand for beds.  Hospitals should evolve into critical care centers and will only serve the sickest of the sick.

Utilization

Closely associated with Productive Medicine is the utilization of equipment and facilities.  Utilization rates must continue to increase.  Facility programming and design must allow for patient flow and staff efficiency that keeps the equipment and facility working.  An extra 80 to 100 square feet for an additional dressing room may be a great investment if it allows for another MRI test every 8 hours.  Planning will have to stop basing space programs on “average” patient utilization rates and start basing it on desired optimization rates and return on investment.

There will undoubtedly be other drivers and responses that will, from time to time, come to the surface and create opportunities for new facilities – this is after all the United States, home of entrepreneurs.  The basic intent of the Affordable Care Act is to make healthcare accessible to the millions of citizens without healthcare insurance and to reduce the total cost of healthcare.  However, it may be the unintended consequences that provide the greatest facility challenges and opportunities for the future.  Stay tuned to this blog as we explore the healthcare landscape for the first signs of the unintended consequences of more federal regulation.

Bill Eide has been developing, planning and building healthcare facilities ALMOST since the Hill-Burton Act was enacted.

#Social Madness is here, and Milestone is “in it to win it”

May 31st, 2012 by Scott No comments »

Beginning June 1, 2012, the Business Journals in 43 cities across the United States are hosting a social media competition.  Companies had to apply to be included in the competition, and Milestone Project Management was one of the firms to be selected to compete.  We are very excited, but we NEED YOUR HELP!!!

I know what you are saying….”but Scott, how can I help Milestone win this competition, what with my busy work day and all??”

The answer, Virginia, is quite easy!

First, go to our website www.MilestonePM.com and click on the #Social Madness button.

Secondly, LIKE us on Facebook!!

Lastly, follow us on Twitter!!

The first round of competition ends on June 19th, with the top 8 companies in our “Houston <100 Employees” bracket moving on to compete for the overall Houston “Houston <100 Employees” winner, to be announced on July 17th.

From there, all the city champs will be competing against each other nationally, with the three size category winners announced on September 11th.

Please help us put forth a strong effort by telling all of your friends, relatives, fans and colleagues about Milestone Project Management.

WE ARE IN IT TO WIN IT!!!

Project Steering – a project management philosophy at Milestone

May 18th, 2012 by Scott No comments »

Milestone has a reputation for customer service and support, which is manifested through the philosophy of “Project Steering”.

Project Steering is a framework for decision making that provides expertise, guidance and assistance to the Owner. Through project steering Milestone defines the issues, objectives, requirements and goals to enable the Owner to make decisions quickly and with confidence.

The tenants of Project steering are to fully understand the people and positions, policies and procedures and project objectives (cost, schedule, market strategy, etc.).  By building your knowledge bank while familiarizing yourself with schedules, project cost estimates,  and contracts, the project manager becomes armed with the basic information of the “ground rules” of the project and then can craft an implementation strategy supported on that foundation.

Collaboration is the key to continuously refining the project data and assigning tasks and accountability to the project team.  We ask your team members for commitments and hold them accountable for their actions.  We lead meetings – communicating and facilitating discussions for decision making and information gathering – these are the core functions of a Milestone project manager that is implementing Project Steering.  We believe that the Owner, through the project manager, should maintain the project documentation and be responsible for meeting minutes and action items.  We are accountable to our team, we provide timely information, seek out questions and answers and remain accountable after the project is completed and occupied.

We invite participation in lessons learned sessions and when required we provide constructive criticism and implement plans for improvement.

One of the most important things we do is say “please” and “thank you.”  We also Smile – it sounds trite and perhaps a little naive, but its one of the key components to this philosophy, and its very easy to do every time.

Milestone recommends that every project manager read Barbara Bryson’s “The Owner’s Dilemma” for more detailed information on the philosophy of Project Steering.

Success is defined through metrics.  We work to quantify success based on the Owner’s measuring the basis in objectives: time, cost, project requirements and objective/definable goals.  We also seek to quantify the intangibles such as the level of satisfaction with the outcomes and the willingness to work together on future efforts.

You must establish:

  • Common Ground
  • Shared Goals and Objectives
  • Metrics of Success

The advantages of our approach:

  • Experience-based management decision support
  • A collaborative effort
  • All team members are valued
  • Early team involvement optimizes the potential value of the team
  • Definable and measurable goals and objectives
  • Cost and schedule control are inherent to the process
  • Involvement is welcomed and encouraged
  • Predictable and exceptional results

Five Ways Milestone Project Management help our clients be more profitable

November 7th, 2011 by Scott No comments »

At MPM we apply our efforts and our expertise to help you achieve greater growth and profitability through five “Smart” Services.

  1. Smart Source and Partnering.  The demand for capital project management ebbs and flows with your strategic plan.  When the demand grows for project management it is more cost efficient (profitable) to use our professional project management team rather than hiring and maintaining a staff. Retain the leadership of capital projects within the executive suite but let us provide the staff you need. The money you save on not having an in-house staff can be invested in other more profitable ventures.
  1. Smart Negotiation. Negotiate your facilities repair and maintenance supplier/vendor contracts.  Because we are in the market every day we can help you evaluate their proposals to make sure the “favored customer” rates aren’t above current “market rates.”  Competitive pricing can result in significant savings and increased profitability.
  1. Smart Tools. Use our smart management tools to create project scope documents, capital requests, strategic capital budgets and track project development.  We will help you establish the controls and reporting mechanism so you always know the status of your projects and are always in a position to make knowledgeable (information and data based) smart decisions.  Our tools will help you use project data to drive project decisions and proactively manage the project.
  1. Smart Schedules. The shortest schedule isn’t always the best schedule. Unrealistic short schedules can drive the cost of a project up and result in operational problems in the future, which reduce profitability. Smart schedules allow you to take advantage of the market place and your capital. Our expertise in schedule management will help you get your project to market at the right time and at a cost that will result in potentially greater future profits.
  1. Smart Planning and Expertise. Applying expertise at the right time, to the right areas and issues results in better projects.  Better projects have more potential to produce greater profits.  Putting your money where it will do you the most good (location, quality materials, efficient design) is the result of smart planning and expertise.  Making smart decisions based on real expertise throughout the duration of the project is the best way to assure reaching your return on investment goals.

There are more ways we can help your organization be profitable.  From leadership to stewardship we are your partners in creating better, more efficient, more viable healthcare facilities regardless of the obstacles that have to be over come.

Please call Bill (713-523-2552) if you would like to discuss how we could help your hospital be more profitable and visit our web site (www.milestonepm.com) for more information about Milestone Project Management.

“Cloud Project Management” in the Fall 2011

September 22nd, 2011 by Scott No comments »

It has been almost six months since I last reported on how Milestone Project Management is working with our Owners and project team members in “Cloud Project Management”.  It has been an exciting time at our firm as we have really standardized and formatted the information disseminated by our web-based project management site.

Early on, we discovered that each user (architect, client, contractor, etc) needs to have a training session on how we access, present and post information to the site.  We build this 45 minute session into our project scope and use it as a team building exercise.  I think it has really “paid off in spades” when it comes to collaboration on the project.

Id like to share with you some thoughts that one of our architect participants has on our transparent and online solution.

David McLemore, AIA, ACHA of Kirksey Architecture, says “Everybody talks about the need for strong communication because we are all trying to find ways to better integrate our processes and better share the information we are utilizing to design, construct and successfully finish our projects. Working with Milestone and St. Luke’s we have just begun to “tap” into the potential for web based project communication, and we are already seeing positive results…in my opinion. Tasks are communicated clearly to all relevant stakeholders, discussion of key issues can be tracked and held without the need for a conference room… and critical documents can be accessed by the entire team, from just about anywhere, without the need of having to track someone down to find them. It will be interesting to see just how much this methodology can be employed to everyone’s advantage in the future…”

As of this writing, we currently have over 35 projects on our web based site, and more importantly we have closed six since the first of the year.  I think that this is significant since we have initiated all six and have closed them out….we have run the entire lifespan of these projects using this web based collaborative tool.  Our Team has learned alot along the way, and we have built a very strong foundation of how we are moving forward with our new and current projects by standing on the shoulders of these completed projects.

The developers of the site we are using to host our projects have been very collaborative to work with by taking our suggestions and working them into their platform.  A very lovely feature is the iPhone application.  With this app, members of our team can access dates, action items, team member status, and if activities are on-time or over due.  This information is crucial to our Owners who are stopped in the hallway and asked about project details…the answers can come straight away during that brief interaction.  No more waiting to get back to someone.  Amazing!

“Cloud Project Management” in early 2011

April 3rd, 2011 by Scott No comments »

This is an update to my previous posts on Internet Project Management.

In the era of instant communication (twits, smart phones, and instant messaging – email is so 1996), we at Milestone have been pushing the envelope of how we communicate with our clients and project team members, to provide access to project data (timelines, issues, files, “threaded conversations”, etc) quickly and easily.

In the past articles, I have discussed a few hosting services that we explored and did some “beta testing” on, but in this article, I wanted to really drill down on what we are doing to put the philosophy of “Cloud Project Management” into action.

Currently, we are tracking over 25 projects with three clients using TeamworkPm.  Through some easy customization, we are tracking action items, schedules and milestones, sharing files (floorplans, space programs, product data) and “threaded” conversations.

We have had great feedback from not only from the Client’s senior leadership, but from our hospital directors and architects and engineers.  I think we all would agree, our emails or telephone calls about “where are we with this project?”, or “have you called Peter about the chiller” emails, have really dwindled.
In using the project timeline and milestones, we communicate the upcoming dates of projects.  We work in collaboration with the contractors uploaded construction schedule and our posted Project Development schedule, so if the “high level” milestones are not enough information, the Client can pull up the more detailed construction or our development schedule to see when the MRI is going to be delivered.

Of course, the information is only as good as the frequency of when it is input to the website, but by simply responding to a message that is generated by the hosting service, the information is uploaded and disseminated automatically.  No need to remember who to cc on an email….the project profile does that for you.

Currently, we at Milestone have standardized this approach to project management and are looking for ways to “passively” inform our clients and team members of the current status of projects.

Look for my next blog in a few weeks about how we are tracking Action Items and Issues Lists.

Have a terrific Project!!,

Scott

Don’t Get “Tripped Up” Over Flooring Issues

March 10th, 2011 by Scott No comments »

Flooring in healthcare facilities continues to be a challenge in regards to the maintenance, appearance and safety of the product. Not only is it vital to select the right flooring for each room in the hospital as required by building codes, licensing requirements and practical considerations, but it is equally critical to properly prepare the subsurface (concrete slab or other material) to assure the proper installation of the floor.

With the introduction of water-based adhesives, there has been a growing problem of flooring failure with regards to the separation of the flooring from the subsurface material or concrete slab. The failure is generally caused by excess water vapor off gassing from the concrete slab as it cures, or the presence of free water under the slab that the porous concrete wicks to the surface of the slab. Concrete never stops curing, but it will eventually reach a point where the amount of free water or vapor is negligible and will not affect the flooring mastic. Further compounding this problem is the pressure to complete projects faster, which often results in the concrete not being cured to a point that water and water vapor are reduced to an acceptable minimum. Often, buildings are enclosed early, which in turn traps water and humidity in the building. The building materials, including the concrete, absorb the water. The trapped moisture will eventually find its way to the surface of the slab and interfere with the flooring mastic.

Be sure to check out our next Milestone (on) Times for our in-depth look at the problems that can arise when flooring is not installed properly and what steps you should take to resolve these issues.

Example of Flooring with Slab Moisture Issue

Adventures in Imaging

November 10th, 2010 by Scott No comments »

Ready for my close-up!

In the past year, Milestone Project Management has been responsible for several imaging projects, including the replacement of a nuclear medicine gamma camera, the replacement of two traditional MRIs, and the installation of a new high-field open MRI. A new 3T magnet was installed for one of the replacement MRI projects, and I was thrilled to have the opportunity to volunteer for a scan last week.

Prior to having a scan, most of my experience with MRIs had been (1) removing them from buildings and (2) installing them. I didn’t have an experience to compare this to – other than the descriptions I’d heard from other people and the videos I watched on YouTube. I heard about feelings of claustrophobia, and the noise that the machine makes likened to a jackhammer.

What was it like? Well, everything started out just fine – after changing into a gown I sat down for a few minutes with a warm blanket while the scan room was prepped. Once in the room, the technician gave me a pair of earplugs and also a headset for listening to music. And then I was “inserted” into the bore of the MRI – head first. This is where I got a little uncomfortable. All I could see was the white interior of the machine; there was nothing to focus on. I had the technician move me out of the machine and I asked him for something to put over my eyes – to keep me from looking around. He moved me back in and explained that I was far enough towards the rear of the machine that I could actually see out – I just needed to tilt my head a little. That made me feel loads better, and we started the scan.

So I listened to some tunes from the 80’s and heard some intermittent beeps and buzzes. I was trying my best to relax when the noise from the scanning started. Frankly, it sounded like the warning noises you hear before something (like a spaceship in the movies) blows-up. VERY disconcerting. But I just lay there imagining what the pictures would look like, and I tried to think about other things, including my holiday shopping list, while the series of beeping and knocking sounds progressed.

After about 20 minutes, I heard the technician say that the scan would only take a few more minutes and then he would come in and get me out. At this point, I started to relax – until the jack hammering started!

I was very happy to exit the machine a few minutes later, and excited to review my scan with one of the MRI physicists that I had been working with. I am thankful to have had this opportunity – so if I need to have a scan done in the future, I will know what to expect.

Internet Project Management: Fall 2010 – Update

November 1st, 2010 by Scott No comments »

Update to previous post:

Dear Gentle Reader (tip o’ the hat to Dear Abby),

Over the past two weeks, we at Milestone Project Management have continued to review “web based/cloud based” sites that offer project collaboration tools for the various stakeholders for our complex healthcare projects.

The evaluation process was rather informal,but extensive.  We talked to the site developers, viewing online demonstrations/webinars, in some cases, downloading demo’s or trial memberships to “test drive” the capabilities of the systems.

We have decided to move forward for the next six months with TeamWorkPM.   While not as typically robust as other project management sites, we felt that TeamWorkPM had the right balance of detailed and overview information that made it very flexible and easy to use (see October 17th blog about tracking necessary and not-so-necessary information to an Owner) .  Being intuitive to use which was a “must” for us as our stakeholders on a project have a wide disparity of computer skills and/or time to spend trying to find information quickly.

Additionally, one of our clients is moving forward with using the site to not only track their Capital Projects, but also to monitor their leasehold contract terms and minor tenant improvements.  This is one example of the flexibility of this system.

Over the next six months we plan to move forward with over 12 projects on this site.   The project types will range from conceptual – long term projects, to short duration “patch and paint” or equipment switchouts.  We will even use TeamworkPM to assist in the collaboration of some minor electrical projects.

Currently, our “test drive” of the system allowed us to collaborate with our architects and user groups to disseminate project sketches, equipment lists, action items/issue tracking, milestone dates and decision documentation.  I was quite surprised how the team embraced the system and how easily the designers able to uploading sketchs and solutions to the site.  With the release of Teamwork’s free (yes, free) iPhone app, I expect our team members to be able to communicate and to pull up specific project status from the palm of their hand.  If you think about it, what a powerful concept for an Owner to be able to do….sitting at a board meeting, the discussion unexpectedly turns on the specific architecture of an inpatient room , you did not prepare for this conversation – but, you can quickly pull up the drawing and support documentation right on your iPhone or better yet, your iPad – powerful stuff.

As we move forward into 2011, watch this blog for my candid experiences using “cloud” project management (I should coin and trademark this term – a tip o’ the hat to Gene Simmons).  I also welcome comments from you, dear reader – let me know your thoughts.

The journey continues….

Scott

Internet Project Management: Fall of 2010

October 17th, 2010 by Scott No comments »

What a long title….I was thinking of calling it “Digital Project Management”, but it occurred to me that saying something was “digital” has the same connotation for me as saying “Electronic” or “Virtual” Project Management”…some how it just seems dated. So, I decided to date stamp this article with Fall 2010 – seems current, right?

What I really want to discuss, is my relentless search for tools to manage strategic capital projects from the Owners perspective using websites and “cloud” computing.

Currently at Milestone, we are experimenting with a few of the lesser known project management “tools” that are out there. From my colleagues at work, we have a company history of working with E-Builder, Skyre, Buzzsaw, etc.

For the most part, these platforms require a long learning curve, some require software on each users desktop, expensive user fees, and quite frankly functions, that from an Owner’s perspective, are low priority features (tracking RFI’s, Submittal’s, ASI’s, etc).

What we are searching for is the “big picture”, the “50,000 foot level view”, as Owners, we are guiding the overall direction of the project. Our role in the typical RFI tracking, while important (as it could lead to cost impacts), is usually relegated to ensuring that questions are being tracked and answered in an acceptable amount of time.

Most platforms seem to focus on this aspect a little too much, and I would categorize them as “Builders” or “Contractors” platforms.

As we move into 2011 and test a few of these project management systems, I would really like your candid comments about systems that you have used, and recommendations on platforms that worked well. Perhaps together we can find “project management utopia”

Im looking forward to the journey,

Scott