Healthcare Design - September 2022 - 41

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settings is ambiguous and " medical office building "
has become a catch-all phrase referring to
anything from a retail clinic to a sub-specialty
care center with a complement of diagnostic and
treatment services. The latter, called an MOBplus,
requires a more thoughtful and strategic
approach to programming, planning, and design
and usually comes at a noticeably higher cost.
Each MOB project presents a unique set of cirand
ambulatory care center by incorporating features that allow for more
specialized care and more complex patients. Various " upgrades " may be
necessary to meet code requirements or clinical expectations in MOB-plus
facilities. For example, the level of technology integration is often greater,
pneumatic tube stations may be desired to improve efficiency, and higher
floor-to-floor space may be necessary.
It's important to identify these design considerations early in the plancumstances,
including state and local codes and
specific regulations that will impact planning
and design. What satisfies one Authority Having
Jurisdiction (AHJ) may not satisfy another.
Distinguishing among what is required by code
or other regulatory agencies, what is best practices
and preferred (from a quality, safety, or
engineered systems perspective), and what is
elective or " nice to have " is critical to defining a
project's scope and budget.
The following questions can help guide discussions
to better define an outpatient project.
IS THIS MOB ACTUALLY AN
AMBULATORY CENTER?
Though it contains healthcare programs, an offthe-shelf
MOB is generally understood to consist
of single or multitenant business-occupancy
outpatient programs. A psychologist's office or
primary care practice, for example, are considered
business occupancy.
More complex or specialized outpatient services,
such as treatments or procedures that
render a single patient unable to take " selfpreservation "
action in an emergency, may fall
into the National Fire Protection Association's
(NFPA) Ambulatory Health Care occupancy
classification. This means they must comply
with specific NFPA occupancy requirements
to receive reimbursement from the Centers for
Medicare & Medicaid Services.
Ambulatory occupancy types have several
planning and design requirements, including
fire protection systems and mechanical, electrical,
and plumbing system design, that have real
cost implications and are not required of business
occupancy buildings. Though these design
and construction costs can be much higher than
a general business occupancy, the ability to gain
the highest reimbursement possible directly
impacts an organization's ability to achieve a return
on its MOB investment.
IS THIS PROJECT AN MOB-PLUS?
Many organizations today are looking for an
MOB-plus-essentially a more robust version
of the MOB that blurs the line between MOB
ning process as they can have significant implications to the budget. Here
are a few tell-tale signs that a client's project is actually an MOB-plus:
Specialty care. Though specialty care clinics like cardiology, neurology,
or oncology do not necessarily require more specialized spaces, they often
do include more " upgrades " than typically planned for in a traditional
MOB and usually result in an MOB-plus design. The patient populations
in these care environments are often more medically fragile and features,
such as plumbed oxygen and suction, may be necessary to safely administer
care. Medical specialties are also more likely to require ancillary services
like labs or pharmacies or to be co-located with complementary diagnostic
and treatment services such as sleep study, PET CT, MRI, or infusion.
Location. An MOB built near a hospital or that connects to one will likely
become an MOB-plus. The on-campus location offers the potential for
higher Hospital-Based Outpatient Department (HOPD) reimbursements
and a greater return on investment. But most HOPD programs come with
additional features to achieve necessary accreditation or code compliance.
For example, if co-located with other non-HOPD outpatient clinics, the
HOPD clinic must be physically separate from the other outpatient programs
in the building. Often, this means that registration, waiting spaces,
clinical support spaces, and other resources must be separate and dedicated
only to the HOPD clinic rather than shared among departments.
Future flexibility. Physical expansion (horizontal and/or vertical)
should be considered when siting and organizing any MOB. But facilities
may also use standardized design to facilitate flexibility and the opportunity
to grow in place. For example, clinic floors can be organized into modules
or neighborhoods of smaller, self-sufficient groupings of nine to 12 exam
rooms with their own clinical support spaces (clean rooms, soiled holding,
care team stations, etc.). Several of these neighborhoods may be organized
together on a single floorplate, and each may accommodate a single clinical
practice or be shared between two sub-specialty teams.
Emergency power and medical gasses. Emergency power (beyond
code-minimum requirements) and medical gasses typically are not included
in a standard MOB cost model because this level of emergency power
isn't code-required and is expensive. But because care complexity and patient
acuity in the outpatient setting is increasing, most of our healthcare
clients are now requesting emergency power and piped medical gasses.
MORE
ONLINE
For an extended
article as well as
images of recent
MOB projects, visit
hcdmagazine.com/
trends/mob-design.
PLANNING FOR COMPLEXITY
Underestimating the potential for complexity with an outpatient facility
can become an expensive mistake. The traditional MOB continues to
evolve as care environments adapt to meet code requirements and clinical
expectations. Ultimately, a successful MOB design will address regulatory
requirements and balance owner expectations, project goals, and budget.
The type of MOB needed will become apparent with careful planning, a
needs assessment, and a thoughtful analysis of the patient populations as
well as business and clinical goals for the facility. 
Sarah Walter, AIA, is a senior medical planner at EYP, a Page company. She
can be reached at SWALTER@EYPAE.COM .
SEP TEMBER 2022
41
http://www.hcdmagazine.com/trends/mob-design
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