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September 2016

In this issue we discuss how construction standards differ between Medicaid Reimbursed Clinics and Private Medical Practices.  This is the first of a multi-part series.  We start the conversation by looking at ADA accessibility.  Our companion article centers on resilient design for health facilities.  If your site is anywhere near a body of water, this is a must read.
Medicaid Reimbursed Clinics vs.
Private Practices 
How are these "Build Out's" Different?
(First in a Series)

A good part of our Health Care Architectural practice involves assessments of rental space for possible use as a Diagnostic & Treatment Center (D&TC) which is eligible for Medicaid reimbursement.

For most physicians and practice managers, even those with many years of experience in running successful private practices, CMS physical plan requirements are difficult to navigate an understand. The most important thing to understand is that "In Return" for Medicaid reimbursement, CMS and in turn State Health Departments, will hold a potential operator to much higher construction standards.  The net effect is that you will need more space for your clinic an you will incur higher construction costs to implement the many infrastructure improvements need to gain state approval and open your doors.

At their core, these higher construction standards seek to achieve higher levels of fire safety, infection control and barrier free accessibility.
Resiliency in Health Care Facilities 

Superstorm Sandy exposed critical weaknesses in the Resiliency of health care systems throughout the North East.
This was especially true for coastal areas and other areas prone to river flooding and flash flooding in New York City, Long Island and New Jersey.
NYC fared fairly well during Sandy, although there were Hospital, Long Term Care and Adult Care Facility closures.  This was the case because the Health Care system had excess surge capacity and unaffected neighboring facilities had the ability to "Pick up the Slack".

The nightmare scenario involves a series of catastrophic events occurring concurrently during a severe weather event which would significantly reduce an impacted health system's excess capacity. This becomes more likely as the nexus of health services shifts to community based/ambulatory facilities, reducing the reliance on hospitals. There are many community health centers that took months to reopen after Sandy.  Some never reopened.
We hope you enjoy this month's issue. Do you have questions or feedback about the information provided or regarding your facility that we can answer?  Contact us at and we will be happy to provide you with any additional information you may need.  We want to continue to offer content that interests you, our readers. Please drop us a line and let us know what topics you might want to learn more about. As always, we love hearing from you.


John W. Baumgarten, RA, AIA, NCARB, LEED AP
Principal & President

Michael A. Sciara, RA, AIA, NCARB, LEED AP
Principal & Vice President