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Architects can tailor new buildings to oncology’s specific needs and Arizona Oncology built its newest facility from the ground up rather than renting generic offices.
Snehal Bhoola, MD
Typical examination room doors separate slightly from the doorframe as they open and allow passersby to see into the rooms. It’s hardly ideal for a half-dressed patient inside. That’s why the new Arizona Oncology building at Arizona State University Research Park, southeast of Phoenix, has door-length hinges that eliminate gaps and protect patients from exposure.
It’s a small detail, but it illustrates how much architects can tailor new buildings to oncology’s specific needs and why Arizona Oncology, as it tries to succeed in an unusually competitive market, built its newest facility from the ground up rather than renting generic offices.
The greater Phoenix area is home to at least a half dozen other private practices, several large hospital chains, and satellite branches of the Mayo Clinic and MD Anderson Cancer Center. Each of these competitors is constantly working to expand its treatment options, improve the patient experience, and increase market share.
The freedom to build and expand can work against the best interests of practices. “Unlike some other states, Arizona does not require medical practices to demonstrate need for new services,” said Snehal Bhoola, MD, a practice partner who specializes in gynecologic oncology. “Private practices and corporations can build new facilities, buy new equipment, and otherwise expand as they see fit. It does not create the most stable and secure of business climates for healthcare providers, but it’s probably a good thing overall because it keeps us striving to get better and innovate.
“There are, obviously, a huge number of factors that decide which practices will succeed. We believe that all-inclusive facilities are a major differentiating factor and that this new location will be a major competitive advantage for us in the region it serves,” he said.
The 22,000-square-foot building has 19 exam rooms, 35 infusion chairs, a compounding pharmacy that is compliant with pending US Pharmacopeia <800> standards, and a retail pharmacy. Its diagnostic-imaging nuclear medicine department houses a positron emission tomography—computed tomography scan. Its 2 concrete radiology treatment vaults contain an external-beam treatment linear accelerator and internal radiation therapy with high-dose radiation brachytherapy equipment. Its staff includes 3 medical oncologists, 2 gynecologic oncologists, and 1 radiation oncologist, as well as genetic counselors, dedicated research nurses, financial counselors, nurse navigators, pharmacists, and nurses specializing in every cancer treatment modality.
Among Arizona Oncology’s competitors, only Mayo and MD Anderson can boast of so many treatment options under a single roof, and Bhoola contends that good design makes the new facility better for most patients than anything those renowned organizations can offer.
For example, patients park in a small lot, a short distance from the entrance, rather than in a huge garage that would require a long walk. The facility itself, while large by the standards of private oncology, still does not approach the dimensions of most hospitals. The radiation vaults are a few steps from the infusion chairs instead of being down in a distant basement.
Avoiding those extra steps is important to patients who are often significantly weakened by cancer and chemotherapy. Workers appreciate the convenience as well. Time spent walking affects productivity, which is why the architects who designed Arizona Oncology’s new facility modified their plans again and again to minimize steps for patients and staff alike.
“Essentially, we calculated all the places that every person inside the building would typically need to go and compared the efficiency of various layouts, with the emphasis on saving steps for patients,” said lead architect David B. Howell, the principal at David B. Howell Architecture & Design, of Tucson, Arizona.
Typical medical office design has cancer patients moving back and forth from a single large waiting area to examination rooms, infusion chairs, and other treatment zones. In the new Arizona Oncology building, each division—medical, gynecologic and radiation—has its own corridor, and the treatment rooms are organized such that the rooms patients are most likely to visit are closest to the entrance. To spare patients from unnecessary walking, there are mini-waiting areas between each of the major service areas.
“The emphasis on efficiency carried over into the individual rooms as well,” Howell said. “Many large treatment centers put a single nursing station to one side of their main infusion rooms. The new center has several nursing stations, so each nurse is closer to patients. Shave a few seconds off each walk and multiply that by the hundreds of trips that a nurse makes in a typical day, and you’ve given nurses significantly more time to help patients.”
Arizona Oncology now has 80 physicians practicing at 3 dozen locations in the lower half of the state, from Flagstaff to Nogales. It is thus a very large private practice, but its size is a recent development. As late as 2008, the practice had just 6 medical oncologists.
The decision to expand came in response to the increasing cost and complexity of cancer care and the increasing competition, much of it from large and well-funded organizations. MD Anderson teamed up with Banner Health to open a cancer treatment center in the Phoenix suburb of Gilbert. The Mayo Clinic has made huge investments on cancer care in Phoenix, including the construction of a $180 million proton beam facility, which opened last year.
Arizona Oncology was already part of the US Oncology network, which helps its members with nonmedical tasks ranging from purchasing to marketing, administration, and business planning. The practice partners, therefore, sat down with the business experts from US Oncology and devised a response to the changing market conditions, a response that entailed transforming the small medical oncology practice into a large and comprehensive cancer care organization that operated across the state.
Arizona Oncology’s growth has come from hiring new physicians and merging with existing practices. The increased scale brought many benefits. The practice could pitch itself to referring doctors as the right place to send their patients with cancer. It could afford to advertise itself via television and radio and billboards in one of the nation’s largest media markets. It even had the size to begin moving some of its offices from generic rental space to custom-designed facilities.
The new treatment center near Arizona State University is the first that Arizona Oncology both owns and built for itself, but 3 more of its offices were designed and built specifically for its operations and are in rented space.
“Determining where to put the treatment centers and how large to make them is more of an art than a science,” said Jeff Siupik, director of Arizona Oncology’s radiation services and practice development. “On the one hand, you want lots of well-distributed offices so you’re close to everyone. On the other hand, you want those offices to be large enough to offer a comprehensive treatment list.… We’re very happy with the balance struck by the new treatment center. It offers everything a specialty hospital can short of proton beam therapy, but it packs everything into a human-sized facility that’s convenient to a large patient population.”
As one of the practices that participates in CMS’ Oncology Care Model, Arizona Oncology has expanded its operating hours, started opening on Saturdays, and taken other steps designed to reduce long-term costs by giving patients the sort of easy access designed to address health issues early in development.
The practice has been talking to the local private payers about moving from strict fee-for-service reimbursement to fee-for-outcome payment, which would allow the practice to choose and design patient-centered services that would keep patients out of hospital beds and emergency departments. It would also allow the practice to share in the savings from reduced hospital use.
Those discussions have yet to result in any changes to Arizona Oncology’s compensation model, but periodic discussions are taking place with UnitedHealthcare, Blue Cross Blue Shield, and Aetna. Indeed, Bhoola and his partners believe that some flavor of fee-for-outcome is the future, and the only question is when pilot programs will produce enough data on best practices to trigger a significant shift.