Tag Archives: healthcare

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GPE Releases Metro Phoenix Healthcare RE Market Overview

As we end 2013 and begin 2014, the question healthcare landlords and tenants are asking is, “How is the Affordable Care Act (ACA) going to affect me as it is implemented?” Providers continue to remain uncertain of their practice’s future by requesting shorter lease terms and renewal terms. Healthcare organizations such as Banner Health (“Banner”) have been purchasing medical office buildings and retail centers near their hospitals at “bottom-of-the-market” prices and becoming owner-users of these properties. On Feb. 15, 2013, Banner purchased 755 E. McDowell Rd., a 93,411 SF property for $6,169,742 ($66.05 psf) near Banner Good Samaritan Health Center in Phoenix. Near Banner Baywood Health Center, Banner purchased a 103,411 SF retail center called Cooper Village, located at 6704-6744 E. Broadway Rd., Mesa, for $4M ($38.68 psf) on April 4, 2013. On the provider side, Banner has been purchasing practices and placing them in these properties.

The leasing statistics in the Phoenix market prove to show little change from Third Quarter 2013 to 4Q 2013. The average lease rate remains steady in the 4Q at $21.99 full service from $21.72 in the 3Q, according to CoStar. The average lease rate has been at this level for most of 2013 and the vacancy remains at +/-30%. The above data is comprised from 324 medical office buildings consisting of 10KSF or more, for a total of 12,580,074 SF.

Sales Activity

In the 4Q 2013, the medical office/investment sales continue to improve as we see larger properties change hands and little or no distressed assets traded. According to CoStar, there were a total of 12 medical office sales transactions in the  4Q, 2013 including three large investment sale transactions; owner/users including John C. Lincoln Healthcare Network and two others that purchased smaller medical office buildings; only one REO sale; and the remaining are smaller investment sales of Class-C medical office buildings. The total sales volume for the 4Q 2013 was $57,496,412, with an average price per square foot of $143.44, decreasing from $204.80 in the 3Q, 2013.

Details for the three large investment sale transactions for the Fourth Quarter 2013 are below:

Copper Point , 3530 & 3570 S. Val Vista Drive, Gilbert, AZ 85297

93,961 SF building sold Dec. 27, 2013 for $108.56 per SF for a total of $10.2M. Built in 2008, WCCP Copper Point, L.L.C. purchased this property from Investment Equity Development, L.L.C. Kathleen M. Morgan, CCIM and Trisha A. Talbot of GPE Commercial Advisors are leasing this property.

Mercy Medical Commons, 3645 S. Rome Drive, Gilbert, AZ 85297

46,732 SF building sold Dec. 23, 2013 for $303.86 per SF for a total of $14.2M. Built in 2010, MedProperties, L.L.C. purchased this property from Gilbert Mercy Medical Partners.

McAuley Building, 500 W. Thomas Road, Phoenix, AZ 85013

168,511 SF building sold Oct. 24, 2013 for $123.41 per SF for a total of $20,795,381. Built in 1994, Heitman, L.L.C. purchased this property from LaSalle Investment Management in a bulk portfolio sale, including MOB assets in Arizona and California.

Senior Housing Supplement

Senior housing continues to be a “hot” topic as we continue to retire “baby boomers” in record numbers. Questions of how the changes in healthcare will affect the services offered in this healthcare segment, and how the real estate for this industry needs to change and/or grow to meet the current and upcoming demand are still being discussed.

The demands for senior housing is not only defined by need, but especially for independent and assisted living the delineation starts with public versus private pay. Then, within private pay, a number of models and demographics are affected by a variety of income levels. According to the Senior Care Investor, November, 2013 forecasting the supply and demand of senior care facilities, decisions will have to be made on whether to remodel, sell and/or reinvest into developing new facilities.

Relating senior housing demands to our local market, in November 2013, the National Investment Center for the Seniors Housing and Care Industry (NIC) reported that Phoenix is among the top five markets with assisted living properties under construction. The top five markets account for 43 percent of the assisted living construction nationwide.

In other local news, Encore on First, a tax-subsidized senior-housing complex located in downtown Mesa, opened in December 2013. Encore located at 25 West First Avenue Mesa, Arizona is a five-story, 81-unit complex offering its residents the opportunity to walk to nearby venues including the Mesa Arts Center, restaurants and future light rail, according to the Arizona Republic. One Encore resident pays $550 monthly for her apartment with the federal tax credits offered for this facility.

CoStar reports two senior care facility transactions in the 4Q, 2013.

Casa Valle, 5516 E. Thomas Road, Phoenix, AZ 85018

13,580 SF rehabilitation center sold for $92.05 per SF for a total of $1.25M. Built in 1949, Crossroads, Inc. purchased this property from Primer Paso, L.L.C.

Country Meadow Guest Home, 2815 W. 48th Street, Phoenix, AZ 85008

5,016 SF skilled nursing facility sold for $69.78 per SF for a total of $350,000.  Built in 1949, Bahati, L.L.C. purchased this property from an individual investor.

Vince and Kate, CBRE

CBRE Hires Kate Morris and Vince Femiano

CBRE has hired First Vice President Kate Morris and Vice President Vince Femiano, the top healthcare tenant brokerage team in the local commercial real estate industry, to join the firm’s Healthcare Services Group in Phoenix, Ariz. The duo will focus their attention on the dynamic local healthcare market, and will be providing services to healthcare systems, practice groups, healthcare providers, medical building owners, and others in the ever-changing healthcare industry.

I’m excited to welcome Kate and Vince to the team. They are a perfect addition to our Healthcare Services Group,” said Craig Henig, CBRE’s senior managing director and Arizona market leader. “Their years of experience and skill sets make them a powerful partnership that will allow for unrivaled service to our clients in the healthcare sector.”

Morris and Femiano come to CBRE from Transwestern where they headed up the company’s Healthcare Practice Group in Phoenix. They specialize in tenant advisory services for healthcare and medical clients, and have established themselves as the preferred provider of healthcare real estate services for over 800 physicians in the local market. Among their many major assignments, they are responsible for the oversight of transactions for a six hospital healthcare system in Phoenix and a four hospital healthcare system in Chicago, Ill., serving as the single point-of-contact for all real estate related operations. Additionally, they are growing their agency platform and working with one of the leading healthcare REITs in the nation.

The duo specializes in offering all-encompassing real estate services to healthcare clients, with an emphasis on tenant advisory, agency and investment services. They are particularly well-versed in Stark compliance issues, as well as all aspects of leasing, building purchases, dispositions, strategic planning, transaction management, consulting and other facility-related transactions as they relate to medical service providers and healthcare organizations.

CBRE’s Healthcare Services Group provides a comprehensive real estate services offering to leading healthcare systems locally and across the country. CBRE’s integrated approach aids clients in reducing cost and unlocking capital, while being sensitive to the patient experience. Members of the Healthcare Services Group recognize the significant challenges facing the healthcare industry and the need to carefully balance cost management with patient satisfaction. An integrated approach to real estate services will allow Morris and Femiano to provide clients with innovative, market-leading solutions that leave no stones unturned in searching for economic opportunities.

Morris holds a bachelor’s degree in business administration from Iowa State University in Ames, Iowa and a master’s degree in business administration from Loyola University of Chicago.

Femiano holds a bachelor’s degree in business administration from Arizona State University in Tempe, Ariz.

Photo by Gregg Mastorakos

Healthy Side Effect: ACA's impact on CRE, sustainability

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" width="200" height="301" /> Mark Stapp, professor of real estate practice and executive director of Arizona State University’s Master of Real Estate Development program.

There’s another trend growing out of the Affordable Care Act’s (ACA) emphasis on wellness. Mark Stapp, a professor of real estate practice and executive director of Arizona State University’s Master of Real Estate Development program at the W.P. Carey School of Business, says the trend can benefit Arizona’s economic development efforts.
“You say sustainability, and people think about energy, green building and conservation,” he says. “In reality, sustainability also includes a healthy workforce. When the workforce is healthy, productivity increases.”
Stapp says a combination of Millennials’ lifestyles combined with an aging boomer population means changes in development patterns. “Improved healthcare and an emphasis on wellness shifts where and what space is in demand. The population wants healthy places to live.”
Stapp sees the trends as drivers bringing populations closer to city centers. He also believes a healthy community is a big economic development selling point.
“The movement (in the Affordable Care Act) is to maintain and improve health rather than fix it,” he says. “This is crucial with the shortage in primary care physicians. It also means that healthy living is going to become integrated in other areas of the community.”
Stapp sees new business models developing around the ideals of healthy living. “As (the ACA) evolves, its policies will change and encompass a broader range of health care and wellness options. Integrative healthcare will become far more important,” he says.
What this means to economic development, Stapp explains, is that healthy cities are more productive.
“Supporting healthy lifestyle choices becomes a competitive advantage,” he says. “This is a direct shift of a portion of healthcare responsibility from insurance companies to communities.”
Changing the types of medical practices and patterns will also change building design and usability. “Real estate has value to support an activity,” he says. “If an activity goes, so does building value.”
Stapp sees a gradual change in office environments. “There is a shrinking demand for space. Can medical campuses withstand the test of time?” he asks. The bigger pie, in terms of health care and wellness, he says, is to look ahead to rapidly emerging trends that may make today’s medical office infrastructure useless.
“People are capital,” says Stapp. “Businesses are going to protect capital, and that is going to lead to adaptation when the demand creates new opportunities with different office uses.”

Banner MD Anderson Cancer Center in Phoenix.  Photo / Gregg Mastorakos

Healthy Outlook: Affordable Care Act means new healthcare opportunities in CRE

“Tastes great!”
“Less filling!”
The old beer adage flavors trends in healthcare commercial real estate entering the Age of Affordable Care Act (ACA). There are tasty opportunities for new types of healthcare real estate and a glut of less-filled medical office buildings (MOB) that may result from consolidations.
Healthcare providers are looking for patient-luring, high technology facilities and they want to pay less for the capital development. Facilities will be smaller, more flexible and expandable. Look for an airline-style hub-and-spoke system.
The new law and changes in healthcare delivery are also going to affect real estate — building sales and leasing, and the value of physician practices and clinics. Many existing medical office buildings will have to re-adapt. Some older facilities may be destined for scraping and redevelopment into other uses.
Deadline on evolving trends

Healthcare has been evolving over the past decade and ACA merely deploys previously evolving trends. All healthcare providers are now implementing change. To understand the future trends in healthcare, the ACA backend effect has to be understood.
Cars and people both run better with 5,000 mile oil changes and 25,000 mile tune-ups — for people, it’s periodic blood tests and annual physicals. It costs significantly less to deal with preventive healthcare for people than treating preventable illnesses.
“The top five illnesses in terms of cost and numbers are lifestyle-related and preventable,” says Mark Stapp, professor of real estate practice and the director of the Master of Real Estate Development programs at the W.P. Carey School of Business at Arizona State University. Stapp says ACA’s focus on wellness is going to have “profound effects on medical real estate and economic development.”
While most political and public discourse focus on the consumer side of the law, healthcare providers are gearing up for what the law means in terms of delivering healthcare and the facilities required for delivery. ACA deploys three fundamental healthcare delivery changes:

1. Creation of Accountable Care Organizations (ACO)
2. Emphasis on keeping people healthy
3. Using hospitals for only the most acutely ill

Meeting the standards of care financially rewards healthcare providers; failing to meet the new standards results in financial penalties. The solution is a model deployed by Banner Health in the Valley — deliver healthcare into neighborhoods using a hub-and-spoke system. This is one reason Banner has built six health centers across the Valley.
Private sector healthcare organizations are not the only ones affected by the law. The Maricopa Integrated Health Service is considering a bond issue to fund its strategic plan. If passed, resulting construction and renovations will enhance its already-existing hub-and-spoke healthcare delivery system.
With thousands of Arizonans obtaining health insurance for the first time, there is an increased demand for healthcare providers. That component of ACA alone would seem to make MOBs an ideal real estate investment. The reality is, to obtain efficiencies, older buildings may not work.
“There are a lot of medical office buildings and clinics that are going to be functionally obsolete; and not just old ones,” reports Tom Weinhold, managing director of Cassidy Turley’s healthcare practices group. “Owners are going to have adapt to general office use or possibly tear offices down and replace them with other uses. Medical infrastructure has requirements today that some buildings cannot accommodate.”
Stapp says it could be a double-whammy in an already over-built office market.
“General demand for office space is decreasing,” he says. “Real estate has value from supporting an activity. If that activity goes, so does the value. The changes in medical care are driving changes in building design.”
Stapp says there are prospects because of ACA, too.
“Much of the public discourse is focused on the healthcare delivery, but there are rippling opportunities,” he says. “The emphasis on wellness is going to more broadly open that field. Community design, how and where people live, transportation options will all change development patterns. The population wants a healthy environment and business will find opportunities in that demand.”

Development opportunities

“The days of the ‘build it and they will come’ hospital towers are over,” suggests Layton Construction’s Steve Brecker, executive vice president-healthcare. “Owners large and small are looking at their dollars much more carefully than before. There is a bigger analytical process in the decision to build or renovate a facility.”
Brecker’s comment, which comes from the firm’s nationwide perspective, is that no healthcare organization is overbuilding. Everything is right-sized for staff efficiency. “Interiors are the focus today. Unlike the ‘70s and ‘80s, a lot of forethought goes into everything from the lobby design to the comfort of the waiting areas,” he says.
At McCarthy Building Companies, Vice President of Business Development Chris Jacobson has a similar observation. “It’s a lot less expensive to build a clinic in an outlying area and bring healthcare to the patients as opposed to forcing patients to drive a long distance to a medical center,” he says. “The outlying clinics capture market share for a provider, and feed more acutely ill patients into the central medical center.”
This is the gist of the hub-and-spoke system deployed by Banner.
“Banner is the trendsetter,” Jacobson says. “They are using an accountable care model (as an ACO) and emphasizing wellness to save money.”
Banner’s Vice President of Development and Construction Kip Edwards says, “We’re going to deliver care at the most convenient and accessible level to our patients. This means not only clinics, but online, telemedicine and other support and educational services.
“What we’re doing is putting physicians, PAs and nurses into a neighborhood setting, so that a patient does not have to wait to see a doctor. In the current system, you’re sick today. You call the doctor and can be seen in three days or next week. You’re not sick next week, you’re sick today. Banner is developing the facilities so a patient can get into the doctor today at the place where all his records are located. Then, if he needs x-rays, prescriptions and a lab test, it’s all in one place; no more running all over town.”
“What all this means for designers and builders is that owners are cautious and we’re not seeing new mega projects,” says Steve Whitworth, healthcare division manager for Kitchell Development. “Most projects these days are in the $5M to $10M range. We’re seeing outpatient space expansion, practices combining and technical upgrades.”

Clinics are being absorbed

Banner, along with Vanguard, Cigna and other major providers, are buying up medical practices to be those family clinics.
“Some of the practices are going to stay in their office condo or leased space,” reports Weinhold. “We’re seeing the big providers saying to doctors, ‘We’ll take your debt and administration, give you some up-front money, and you can work for us.’ Sometimes, there will be an agreement to keep current space for three to five years.”
The consolidations and acquisitions have completely chilled the market for medical practice sales. Although not CRE, many physicians and groups used to plan on a practice buy-out — with or without real estate — that would fund retirement.
“That’s just not the case anymore. No one wants to buy a medical practice except the accountable care organizations,” Dave Peterson says. The owner and designated broker of Arizona Business Intermediaries, LLC, has seen the market grind to a near halt, “It used to be I could take on a practice listing, send it out to a direct marketing list of other physicians and close a deal. Small physician practices used to value at two- to three-times earnings. Now, it’s sometimes less than one times earnings.”
Peterson says that the big healthcare organizations are buying practices on set formulas and with some upfront money. In the end, he says, the now-employee doctors will move into a neighborhood or community clinic.
“There are two impacts on the value of practices and the interest of physicians being their own boss,” he adds. “The first is [ACA]. It’s putting practices in the position of only one interested buyer — large healthcare organizations. The second, which a lot of people don’t consider, is the cost of medical school and its related debt. All of this makes working for a healthcare organization on salary appealing.”
It also causes medical practice values to plummet — dental clinics, cosmetic surgeons and other discretionary practices are not affected by ACA.

New opportunities

“With the emphasis on efficiency and limited dollars, today’s builder is a construction manager and trusted advisor,” observes Layton Construction’s Brecker. “We’re not waiting for plans and giving estimates, we’re involved in the design to use our experience to help the owner and architect design a project that delivers what’s needed for the dollars available. It’s different than just a few years ago.”
Hamilton Espinosa at DPR talks about ROI and efficiency, “As providers are pushing healthcare into the neighborhoods, they are going to spending less to build or remodel. At the hospitals and medical centers, major renovations are not going to be funded unless there is a return on investment.”
Espinosa says full-time equivalent employees and energy are the biggest operating costs for a healthcare system.
“If we can show that a renovation is going to increase staff efficiency and cut energy cost, the owner is going to be willing to put more capital into the project,” he adds.
This is another example of the builder becoming part of the overall design team early in the process. Builders may have an opportunity for more development money if offsetting operational savings are part of the construction project.
Following the Banner model opens other opportunities.
“John C. Lincoln is developing a freestanding emergency department (off Carefree Highway and I-17, Phoenix). Scottsdale Healthcare is building neighborhood clinics and urgent care centers,” points out Kitchell’s Whitworth. “The freestanding (emergency department) is the seed of a future hospital. Dignity (Health) is doing the same thing in Glendale.”
Kitchell is also using new construction techniques to build medical facilities. “It started with the Chandler Regional (Medical Center),” Whitworth explains. “We’re building modules in a warehouse and then bringing them to the site for installation. There’s a safety factor by cutting the number of people interacting onsite. Because healthcare organizations are almost using the same template for interior work, there is a cost savings building offsite.”
Kitchell does not have its own facility, but uses partner warehouse space or on occasion, leases space, for the offsite panel construction.
“We’re constantly looking for new ways to do things to reduce costs and increase quality,” he says.

New moves for service delivery

Other healthcare providers are getting ready to implement ACA strategies. Rather than acquiring practices and building all its own clinics, the Mayo Clinic seeks to affiliate and partner. This move is not at the exclusion of building its own clinics, but in addition to greenfield facilities. Mayo has affiliations with the new cancer center at Yuma Regional Medical Center and the Sierra Vista Regional Health Center is developing a Mayo telemedicine connection.

John C. Lincoln Health Network North Mountain Hospital in Phoenix. Greg Mastorakos

John C. Lincoln Health Network North Mountain Hospital in Phoenix. Greg Mastorakos

“We’re putting less focus in inpatient services,” reports Cheryl Lisiewski, director of facilities project management for Mayo Clinic. “Our remodeling and expansion are creating a better environment for outpatient services and increased examination space.”
Mayo is undergoing a nearly $350 million expansion on the Phoenix campus with a proton beam therapy facility and new cancer center.
“We’re looking to develop new clinical offices, but primarily, the expansion allows us to renovate and backfill offices for departments that are now in compressed spaces,” she says. The expansion does generate some new inpatient beds, but it’s almost exclusively designed to meet outpatient needs.
The investment on campus is not preventing Mayo from reaching into the community. “We may develop stand-alone and primary care facilities,” explains Lisiewski. “We’re also interested in strategic partnerships for the Mayo Care Network. It’s similar to what we’ve done in Minnesota and Wisconsin.”
Mayo Clinic expects to announce its first primary care clinic in an outlying community in the near future. Negotiations were not completed at press time. Mayo’s model is good news for MOB leasing, but on a small scale compared to the number of facilities. Its partnerships mean working with existing practices or newly consolidated groups.
“There isn’t a relationship between MOB office space that will be delivered and population growth,” cautions Weinhold. “Well-located space is being snapped up by REITs at premium prices. Outlying MOBs are seeing values decline. It’s not just a simple conversion to switch an MOB to a general office.”
“There are a lot of different vehicles being used,” he adds. “Walgreens, CVS and Walmart are developing in-store mini-clinics. The urgent care centers, FastMed and NextCare, are going into retail center end caps. NextCare has started building on retail pads.”
These options are not good news for owners of Class-B and -C office space.
“I had physicians who were buying medical office buildings before and during the recession,” recollects Arizona Business Intermediaries’ Peterson. “Now they want to get out, but they’ll be lucky to recoup the purchase price on some of those properties. It’s not just recession-pricing, it’s that the buildings are going to be empty under [ACA].”
“The big problem, too,” explains Cassidy Turley’s Weinhold, “is that a medical office is not

Banner Estrella Hospital, in Phoenix, during construction phase. Courtesy of McCarthy

Banner Estrella Hospital, in Phoenix, during construction phase. Courtesy of McCarthy

adaptable to a general office. Owners are going to need to come into these office condos and gut the place. It’s unlikely once vacated there are enough small practices to take up the space that’s going to be available.”

New buildings, new opportunities

“New businesses are going to model around the new ideas that come out of [ACA],” projects Stapp at the W.P. Carey School of Business. “There’s a huge impact from wellness, because healthy people reduce healthcare costs. This is going to create opportunities for wellness business — and these businesses are going to need facilities. For example, there is a shortage of primary care physicians. This increases opportunities for complementary integrative medicine. That opens the door to small niche practices not impacted by ACA.”
“Our marketing is going to change for healthcare,” McCarthy’s Jacobson advises. “Without the big projects, we need to adapt to smaller projects and facility upgrades. Cost is going to be a big driver in the process.”
Jacobson say smaller facilities provide opportunities for builders to take on multiple projects using big medical center experience: “The materials and systems are the same for the health centers. Redundancies are not required, but the electrical and HVAC still function the same way as a hospital.”
Jacobson sees opportunities with delivering healthcare into rural areas, “Telemedicine, robotics and web services may not means anything more than a room in a rural clinic, but the backbone is going to require central facilities like call centers and data centers.”
Whitworth echoes that comment, “We have a benefit at Kitchell that we can call a medical professional any time, 24/7, and they’ll tell us whether to take two aspirin, get to an emergency department or make an appointment for a doctor. That medical professional has to be located in a facility somewhere.”
“Banner is going to spend $15B over the next 10 years renovating its medical centers and building clinics,” concludes Banner’s Edwards. “Sometimes, we might find a facility we can renovate or repurpose. Other times, we might have a greenfield building. Occasionally, we might lease space.”
Multiply that by the number of healthcare organizations in Arizona, and the future of healthcare CRE has some potential.
“I just don’t see it happening next year,” says Espinosa.

Eric Jay Toll is a freelance writer based in Scottsdale. He covers CRE, development and construction, business, medical and travel news for a variety of publications. His work appears in AZRE, Az Business, USA Today, CardioSource World News, and Toll is the senior correspondent for Arizona Builder’s Exchange. Toll spent three decades as a land planner, including 17 years in public agency development and economic development department management. He lives in Phoenix.

David Derr

David Derr Joins Shepley Bulfinch

Shepley Bulfinch is pleased to welcome healthcare planning and design leader David H. Derr, AIA, as a principal in the firm’s Phoenix office, where he will lead the healthcare practice in the Southwest.

In announcing the appointment, Shepley Bulfinch president Carole Wedge said: “David’s strategic understanding of regional and national healthcare trends are a real strength as we advances our presence in the expanding healthcare markets of the West and Southwest.”

David has led healthcare planning and design projects that span the US and the Middlle East, with experience in expanding firms’ healthcare practices. His notable project work includes a replacement medical center for Kaiser Permanente (San Leandro CA); the flagship ambulatory care center for Group Health Cooperative (Bellevue WA); and a proposed cardiac center in Bahrain.

“As a healthcare architect who is keenly aware of the fundamental impact of design on the quality of care, I’m particularly pleased be helping lead Shepley Bulfinch’s healthcare practice,” said David. “Shepley has the rare ability to bring planning, clinical best practice, design excellence, and execution together in its facilities.”

David is a member of the AIA and the AIA Academy of Architecture for Health (AAH). He holds a Bachelor of Architecture degree Ohio University.

Judy Rich

Judy Rich – 50 Most Influential Women in Arizona Business

Judy Rich – President and CEO, TMC Healthcare

Rich has held roles in healthcare that range from staff nurse to CEO. Rich joined TMC HealthCare nearly 10 years ago and was COO for Tucson Medical Center until 2006 before she was named president and CEO of the 650-bed nonprofit hospital in 2007.

Surprising fact: “I often come to TMC on the weekends when my daughter is volunteering with Therapeutic Ranch for Animals and Kids, introducing the ranch’s rabbits, chicks and other small animals to TMC’s pediatric patients.”

Biggest challenge: “As CEO, it’s important to zoom in to understand the seemingly minute details of operations, as well as zoom out to see the organization from the 10,000-foot level. Balancing between the two is challenging and takes discipline.”

Fifty Most Influential Women in Arizona Business – Every year in its July/August issue Arizona Business Magazine features 50 women who make an impact on Arizona business. To see the full list, read the digital issue >>

HEALTHCARE REFORM: Deadline for Employers to Provide Exchange Notice

The deadline for employers to distribute the Exchange Notice to employees is Oct. 1, 2013. Additionally, employers are required to provide the notice to each new employee hired on or after Oct. 1, 2013, no later than 14 days after the employee’s start date. The notice must be distributed regardless of whether the employee is full-time or part-time. Employers not offering group health plan coverage must also provide the notice:

Delay In Employer Mandate

On July 9, 2013, the IRS released Notice 2013-45 to provide a one year delay for employers with 50 or more employees. Employers will not be liable for employer mandate penalties until 2015.

92190696

The changing role of nurses

They are the healthcare providers that will see 22 percent job growth – more than any other occupation – through 2018. They are the communicators. They bridge the gap in the medical industry. They are the part of the healthcare team that makes sure that the right patient is in the right place getting the right thing done.

They are nurses and they are now taking on more specialized roles, applying advanced technologies and filling voids created by an anticipated shortage of primary care physicians.

“We are encouraging our nurses to return to school to advance their degree,” said Deborah Martin, senior director of professional practice at Banner Health. “Patients are much more complex in our hospitals, as well as in the home and our communities … Nurses need to have higher levels of education to manage these complexities in all settings where nurses practice. Advanced degrees are now required for our upper level nursing managers.”

About 10,000 Baby Boomers reach retirement age every day, fueling the long-term demand for specialized nurses. To help fill that need, Arizona State University implemented the Adult-Gerontology Nurse Practitioner Doctor of Nursing Practice (DNP) concentration.

“It will prepare nurse practitioners to deliver primary care to adults throughout their lifespan with increased emphasis on care of the aging population,” says Katherine Kenny, clinical associate professor and director of the DNP program at ASU.

Johnson & Johnson’s website lists more than 3,000 capacities in which nurses can be employed — from school nurses to jailhouse nurses. Nurses practice in hospitals, schools, homes, retail health clinics, long-term care facilities, battlefields, and community and public health centers. Everywhere there are people, there are patients, and everywhere there are patients, there are nurses.

“Nurses are becoming more influential in the policy changes that are occurring with the Affordable Care Act,” Kenny says. “More nurses are practicing in ambulatory care settings and public and community health.”

Arizona educational institutions are now offering a wide range of educational opportunities which support the nursing profession’s challenge to improve patient care outcomes for individuals, systems, and organizations. And because of skyrocketing healthcare costs, preventative care and education have become integral elements in reducing chronic illness and minimizing re-hospitalization.

“Nurses are now specializing in everything from palliative care and managing chronic illness, to maintenance and preventative care,” says Ann McNamara, dean of Grand Canyon University’s College of Nursing. McNamara says students at GCU are spending more time concentrating on home healthcare and hospice in their new hands-on simulation labs, complete with live actors, computer-operated mannequins, and dynamic patient scenarios.

Angel MedFlight provides air medical transportation services from bedside to bedside.  The company’s CEO, Jeremy Freer, says “[Our] nurses are able to put all the components of the puzzle together and make the medical flight process more efficient, effective and compassionate.”

Nurses are also assessing the long-range healthcare needs of patients.

“Where once the hospital nurse’s prime responsibility was to provide the best care possible that the patient needed at that moment, now the nurse is also focused on what happens next,” explains Maggi Griffin, vice president of patient care services at John C. Lincoln Health Network.

Griffin says that patient discharge planning and post-hospitalization follow up are other key roles of the evolving nursing profession.

Advancements in technology have significantly enhanced patient care in recent years.  Nurses now have the ability to monitor patient conditions remotely, and electronic health records enable nurses to track, evaluate, and document patient information.

“Technology is opening doors to deliver nursing care in new and innovative ways, often serving as a second set of eyes to enhance patient safety or monitoring patients from their homes,” says Deborah Martin, senior director of professional practice at Banner Health. Martin adds that Medication Bar Coding is another example of how technology is helping nurses be more effective and prevent errors.

Due to the skyrocketing cost of healthcare in general, nurses are becoming more involved in a patient’s primary care.

“As advanced practice providers of healthcare, nurses with master’s and doctoral degrees are able to deliver high quality care to patients in their own individual practice,” Martin says, “as well as work side by side with physicians to provide care in a more cost effective manner.”

“As the major component of hospital rosters, nurses’ salaries account for a significant part of any hospital budget,” Griffin adds. “With financial stresses coming from the economy, from government healthcare program budget cuts and from other areas, nursing is much more tightly controlled.”

A decade ago, nursing shifts were scheduled regardless of room occupancy. Currently, industry experts say those staffing schedules fluctuate based on patient population in each unit.

The other major shift is in the demand for specialized nurses. Julie Ward, chief nursing officer at St. Joseph’s Hospital and Medical Center, says specialties have nurses working in both the inpatient and outpatient settings.

“We are also exploring roles for nurses to shepherd groups of patients through the maze of care,”  Ward says. St. Joseph’s nurses make follow-up phone calls to patients to ensure the patient is safe and able to follow their discharge instructions, Ward says.

Still, the primary evolution of the nursing industry has been in higher education. Gone are the days when nurses were simply bedside attendants. Now, they are replacing the expensive medical doctors and are running their own practices as Family Nurse Practitioners (FNPs) and in other upper level specialties. Most hospitals are encouraging their nurses to return to school to improve their knowledge base and advance their degrees.

The Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine of the National Academies (IOM) launched a two-year initiative to respond to the need to assess and transform the nursing profession. The IOM appointed a Committee on the RWJF Initiative on the Future of Nursing for the purpose of producing an action-oriented blueprint for the future of nursing. Through its deliberations, the committee developed four key messages:

* Nurses should practice to the full extent of their education and training.

* Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

* Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States.

* Effective workforce planning and policy making require better data collection and information infrastructure.

“We are encouraging our nurses to return to school to advance their degree,” Martin says. “Patients are much more complex in our hospitals, as well as in the home and our communities. As noted by the IOM, nurses need to have higher levels of education to manage these complexities in all settings where nurses practice. Advanced degrees are now required for our upper level nursing managers.”

Translatinal Accelerator looks to invest in Arizona bioscience companies, 2008

BioAccel Challenges Entrepreneurs to Solve Healthcare Problems

BioAccel, a 501(c)3 non-profit and Arizona’s premier resource for healthcare innovation, is announcing the BioAccel Solutions Challenge to solve medical and health delivery problems in Arizona, stimulate new company formation and increase investment in the industry.

BioAccel will publicly release a vetted list of key healthcare problems, or “needs,” identified by industry practitioners and leaders, aimed to challenge entrepreneurs to create innovative solutions to solve them. The needs are expected to focus on improving patient care and health outcomes by using medical devices, molecular diagnostics and potentially health IT, and will be released this summer.

Qualified applicants will receive a $50,000 investment from BioAccel if they succeed in receiving matching funds from investors during a competitive and lively Investment Day event. Successful groups will then have $100,000 in proof-of-concept dollars to form companies to address these patient care needs.

“Necessity is definitely the mother of invention. There are a lot of very talented entrepreneurs in Arizona whose are poised to solve difficult challenges that face the healthcare system. They simply need to be informed about well qualified healthcare needs, so they can apply their creativity to finding solutions to real problems,” said MaryAnn Guerra, CEO of BioAccel. “The BioAccel Solutions Challenge program unlocks the innate nature of entrepreneurs to innovate new products as well as provide the capital and support they need for early-stage success.”

Upon announcing the needs, BioAccel will be hosting Q&A sessions across the state as well as a webinar to support the groups.

“We’re encouraging groups across the state to form in anticipation of the release and to start thinking about how they will create innovative solutions,” said Kelvin Ning, Associate Director of Business and Technology Development at BioAccel.

The final Investment Day event is targeted for the end of 2013.

“The BioAccel Solutions Challenge is bringing together innovators and investors across the state to drive economic development, while at the same time addressing critical needs that face our medical community. Our focus is to catalyze this interaction and stimulate the growth of new enterprises and novel products,” Guerra said.  The BioAccel Solutions Challenge organizes problem, solution and market need, along with the resources needed to support validated outcomes.

As part of the BioAccel Solutions Challenge, winners will receive mentorship and support from BioAccel’s extensive business and financial network. Winners will also have access to BioInspire, BioAccel’s device incubator in Peoria, which provides affordable space and support for medical device technologies.

“BioAccel’s objective is to create sustainable companies that produce valuable products that are needed in the marketplace. Our hope is that these companies progress into our commercialization programs and beyond,” said Dr. Ron King, Chief Scientific and Business Officer at BioAccel.

In addition to creating jobs and new companies, the BioAccel Solutions Challenge will drive the organization’s Technology Advancement Program (TAP) that is focused on creating a more robust and qualified technology pipeline.

The TAP and New Venture Development Programs are commercialization programs unique to BioAccel, which are designed to specifically address the well-known Valley of Death that separates discovery from commercialization. Beyond access to BioInspire and capital, embedded within these programs is BioAccel’s due-diligence process, network of local and national subject matter experts, and healthcare business expertise.

 

childbirth

MomDoc Names New COO

MomDoc, a well known staple in women’s health care in the Valley, has named Lori Linder its new Chief Operating Officer. Linder is a familiar face in the healthcare field. She will assume responsibilities in early May.

Linder has more than thirty years experience working with Banner Health, Arizona’s largest health care system. She has served as Chief Financial Officer for Banner Ironwood Medical Center since the center opened. She also functioned as Banner’s Interim CEO. She provided leadership when Banner opened Cardon Children’s Medical Center and served as the CFO at Banner Desert Medical Center as well.

“I am very excited to be joining an organization of the caliber of MomDoc. With 33 years in healthcare administration, I hope that my experience can assist MomDoc in these changing and challenging times in American healthcare,” she says.

MomDoc CEO Nick Goodman is pleased to have Linder at the helm. “Healthcare is changing rapidly. As leaders in women’s health medical care it is our honor to work with Lori Linder. She brings to the MomDoc leadership team considerable depth of knowledge on the full cost spectrum of the entire continuum of care.”

Linder brings a wealth of experience to the position of COO at MomDoc as well as a Bachelors of Science in Accounting and a Masters of Business Administration, Finance and Healthcare from Ohio State University. MomDoc hired Linder after tremendous year over year growth within the practice.

“This exciting time in healthcare will allow proven models that take into account best practices, best outcomes and cost reduction measures to take the lead in discussions rather than fee schedule based systems; with Lori MomDoc will continue to innovate so that patients can get the care they need, from those they want to see at the time and place they want to be seen,” adds Goodman.

MomDoc is recognized in Arizona for its six practices with fifteen offices. Under the MomDoc umbrella are Drs. Goodman and Partridge, OB/GYN in the valley for over thirty years; MomDoc Women for Women, a practice with all female providers; Healthy Pregnancy Perinatology, specializing in high risk pregnancy; Mi Doctora, a fully Spanish speaking women’s healthcare practice; MomDoc Midwives, where midwives provide excellent hospital based deliveries; and SHE, Sexual Health Experts, unique to Arizona, featuring an emphasis on women’s sexual health.

Health Insurance

Scottsdale Healthcare, John C. Lincoln form affiliation

Scottsdale Healthcare and John C. Lincoln Health Network have endorsed a letter of intent to form a system-wide affiliation to better meet the healthcare needs and thus improve the health of the communities they serve.

The nonbinding agreement between the two non-profit organizations allows both to pursue an exclusive negotiation during a due diligence period in order to create a combined health system. Discussions are anticipated to be complete by July 31.

The new non-profit system, which would be called Scottsdale Lincoln Health Network, would include five hospitals with approximately 10,500 employees, 3,700 affiliated physicians and 3,100 volunteers. Scottsdale Lincoln Health Network would also include an extensive primary care physician network, urgent care centers, clinical research, medical education, an inpatient rehabilitation hospital, an Accountable Care Organization, two foundations and extensive community services.

Both John C. Lincoln and Scottsdale Healthcare have a strong reputation and history of providing high quality care for the residents of Phoenix and greater Scottsdale. The non-profit health systems share similar visions and cultures, and both are Magnet organizations, a national recognition of providing the highest standards of patient care.

“This affiliation will provide resources to further develop the current high quality care in the hospitals and community healthcare facilities, enhance our geographic presence and honor the legacy of each organization. Our shared vision is to become a fully integrated, locally controlled, world-class health system,” said Scottsdale Healthcare President & CEO Tom Sadvary.

John C. Lincoln Health Network and Scottsdale Healthcare are financially strong, operationally successful and committed to meeting local health needs. Both organizations have been developing integrated delivery systems to expand services beyond acute care.

“Each of our organizations is known for quality and collaboration with community partners to promote the well-being of the communities we serve. The combined Scottsdale Lincoln Health Network will allow us to provide more cost effective healthcare and to thrive during this period of rapid change as a result of national and local health reform as we continue to develop a full continuum of  services beyond acute care,” added John C. Lincoln Health Network President & CEO Rhonda Forsyth.

Upon completion of the affiliation agreement, the Scottsdale Lincoln Health Network governance will be focused on their shared vision which includes:

·         More convenient access to acute and preventive care.
·         Increased coordination of medical care.
·         An expanded network of high quality primary care and specialty physicians.
·         Creation of a single electronic health record that can be accessed at all levels of care throughout the affiliated health network.
·         Improved patient outcomes through shared best practices.

“This affiliation will attract top medical talent by providing opportunities for physicians and other providers to lead the transformation of care delivery, and will enhance our leadership role in medical education and clinical research,” said Scottsdale Healthcare Board Chair Steven Wheeler. “Together we can provide a more comprehensive array of services by applying our combined resources to strengthen our clinical capabilities.”

Forsyth added that maintaining Magnet designation of the system hospitals provides a work environment that attracts top talent.

“As major provisions of the Affordable Care Act continue to take effect, we have the opportunity to shape the future of healthcare in the Valley by cost effectively using our respective resources to enhance our impact in the communities we serve,” said Forsyth.

“We want to maximize our ability to improve the health of our community and create more access to care. A more robust health network with primary care physicians, specialists and partnerships with other healthcare organizations will add capabilities for providing patients with a full continuum of coordinated healthcare services,” said John C. Lincoln Health Network Board Chair Frank Pugh.

 

economy

Arizona Could Hit Full Economic Recovery in 3 Years

We’re finally on the path to full economic recovery, and Arizona may get there in about three years. That’s the main message from experts who spoke today at the 49th Annual Economic Forecast Luncheon co-sponsored by Arizona State University’s W. P. Carey School of Business and JPMorgan Chase.

About 1,000 people attended the event at the Phoenix Convention Center, where economists painted a generally brighter picture for 2013.

“As of September, Arizona ranked fifth among states for job growth, and the Phoenix area was fourth among large metropolitan areas,” said Research Professor Lee McPheters, director of the JPMorgan Chase Economic Outlook Center at the W. P. Carey School of Business. “Arizona is expected to add 60,000 jobs in 2013, led by professional and business services, retail, hospitality and health care. We should finally dip below 8-percent unemployment in 2013 — down to 7.6 percent.”

McPheters added, as long as the national economy doesn’t drag us down, Arizona may see 2.5-percent growth in its employment rate next year. The state had 2-percent growth this year. Despite the jump, Arizona has gained back less than a third of the jobs it lost during the recession. McPheters believes it will take another three years to return to pre-recession employment levels.

In 2013, McPheters expects improved 5-percent growth in personal income, up from just 4 percent this year. He projects retail sales will go up 6 percent, from 5 percent this year. He expects Arizona’s population to rise 1.5 percent, and he believes single-family housing permits will shoot up a whopping 50 percent, with the local housing market now on the mend.

Both McPheters and Beth Ann Bovino, deputy chief economist at Standard & Poor’s, hinged their forecasts on whether the national economy can really pull forward; otherwise, Arizona will go down, too. The biggest question out there is whether Congress can avoid the “fiscal cliff” – where automatic spending cuts would kick in, just as various tax cuts expire. Bovino says that could plunge the United States back into recession and push national unemployment back above 9 percent by the end of the year.

“If we can avoid the fiscal cliff, then it looks like the economy could finally be in a self-sustaining recovery,” said Bovino. “We expect this year’s gross domestic product (GDP) to hit 2.1 percent, stronger than previously projected. For 2013, we’re looking at about 2.3 percent. Reports also show a stronger jobs market and signs that households are willing to buy big items, such as cars and homes.”

Bovino adds the U.S. unemployment rate was at 7.9 percent in October, and she sees signs more people are joining the workforce and getting jobs. However, she says the labor participation rate is still near a 30-year low, meaning more people will still be coming back to the workforce to look for jobs, keeping the unemployment rate low for a quite a while. Despite this, Bovino expects the national unemployment rate to drop to 7.6 percent next year.

She also has a good outlook for the national housing market, with housing starts already up 45 percent this September over last September. Bovino referenced a report that 1.3 million homes rose above water – with the value going higher than what was owed – in the first half of this year alone. She expects residential construction to go up almost 19 percent in 2013.

In the financial sector, Anthony Chan, chief economist for private wealth management at JPMorgan Chase & Co., says corporations remain flush with cash. They’re waiting for some clarity on where the market will go as a result of the fiscal-cliff situation and other factors.

“U.S. corporations are reluctant to go through global mergers and acquisitions or make big investments until they have a clearer picture,” said Chan. “Corporations are keeping high cash balances, in order to deal with the uncertainty. They’re making near-record profits in some cases, and many values on the stock market look good. However, everyone’s waiting to see what will happen.”

He said high-yield investments, such as bonds, and gold remain relatively attractive. The U.S. dollar keeps falling against currencies from emerging markets, as monetary agencies work through different strategies of dealing with the rough economy.

In the local housing market, Elliott D. Pollack, chief executive officer of Scottsdale-based economic and real estate consulting firm Elliott D. Pollack and Company, also drew some conclusions.

“Even though about 40 percent of Arizona homeowners are underwater on their mortgages, we’re starting to see a recovery,” said Pollack. “The single-family-home and apartment markets look great. Industrial real estate has improved quite a bit. Only office and retail have quite a way to go.”

Pollack adds new residential foreclosure notices are down almost 70 percent from the peak in 2008. Phoenix-area home prices are up more than 35 percent over last year. New-home sales are also doing well, with 67 percent of the local subdivisions active today projected to be sold out in less than a year. Builders are going to have to work to meet the demand, with less land and labor available.

Pollack sees a strong rental presence, with about 22 percent of local single-family homes being used as rentals right now. That’s up from less than 12 percent just a decade ago. Landlords appear to be buying up many single-family homes, and more people are moving to the area.

“In the absence of a fiscal cliff, things should continue to improve over the next several years,” said Pollack. “By 2015, things should be normalized. As I like to say, we’re only one decent population-flow year away from the issue being resolved.”

More details and analysis from the event, including the presentation slides, are available from knowWPCarey, the business school’s online resource and newsletter, at http://knowwpcarey.com.

exterior image

Banner Health building four new health centers

Community and elected officials from four east Valley communities joined Banner Health leaders on a “whistle stop bus tour” on Thursday visiting the future sites of four Banner Health Centers which will provide new jobs and highly-coordinated patient care in convenient, neighborhood locations.

The four new centers, a $45.2 million investment by Banner Health, will bring new medical services to markets with a demonstrated need for additional primary care in the east Valley. The centers, including sites in Gilbert (Warner and Gilbert roads), Queen Creek (Ellsworth Loop and Ocotillo roads), Chandler (Alma School and Willis roads), and east Mesa (Crimson and Baseline roads), are anticipated to open in mid-2013.

Each 21,000-square-foot facility will offer a mix of primary care services for everyone in the family. Depending on the community, this may include Family Medicine, Internal Medicine, Pediatrics and, in some cases, Obstetrics and Gynecology. In addition, rotating physician specialists are expected to be scheduled onsite to meet patient needs.

Basic imaging and laboratory services are available onsite at each center for added patient convenience. Electronic medical records at all centers are accessible from all of Arizona’s 14 Banner hospitals and other Banner facilities. Each Banner Health Center will have the capacity for future growth in both size and staff. The architect for the east Valley health centers is HMC Architects and the general contractor is Kitchell.

“We look forward to providing residents in the east Valley quality and convenient care that is close to where they live,” said Jim Brannon, Chief Executive Officer for Banner Medical Group. “Our care will be patient-focused and stress preventative care for the entire family.”

All east Valley Banner Health Centers will be open from 7 a.m. to 7 p.m. Monday through Thursday, 7 a.m. to 5 p.m. on Fridays and from 8 a.m. to 1 p.m. on Saturdays.

Ensemble Real Estate Solutions - Autumn Storm

Storm Joins Ensemble Real Estate Solutions As Healthcare Landlord Rep

Ensemble Real Estate Solutions hired Autumn Storm as the company’s Healthcare Brokerage Services Landlord Representative responsible for securing and managing landlord representation listings.

Storm brings extensive real estate experience, most recently holding an Analyst position at Lefevers Viewpoint Group Advisors where she analyzed and appraised large-scale commercial real estate projects.

Prior to Lefevers, Storm was an Analyst/Researcher with Canterra Consultants, Synthesis Development and ESI Corporation where she worked on projects such as analyzing market and financial feasibility for the redevelopment of a hotel site owned by the City of Albuquerque, conducting a comprehensive supply and demand analysis for the redevelopment of the City of Apache Junction’s downtown and analyzing the best use and financial feasibility for a redevelopment project owned by the Housing Authority of Maricopa County.

Storm’s diverse experience will bring value to Ensemble’s clients with the analyses of buy and/or lease scenarios, preparing annual property budgets, securing and managing listings, and negotiating lease rates and terms.

Storm holds a master of Real Estate Development degree from Arizona State University and became an LEED Accredited Professional in 2008.

Storm can be reached directly at (602) 385-2854 or via email at: astorm@ensemblere.com.

bioscience - economic outlook - AZ Business Magazine May/June 2012

Strength Of Bioscience Helps Brighten Arizona’s Employment Outlook

Bioscience brings strength to Arizona’s employment opportunities.

Arizona’s economic doldrums are finally starting to appear in the rearview mirror.

“Here in Arizona, the state ranked No. 12 in job creation (in 2011),” says Lee McPheters, director of the JPMorgan Chase Economic Outlook Center at ASU’s W. P. Carey School of Business. “That’s a vast improvement from last year at this time, when it ranked No. 40.”

Twenty percent of the Phoenix-area companies interviewed for a Manpower Employment Outlook Survey plan to hire more employees during the second quarter of 2012, while just three percent expect to reduce staff.

Leading the charge in Arizona job growth is technology, healthcare and bioscience, Ernst says. “We’ve also seen manufacturing pick-up substantially in the last month with roles in accounting and finance,” he added.

According to Manpower spokesperson Frank Amendariz, other job prospects for the next quarter appear best in construction, transportation, utilities, wholesale and retail trade, information, financial activities, professional and business services, and leisure and hospitality.

“Employers expect stronger employment prospects compared with one year ago,” Amendariz says optimistically.

“There’s a lot more optimism among hiring managers than in years past,” says Andy Ernst, regional vice president of Robert Half International, a specialized staffing services company. “Businesses are looking to hire. As the economy continues to regain its foothold, we anticipate an uptick in hiring as more companies look at ways to market themselves to attract new candidates and retain key members of their team. We anticipate the next 3-4 years being very good on the job front here in Phoenix.”

But no sector has shown the strength or potential that bioscience has shown. During the post-recessionary period of 2009-10, bioscience jobs in Arizona increased by 7.4 percent, compared with a 1.8 percent decline for the state’s overall private sector, according to a new performance analysis of Arizona’s bioscience sector, commissioned by the Flinn Foundation.

The annual study by the Battelle Technology Partnership Practice found that since 2002 Arizona has outpaced the nation in generating bioscience jobs and firms, and in winning National Institutes of Health grants, the gold standard for biomedical research funding. Even venture-capital funding, long a challenge for Arizona’s bioscience sector, was on an upswing in the past year.

“Through the most trying economic circumstances of our lifetimes, bio in Arizona more than held its own,” says Walter Plosila, senior advisor to the Battelle Technology Partnership Practice. “The bioscience sector is past the ‘promising’ stage. It is now becoming integral to Arizona’s future.”

Since Arizona’s Bioscience Roadmap was launched in 2002, bioscience jobs in the state have grown 41 percent to a total of 96,223, versus 11 percent growth for the nation as a whole. Those jobs pay an average annual wages of $55,353, 29 percent higher than the overall average for private-sector wages in Arizona.

With those jobs comes the demand for a better educated workforce.

“In the Phoenix market, there is high demand for experienced professionals with four-year degrees or more who have 2-3 years experience working in their field,” Ernst says. “The unemployment rate for college-degreed workers 25 and older is 4.2 percent and even lower from some specialties such as IT, accounting and finance.”

While the investment in education is paying off for Arizona’s workers, the investment of time and energy in developing a cohesive plan to further the state’s bioscience industry is paying dividends for the state’s workforce and its economy.

Martin Shultz, chair of the statewide steering committee that oversees the Bioscience Roadmap, applauded the commitment of Arizona leaders. “Over the past decade, officials ranging from school principals to mayors to three governors have made long-term investments in our state’s future by supporting the biosciences,” Shultz says. “The excellent return on those investments is undeniable.”

For more information on the Bioscience Roadmap, visit the Flinn Foundation’s website at flinn.org.

Arizona Business Magazine May/June 2012

gavel

Arizona’s Top Lawyers – 2012 Healthcare – Intellectual Property

Arizona Business Magazine used its own research, solicited input from legal experts, and referenced professional ratings and rankings to determine the legal professionals who made the 2012 Top Lawyers list.


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Categories

Banking Healthcare
Business/Corporate Law Intellectual Property
Construction Litigation Mergers and Acquisitions
Employment/Labor
Relations
Real Estate
Environmental Law Securities and Corporate Finance
Estate and Trust Litigation Tax

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HEALTHCARE

Charles L. Arnold ◆ Frazer Ryan Goldberg & Arnold LLP
602-277-2010 ◆ frgalaw.com
Arnold specializes in mental health and elder law, serving the developmentally disabled, the mentally ill, and the elderly.

Susan D. Brienza ◆ Ryley Carlock & Applewhite, P.C.
602-440-4885 ◆ rcalaw.com
Brienza is especially involved in issues concerning herbal products for women, and in biotechnology and nanotechnology issues.

Richard B. Burnham ◆ Gammage & Burnham PLC
602-256-0566 ◆ gblaw.com
Burnham has developed an extensive commercial litigation, administrative law and legislative practice which has evolved to emphasize health care reimbursement matters.

Frederick M. Cummings ◆ Jennings Strouss
602-262-5903 ◆ jsslaw.com
Cummings has extensive trial experience in the areas of health care, medical malpractice and medical products liability defense litigation.

Richard Davis ◆ Mesch Clark & Rothschild PC
520-624-8886 ◆ mcrazlaw.com
Davis’ practice areas include healthcare and cases that involve products liability, condemnation matters and medical malpractice.

Bill Drury ◆ Renaud Cook Drury Mesaros, PA
602-307-9900 ◆ rcdmlaw.com
Drury has a strong track record of success in defending medical malpractice and negligence claims, regulatory claims and administrative claims.

Barry D. Halpern ◆ Snell & Wilmer L.L.P.
602-382-6345 ◆ swlaw.com
Halpern’s practice is focused in business and health care matters.

Roger N. Morris ◆ Quarles & Brady LLP
602-229-5200 ◆ quarles.com
Morris is chairman of Quarles & Brady’s Health & Life Sciences Industry Group.

Lawrence J. Rosenfeld ◆ Greenberg Traurig
602-445-8502 ◆ gtlaw.com
Rosenfeld has more than 35 years of experience in the areas of health law and administrative law.

Beth J. Schermer ◆ Coppersmith Schermer & Brockelman PLC
602-381-5462 ◆ csblaw.com
Schermer’s legal practice concentrates in health care transactions, regulation, and operations.


INTELLECTUAL PROPERTY

Karin Scherner Aldama ◆ Perkins Coie LLP
602-351-8270 ◆ perkinscoie.com
Aldama focuses her practice on commercial and appellate litigation, with particular emphasis on complex commercial cases and issues relating to intellectual property protection, privilege law, choice-of-law, and cross-border litigation.

Glenn S. Bacal ◆ Bacal Law Group PC
480-245-6233 ◆ ipdepartment.net
Bacal Law Group focuses on intellectual property, including litigation, administration, trademarks, copyrights, trade secrets, noncompetes, rights of publicity, and appellate advocacy.

George C. Chen ◆ Bryan Cave LLP
602-364-7367 ◆ bryancave.com
Chen’s practice includes litigation, licensing, counseling, and prosecution of patent, trademark, copyright, trade secret, unfair competition, Internet, cybersquatting, and other intellectual property matters.

Bruce Converse ◆ Steptoe & Johnson
480-257-5274 ◆ steptoe.com
Converse is a member of the Litigation Department and Intellectual Property group. He has a broad range of experience in commercial litigation at both trial and appellate levels.

John E. Cummerford ◆ Greenberg Traurig, LLP
602-445-8377 ◆ gtlaw.com
Cummerford’s practice focuses on the legal and business needs of established and emerging growth companies, with particular emphasis on software, Internet, hardware and related businesses.

R. Lee Fraley ◆ Snell & Wilmer L.L.P.
602-382-6250 ◆ swlaw.com
Fraley offers clients a unique blend of intellectual property counseling, IP rights enforcement and defense, as well as aggressive negotiation of IP-related transactions and acquisitions.

Robert J. Itri ◆ Gallagher & Kennedy, P.A.
602-530-8019 ◆ gknet.com
Itri focuses on intellectual property and securities related litigation, arbitration and enforcement proceedings, contract, trade secret, business tort and shareholder litigation.

Ron Kisicki ◆ Woods Oviatt Gilman LLP
480-659-2213 ◆ woodsoviattgilman.com
Kisicki is admitted to practice before the U.S. Patent Office, and concentrates his practice in intellectual property law.

Peter Kozinets ◆ Steptoe & Johnson
480-257-5250 ◆ steptoe.com
Kozinets concentrates his practice on complex litigation, with particular focus on media and constitutional law, intellectual property litigation and commercial disputes.

Brian W. LaCorte ◆ Ballard Spahr LLP
602-798-5449 ◆ ballardspahr.com
LaCorte’s practice is focused on patent, trademark, and copyright litigation as well as IP transactional work.

Albert L. Schmeiser ◆ Schmeiser, Olsen & Watts
480-655-0073 ◆ iplawusa.com
Experienced in all areas of intellectual property protection, transfer and enforcement, including preparation of patent applications and prosecuting same, patent appeals and interferences.

Maria Crimi Speth ◆ Jaburg & Wilk P.C.
602-248-1000 ◆ jaburgwilk.com
Speth assists clients in protecting their intellectual property through preventative measures to avoid disputes, and taking aggressive measures when disputes arise.

Arizona Business Magazine has used its best efforts in assembling material for this list, but does not warrant that the information contained herein is a complete or exhaustive list of the top lawyers in Arizona, and hereby disclaims any liability to any person for any loss or damage caused by errors or omissions herein.

Arizona Business Magazine March/April 2012

Deer Valley Hospital - new CEO

Harrington Jr. Named CEO Of John C. Lincoln Deer Valley Hospital

Long-time Valley hospital executive John Harrington Jr. begins service as CEO of John C. Lincoln Deer Valley Hospital Monday, May 14. Harrington started his career in health care administration 33 years ago as the assistant vice president of operations at the hospital’s former parent facility, then known as Phoenix General.

Harrington comes to John C. Lincoln from Banner Del E. Webb Medical Center in Sun City, where he was CEO. His previous leadership experience includes serving as the CEO at Banner Heart Hospital, Paradise Valley Hospital and the Arizona Heart Hospital.

In March, Harrington was one of four hospital executives in the United States named to serve a three-year term on the Board of Governors of the 46,000-member American College of Healthcare Executives. He also spent 10 years on the board of directors of the Arizona Hospital and Healthcare Association, including service as chairman of the board.

“John brings a wealth of knowledge and experience – both locally and nationally – to Deer Valley.  He is well known as a dynamic and compassionate leader,” said Rhonda Forsyth, president and CEO of the John C. Lincoln Health Network. “I am confident that John is the right fit for our organization – our mission, culture and vision.”

“I am really excited about this new opportunity. I live in Moon Valley so the two John C. Lincoln hospitals are my neighborhood hospitals,” he said. “John C. Lincoln always has had a great reputation. I look forward to supporting an already strong culture and developing a fulltime senior team to continue to move us forward.”

Harrington earned a BS in microbiology with a minor in business from the University of Pittsburgh. He earned a master’s in public health with a specialty in hospital administration in 1980.

For more information on John C. Lincoln Deer Valley Hospital, visit John C. Lincoln Deer Valley’s website at jcl.com/hospitals/deer-valley.

banner health - emr

17 Banner Health Facilities Achieve Final Stage Of Electronic Medical Record Adoption

Seventeen Banner Health facilities have achieved Stage 7, the final stage in the adoption of electronic medical record (EMR) as acknowledged by HIMSS Analytics, a wholly owned nonprofit subsidiary of the Healthcare Information and Management Systems Society. HIMSS Analytics monitors and recognizes levels of EMR adoption and meaningful use in hospitals in the United States, Canada and other countries.

The Stage 7 recognition by HIMSS Analytics is a compelling example of Banner Health’s emergence as a national leader in health care. Banner Health’s 17 Stage 7 hospitals are among only 82 hospitals in the nation at this top level of EMR use. Banner is also recognized by Thomson Reuters as a Top Five Large Health System in the nation and as a Top Leadership Team/Large System by HealthLeaders magazine.

“While achieving HIMSS Stage 7 for 17 of Banner’s 23 hospitals is an important organizational achievement, the most important beneficiaries are our patients,” said Banner Health’s Executive Vice President/Chief Medical Officer John Hensing, M.D. “Our meaningful use of enhanced electronic medical records is integrated into our patient care processes and even targeted to help our clinicians proactively recognize and treat specific and dangerous disorders such as sepsis and delirium,” he added.

Banner Health facilities that have achieved Stage 7 status include:

  • Banner Baywood Medical Center (Mesa)
  • Banner Boswell Medical Center (Sun City)
  • Banner Desert Medical Center (Mesa)
  • Banner Del E. Webb Medical Center (Sun City)
  • Banner Estrella Medical Center (Phoenix)
  • Banner Gateway Medical Center (Gilbert)
  • Banner Good Samaritan Medical Center (Phoenix)
  • Banner Heart Hospital (Mesa)
  • Banner Ironwood Medical Center (San Tan Valley)
  • Banner Thunderbird Medical Center (Glendale)
  • East Morgan County Hospital (Brush, Colo.)
  • McKee Medical Center (Loveland, Colo.)
  • North Colorado Medical Center (Greeley, Colo.)
  • Page Hospital (Page)
  • Platte County Memorial Hospital (Wheatland, Wyo.)
  • Community Hospital (Torrington, Wyo.)
  • Washakie Medical Center (Worland, Wyo.)

In order to obtain the final stage in the EMR adoption, hospitals must be paperless and be able to share clinical information with other health care facilities, networks, clinics, employers, payers and patients. At this stage, health care organizations also can store and analyze data to use to improve clinical outcomes and patient experience.

HIMSS Analytics surveyors conducted an on-site review of Banner’s EMR technologies at Banner Good Samaritan Medical Center located in Phoenix. Since nearly all Banner facilities have the same level of EMR adoption and usage, surveyors were able to judge facility capabilities across the system based on their findings at Banner Good Samaritan Medical Center.

Four more Banner Health facilities will achieve Stage 7 this summer once they have implemented using bar-coding technology for patient identification and medications administration. The remaining facilities will achieve Stage 7 in 2013.

For more information on Banner Health Medical Centers, visit Banner Health’s website at bannerhealth.com.

Stressed lady in office

8 Tips For Dealing With Stress & Top 10 Most And Least Stressful Jobs

Here are 8 tips from Dr. Kevin Klassen, a cardiologist with Scottsdale Healthcare, and Dr. Anne-Marie Reed, a board certified family physician at Camelback Health Care, for dealing with workplace stress:

1. Do what you can to have a positive outlook about your job, knowing that better alternatives will be hard to find and that almost anything can be better if you make the effort to do so.
2. Help your coworkers. Promoting a sense of camaraderie reduces everyone’s stress and often causes the others to want to help you, also.
3. Walk during breaks and lunch. Exercise before or after work. Physical activity seems to clear your head and dissipate stress.
4. Limit caffeine during the day and alcohol after hours. Both tend to cause dehydration, which can increase stress and anxiety.
5. Eat healthfully and limit calories.
6. Respect the fact that your body needs to rest and make enough time to get a good night’s sleep.
7. Live within your means. Financial stress is one of the worst types of stresses to live with and it impacts not only coworkers but family and friends.
8. Keep a good support system. Family and friends can provide emotional support without any strings attached. Focus on the simpler things in life. Smile and be positive.


10 Most Stressful And 10 Least Stressful Jobs In 2012

10 Most Stressful Jobs of 2012

1. Enlisted soldier, stress score 84.61, average income $35,580
2. Firefighter, stress score 60.26, average income $45,250
3. Airline pilot, stress score 59.58, average income $103,210
4. Military general, stress score 55.17, average income $196,300
5. Police officer, stress score 53.63, average income $53,540
6. Event coordinator, stress score 49.85, average income $45,260
7. Public relations executive, stress score 47.56, average income $91,810
8. Corporate executive, stress score 47.41, average income $165,830
9. Photojournalist, stress score 47.09, average income $40,000
10. Taxi driver, stress score 46.25, average income $22,440

10 Least Stressful Jobs of 2012

1. Medical records technician, stress score 7.52, average income $32,350
2. Jeweler, stress score 8.21, average income $35,170
3. Hair stylist, stress score 8.63, average income $22,760
4. Dressmaker-tailor, stress score 8.65, average income $26,560
5. Medical laboratory technician, stress score 9.33, average income $36,280
6. Audiologist, stress score 9.37, average income $66,660
7. Precision assembler, stress score 9.40, average income $31,250
8. Dietitian, stress score 10.27, average income $53,250
9. Furniture upholsterer, stress score 10.30, average income $29,960
10. Electrical technician, stress score 10.38, average income $56,040

Arizona Business Magazine March/April 2012

carondelet

Arizona Hospital And Healthcare Association Adds Carondelet CEO To Board

The Arizona Hospital and Healthcare Association (AzHHA) is pleased to welcome James K. Beckmann, Jr., President and CEO of Tucson-based Carondelet Health Network to the AzHHA Board of Directors.

As a member of the AzHHA Board, Mr. Beckmann will provide leadership and representation on behalf of the collective interests of hospitals and the patients they serve throughout Arizona.   Carondelet Health Network is Southern Arizona’s only Catholic, not-for-profit healthcare network, which includes four hospitals and serves a three-county region of 1.3 million residents.

“We are delighted that Jim has joined the AzHHA Board, and look forward to the insights and experience he brings to our Association,” said AzHHA President and Chief Executive Officer Laurie Liles.  “With his diverse career in the healthcare and insurance industries, Jim’s perspective will be particularly valuable given Arizona’s dynamic healthcare environment.”

“At Carondelet, we certainly recognize that strengthening healthcare, locally and regionally, requires our active participation,” said Beckmann.  “For that reason, it is a privilege for me to join the efforts of the Arizona Hospital and Healthcare Association’s Board of Directors in ensuring Arizonans have a vital and valuable healthcare system available to all in the future.”

Jim Beckmann joined Carondelet Health Network as President and CEO in October 2011.  Prior to coming to Tucson, he served as Senior Vice President for System Support Services at Carondelet’s parent ministry, Ascension Health, based in St. Louis, Missouri. Ascension Health is the nation’s largest Catholic, not-for-profit healthcare system, providing care in more than 1,400 locations in 21 states.

In his Ascension role, Jim had executive management responsibility for Ascension Health’s supply chain, risk management, corporate responsibility, operational resources and Facility Resources Group.  Prior to joining Ascension Health in 2003, Beckmann had an extensive career in the insurance industry.

Beckmann was born in Columbus, Georgia, and grew up in Louisville, Kentucky. He earned a bachelor’s degree in Economics and Applied Mathematics from Centre College in Danville, Kentucky, and an MBA from the University of Tampa in Florida.

The AzHHA Board has 15 members.

For more information on Arizona Hospital and Healthcare Association, visit AzHHA’s website at azhha.org.

new jobs pharmacy

OptumRx Adding 400 New Jobs In Arizona

OptumRx, a leading pharmacy benefits management (PBM) organization and one of the Optum companies of UnitedHealth Group (NYSE: UNH), said it will create at least 400 new jobs in Tucson over the next 12-18 months.

The announcement was made at a news conference Thursday, attended by Arizona Gov. Jan Brewer and Stephen J. Hemsley, CEO of UnitedHealth Group, at the company’s new office in the University of Arizona Science and Technology Park.

“We are strengthening the infrastructure of Optum Rx in advance of a major expansion early next year, and we especially appreciate the help and support that comes from the outstanding workers and leaders of Arizona in that effort,” said Larry C. Renfro, executive vice president of UnitedHealth Group and CEO of Optum.

“I am pleased that Optum and UnitedHealth Group recognize Tucson’s high-quality workforce and Arizona’s excellent business climate,” said Gov. Brewer. “The hundreds of jobs Optum will create here over the coming months show that Arizona is a premier destination for the growth of innovative businesses such as Optum. I look forward to a long and successful partnership between Optum and Arizona.”

The new OptumRx office, currently undergoing renovation, is expected to be ready for occupancy by mid-year, with recruiting for the new customer service positions expected to begin no later than the fourth quarter. The company will be hiring for Customer Service Advocates and a variety of positions involving training, workforce management and quality management. The company expects the facility to be fully staffed by the end of next year to help ensure OptumRx is prepared to serve millions of additional UnitedHealthcare employer and individual health plan participants.

“The technology at this facility, along with the commitment and know-how of our employees here, will help us fulfill our mission of making the health care system work better for everybody,” said Dirk McMahon, CEO of OptumRx. “An aging population and more people gaining access to health insurance mean more Americans will be using more prescription drugs, so the importance of our Tucson employees to our business will only increase.”

When hiring begins, people with health care or customer service experience are encouraged to apply for these new jobs.

For more information on OptumRx and their new jobs, visit their website at optum.com.

charitable trust

Virginia G. Piper Charitable TrustAwards $3.6 Million In Grants

The Virginia G. Piper Charitable Trust announced grants totaling more than $3.6 million—funds that will help strengthen Maricopa County communities in the areas of arts and culture, services for disadvantaged children, youth mentoring, healthcare initiatives, and older adults.

“Expanding the Encore Fellows program will allow us to place additional experienced adult professionals within organizations that may not typically be able to afford this level of talent.”

The Trust’s January through March 2012 investments cover a range of programs such as: developing effective new tools for parents of blind children so they may better coordinate multiple, complex services needed to support and educate their children; enhancing the sites of two significant cultural venues—Phoenix Zoo and Desert Botanical Garden; and expanding the “Encore Fellows” program—a program facilitated by Experience Matters, a nonprofit that capitalizes on the time and talent of older adults (age 50+) seeking paid or unpaid positions that apply their skills to social purposes.

“Baby boomers are hitting retirement ages at a rapid pace, and there is great momentum to capture their interests and talents. Boomers often see retirement as an opportunity to participate and work in new ways that impact social causes they care about,” said Nora Hannah, CEO, Experience Matters. “Expanding the Encore Fellows program will allow us to place additional experienced adult professionals within organizations that may not typically be able to afford this level of talent.”

Virginia G. Piper Charitable Trust will be recognized by the National Council on Aging in Washington, D.C. for its work over the last decade in establishing effective public and private partnerships that support the development and care of Maricopa County’s older adults. On Friday, March 30, Piper Trust will receive the Arthur Flemming Award for its leadership in developing initiatives that promote healthy, independent and productive living for older adults. There are 1.1 million people in Maricopa County who are age 50 or older.

“Piper Trust continues to have great foresight in developing civic opportunities for older adults who want to apply their experience to social causes. We commend Piper Trust’s leadership in making the value of older adults a priority. The Trust’s work in aging is a role model for funders throughout the country who want to make a difference for older adults in their communities,” said Jim Firman, president and CEO, National Council on Aging.

Desert Botanical Garden: Expand site to accommodate growing clientele and new cultural offerings, $500,000.

Phoenix Zoo: Construct new visitor entrance, $1,250,000.

Foundation for Blind Children: Develop tools for parents of blind children to navigate complex delivery systems, $120,000.

Gabriel’s Angels: Expand intervention training to partner agency therapists and therapy teams, $215,000.

Improving Chandler Area Neighborhoods: Expand services for Chandler area youth, $560,000.

Science Foundation Arizona: Provide a challenge grant to secure new donors, $250,000.

The Neighborhood Christian Clinic: Add three half-day health clinics, $150,000.

Valle del Sol, Inc.: Renovate office space to create a pediatric clinic and purchase medical equipment, $126,625.

Arizona Town Hall: Support the 100th Arizona Town Hall on civic engagement, $5,000.

Experience Matters Consortium: Support four additional Encore Fellowship positions, $80,000.

Solecito Services, Inc.: Expand service and restore or purchase medical equipment, $44,500.

Valley of the Sun United Way: Support of the Homelessness and Hunger Funders Collaborative project (continuation of Community Relief Grant), $300,000.

Health Nations Telemedicine

HealthNation Offers Telemedicine Services To Employers

The digital age has redefined our way of living, and HealthNation has found a way so that employee healthcare is redefined, too.

HealthNation, a company based in Arizona, provides telemedicine services to employers and their employees.

As defined by the American Telemedicine Association, telemedicine is the use of electronic communications to exchange medical information to benefit a patient’s health status. This can range from remote patient monitoring to direct patient consultation.

For HealthNation, this means 24-access to doctors via phone, email or video conference, and electronic medical records. According to its spokesperson, Dr. Tami Romano, it also means avoiding the emergency room and urgent care costs, therefore increasing productivity and reducing healthcare costs.

For employers, this means cost-saving bundles and a healthier workforce.

For an average family of four, the expected savings from HealthNation is about $2,200 if they have an additional PPO health plan — $4,700 if they have a high-deductible plan. Romano estimates that there are even more savings when the employee is uninsured after taking into account inpatient, outpatient and other associated costs.

Other benefits of employees are scheduling benefits. Patients have access to medical attention when they need it, and even just as importantly, where they need it. Patients also have access to reduced prices (more than 40 percent) to prescriptions as well as access to naturopathic doctors. Other services include patient advocacy programs to assist those struggling with billing issues and finding facilities and laboratories that are highly cost effective.

HealthNation believes that a combination of all of these benefits will reduce the health risks of employees, increase employee loyalty and productivity, allow for fewer sick days and more days at work.

Romano, however, acknowledges the difficult transition between traditional medicine and telemedicine. She says the biggest transitional period occurs during the adjustment to the mindset that telemedicine, and not any other traditional approach, is now the first line of defense against challenges to health.

“Patients need to be educated on being proactive with their healthcare needs, to use online resources for wellness programs to stay healthy,” Romano says. “When acute illness occurs, access the healthcare system initially using telehealth rather than go into the ER or urgent care. It is more cost effective, convenient and safe. Often times, people just need information, and the comfort of talking with a doctor and the peace of mind go a long way.”

HealthNation believes, however, that this instant, 24-hours/seven-days-a-week access to certified physicians will allow patients a myriad of options and strategies for a more proactive and healthy lifestyle.

For more information on HealthNation and telemedicine, visit HealthNation’s website at healthnation.net.

Phoenix Children's Hospital, sustainable hospital expansion, kitchell, HKS inc.

Sustainable Hospital Expansion – Phoenix Children’s Hospital

Phoenix Children’s Hospital is one of the country’s 10 largest health care facilities for children. With the rapidly growing pediatric population in our market, the hospital recently reached the half-way point of a $588 million expansion, which includes the construction of a new 11-story patient tower that will nearly double available beds by 2012. The hospital is not only providing a healthy future for its patients with this significant expansion, the project has also embraced sustainability practices in its design, construction, and operations that will support a healthy future for our community.

Phoenix Children’s Hospital takes its responsibility as a health care leader seriously. The hospital made the commitment to build green based on several key considerations: increased public health, reduced operational costs, and a focus on corporate social responsibility.

Promoting the health of patients, visitors, employees, community members, and the global community, Phoenix Children’s Hospital’s expansion will result in economic and efficient operations. Along with its construction partners, design architects HKS Inc. of Dallas and general contractor Kitchell of Phoenix, Phoenix Children’s is building one of the most innovative and environmentally sound children’s hospitals in the nation.

At the heart of the Hospital’s sustainability effort is a Central Energy Plant (CEP) that now powers the 34-acre campus in the heart of Phoenix. This high efficiency CEP features an 800-ton water-to-water heat pump chiller, a technology widely used in the Middle East. In fact, Phoenix Children’s CEP employs the first application of the water-to-water heat pump chiller in a healthcare facility of its size in the United States. This innovative technology will translate to substantial energy savings for the hospital, in addition to boosting Phoenix’s conservation efforts overall. Results will include:

  • Conserving of 5.6 million gallons of water annually (the equivalent of the water needs of 120 households);
  • Reducing discharges to the sanitary sewer system by 600,000 gallons per year;
  • Reducing natural gas consumption by 70 percent; and
  • Saving nearly $11 million in energy and operating costs over 15 years.


The new hospital design also maximizes energy and water efficiency. In patient rooms, views of the mountains on both sides of the Valley will be maintained with high-performance low-e windows and sun-shading screens help to minimize solar heat gain. Additionally, the exterior lighting is designed to reduce light pollution. Combined with an efficient mechanical system design, the new building will use 20 percent less energy than maximum capacity required by code. Furthermore, the hospital is also a good steward of the community’s valuable water resources by installing low-flow plumbing fixtures with automatic flushing sensors that reduce water use in the new tower.

Indoor air quality is an important aspect of designing a sustainable hospital that creates a healing environment for Arizona’s youngest patients, and this process begins with selecting materials free of harmful chemicals. No mercury products or urea-formaldehyde resins were used in construction, and the new cooling system will use non-CFC refrigerant which prevents ozone depletion. Recycled flooring products and low-VOC paints and sealants will protect air quality.

Phoenix Children’s Hospital has also implemented a strategic exterior design, planning for indigenous plants and trees to create exterior places of respite. Local flora line the sidewalks and keep visitors cool and reduce solar heat gain. An expanded cafeteria, roof garden, indoor areas with natural views, and other tranquil spaces on the new campus will help keep employees, patients, and families on-site and off the road during heavy traffic times. Notably, the new facility offers convenient bike storage, a staff locker room in the basement of the new tower, and preferred parking for carpool and alternative-energy cars.

Taking the lead in sustainable construction, the project team has created a paperless strategy where portals and online distribution of materials sent to subcontractors save paper, time, and money. Most notably, Kitchell has conducted a large effort in recycling. On average more than 70 percent of construction waste per month is recycled, which keeps a significant amount of materials out of landfills. Lastly, in a region where dust control in the streets and air can be quite challenging during construction, the site takes extreme measures to reduce the effects of dust on the neighboring community.

Utilizing sustainable design principles, thoughtful green construction techniques, and preparing for environmentally friendly operations, the Phoenix Children’s Hospital expansion is setting a new benchmark in sustainable healthcare design and development.