Recovery readiness in the ‘new normal’

Lorie Damon
Managing director and health care practice lead, Cushman & Wakefield

At this point, you probably never need to hear the phrase “new normal” again, but the reality is all properties, and especially health systems’ facilities and medical office buildings, must operate differently for the foreseeable future. The details are innumerable, but it’s our duty to advise MOB investors and their tenants on recommended, fundamental operating protocols; common area and amenities best practices; waiting room recommendations; and scheduling. Our firm has released Recovery Readiness for Medical Offices, a guide that goes into great detail regarding steps landlords and property managers should consider to prepare for increased patient visits; below are some of the highlights.

First, to paraphrase the ancient Greeks, know thy leases. Our best recommendation is to make sure both landlords and tenants read and understand their leasing documents. It may sound obvious, but you would be surprised how often leases are just filed away and forgotten. Leases likely are silent on pandemic protocols, but other clauses and provisions may apply. Open communication between the parties, discussion and agreement regarding what health care tenants plan to do to ensure patient safety – as well as that of other tenants – and understanding what measures the landlord is taking to assure occupant safety are vital to both parties and should help to ensure that the patients can receive care safely.

In terms of end users’ requirements, we do not anticipate any immediate change in the square footage needed by various health care tenants. We are tracking regulations and reimbursements for telemedicine, as well as usage, as physician offices expand in-person visits. We do expect that adoption and use of telemedicine will continue, but there’s no data yet regarding how it may impact demand for medical office space.

As patients return to MOBs and physicians’ offices, protocols vary by building, but most of our health care/physician clients are screening patients by phone in advance and asking them if they have had fever or other COVID-19 symptoms or have tested positive. Those with a fever or any other symptoms are referred to a COVID-19 testing center. Those who do not have symptoms follow the protocols established by the physicians for their scheduled visit.

So, what happens once the patient arrives to the property or campus? Again, this varies depending on the physician or the building, but across our portfolio of managed health care properties in Denver and elsewhere, we have seen a number of physician tenants ask patients to call or text when they arrive for an appointment, and then wait in their car. Some tenants may choose to perform temperature or thermal scanning for their offices, but prior to implementing this practice, tenants should discuss their plans with landlords, to determine whether the landlord will be providing temperature screening spaces prior to building entry with a licensing agreement, or will require other types of documentation and protocols be followed. Ultimately, the goal is to limit the number of people in the waiting rooms and in the physician suites overall so that physical distancing can be practiced. Patient check in and out is done by phone wherever possible, and shared screens, clipboards and pens are generally removed.

We have seen some physician tenants implement check in and check out in the exam room itself. We will certainly see physically distanced waiting rooms (i.e., limited numbers of chairs, spaced appropriately, and the removal of magazines, toys, or other “shared” items that entertain patients while they wait). Some waiting rooms may disappear altogether. Whatever the protocol, we encourage landlords to communicate procedures to tenants and encourage tenants to communicate new protocols to patients, in advance of their visits, to ensure the well-being of all parties.

Across common areas, consider minimizing open entrances to help regulate the number of people entering the property at once and to discourage congregation in elevator bank(s). If possible, designate one entry and a separate exit rather than allowing two-way traffic. For larger lobbies, consider implementing a clockwise or counterclockwise traffic flow, and install signage, directional arrows on floors and stanchions to advise occupants of the pattern, as well as signage emphasizing Centers for Disease Control and Prevention protocols. At those entrances and exits, consider installation of portable hand sanitizing stations along with signage requiring sanitization as people enter and exit. Security officer(s) should be trained to politely and firmly encourage tenants to maintain 6 feet distancing and possible mask protocol and have clear protocols around dissent.

Just as security will have higher visibility, so, too, will cleaning personnel. They will have to ensure that common areas, entry points to the property, elevator lobbies, elevators and common corridor restrooms are frequently cleaned and disinfected and pay particular attention to door handles/knobs, light switches, staff rooms, desktops, washrooms and other high-touch surfaces. Property managers also need to review and prepare plans for owner-approval regarding changes to cleaning scope or any additional services in response to COVID-19 protection. Managers and owners also need to work with tenants to determine optional, desired cleaning enhancements and associated charges. We recommend distributing a predetermined “price list” with various options to tenants.

What’s more, tenants should be encouraged to inform their visitors of procedures in advance of visit to diffuse potential misunderstandings and negative experiences, and tenant-visitor protocol should be updated or established. For example, tenants will need to provide a “list of visitors” in advance to building management via email or visitor management system outlining visitors’ names and estimated time of arrival. Security guards should have step-by-step instructions and, along with the building’s daytime staff and day porters, have to be informed of protocols.

COVID-19 brought an additional layer of challenge and complexity to health care-property operation and investment. Given the industry’s role in terms of both providing care and as an economic driver, health care landlords, property managers and care providers collectively share a strong sense of duty to ensure the safety of patients who visit our properties as well as the clinical care teams and other tenant employees, and our own management, cleaning and security staff. Though this challenge can be daunting, it is one that we must embrace and surmount.

Featured in the July 2020 issue of Health Care & Senior Housing Quarterly