Over the past several months, I've had many conversations with both health system leaders and facility firms about how increases in telehealth might impact health care facilities. In a world where more care is delivered virtually, people are understandably wondering how they might use their physical assets differently.

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It's tempting to conclude that increases in telehealth will result in dramatically reduced needs for health care facilities. But the reality is more nuanced. In a recent survey by RevistaMed, only 28% of respondents think that providers would need less clinical space due to telehealth. Most respondents, 69%, think that providers may need to restructure space, but total space needs will not change.

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What might space restructuring in response to telehealth look like? Here are four changes I'm watching closely.

1. A potential modest reduction in exam room needs

If more visits are done virtually, then provider organizations might need fewer exam room spaces. But remember that there is rarely a 1:1 correlation between visits and exam rooms. Put another way, a potential 20% increase in virtual visits likely won't equate to a 20% reduction in exam rooms needed. This is due to two main factors: current exam room use and previous appointment backlog. We spoke with several organizations who project that even with more virtual visits, they will still use all available exam room space. But they'll reduce the wait time for patients to schedule an appointment.

For some organizations, there could be a small reduction in square footage needed for health care facilities based on telehealth. One organization we spoke with estimated that they could potentially reduce square footage by anywhere from 8% to 12%. The range depended on the type of building: buildings that had surgery centers and imaging equipment would see a smaller decrease than those that are primarily just physician offices. However, organizations are also preparing for additional volumes to move to physician offices given site of care shifts. These projected increases may outweigh any projected decreases due to virtual visits.

2. An increased need for private spaces for physicians to conduct virtual visits

Many current health care facilities, especially ambulatory facilities, do not include private physician offices. If clinicians will be conducting more virtual visits, it's critical that they have a private, well-equipped space. This will both ensure HIPAA compliance and provide a high-quality virtual visit experience for patients.

If private offices are not possible, another option is telehealth pods—small private spaces dedicated to virtual visits. To best support virtual visits, telehealth pods need:

• Suitable acoustics, including flooring that controls sound, so patients and the provider can communicate;
• Appropriate lighting and wall color; and
• Technology and networking built in so clinicians can both conduct the visit and document it in the EHR.

3. A focus on adequate IT infrastructure

Providers are thinking beyond just virtual visits as they develop their telehealth strategy. Many organizations want to use telehealth to connect patients at a facility with remote providers or allow remote family members to join medical visits. To do this, organizations need to make their spaces telehealth-ready: incorporating webcams, screens, and tablets in convenient, easy-to-use places.

But behind this visible technology, facilities need an adequate networking infrastructure to support increased telehealth. Existing wireless networks will likely not offer enough bandwidth, so facility leaders will need to consider wired network connections with redundant power supplies to ensure uninterrupted connections.

4. Looking ahead, a potential change in the makeup of ambulatory medical facilities

In the long term, telehealth could have a profound impact on one of the most ubiquitous types of health care facilities: the multi-specialty medical office building. There are wwo specific changes I'm tracking. First, the breakdown of physicians within these buildings. Primary care providers may see a larger percentage of visits move virtual than other specialties. This could result in fewer primary care offices in multi-specialty medical office buildings. But given ongoing site of care shifts, any space vacated by primary care will likely be replaced with specialty care, including procedural care that can now be done in a physician office.

The second change I'm interested in is whether telehealth alters the value proposition of multi-specialty physician offices altogether. As more patients take advantage of virtual visits and providers collaborate through telehealth, it may be less important for providers of different specialties to be physically co-located. Instead, they could rely on telehealth-enabled referrals to make seamless care transitions for patients.

How is telehealth impacting your health care facility planning? Let me know at sznycerm@advisory.com.