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Hospitals aiming to reduce their greenhouse gas emissions can begin by taking a few simple steps, experts said at an sponsored by the Bipartisan Policy Center.

"The U.S. health system accounts for 8.5% of the country's greenhouse gas emissions, a larger percentage than any other country in the world," Joseph Betancourt, MD, MPH, president of the Commonwealth Fund, said at Thursday's event. "Healthcare organizations have both the opportunity and, I would argue, the obligation to reduce emissions that come with the industry's size, its large carbon footprint, and its mission to improve health. Indeed, effective strategies for addressing climate change are essential attributes of a high-performing health system."

Hospitals have several big targets to choose from when it comes to saving energy, said Michael Roberts, PE, CHFM, director of energy services at Atrium Health, a 40-hospital health system headquartered in Charlotte, North Carolina. "Energy is 94% of the actual emissions that hospitals emit," he said. "So for me, this is a really big target and we've got to take a look at that; how do we reduce that?"

Identifying Potential Targets

One place to start is radiology, he said. "Radiologists are coming to us asking what they can do. And we're looking at some studies about [machines] that can go into some sort of standby mode."

Operating rooms are another potential target; they are "our highest-ventilated areas in our hospital for infection prevention," said Roberts. "But they don't need to be that way when they're not being utilized. So we've used what we call 'unoccupied setbacks' to bring the OR ventilation rates down when they are not being used, but still maintain the positive pressure that they need for infection prevention." The system is automated so there is no additional work for the surgeons and their staffs, and its use "has been a big energy reduction for us," he said.

Continual staff discussion can reveal other targets, according to Roberts, "whether it's 'We haven't replaced LED lights in this wing' or 'We're leaving kitchen equipment on full-time all the time.' We even had a lighting control system in our cafeteria that had never been turned on, and one of our staff brought that up."

Energy reductions can be achieved even in older buildings, said Clark Reed, MA, national program manager for Energy Star, a program administered by the Environmental Protection Agency that awards energy efficiency ratings to buildings. Buildings that receive Energy Star certification have been verified to perform among the top 25% of similar buildings nationwide. On average, Energy Star-certified buildings use 35% less energy and generate 35% fewer greenhouse gas emissions than their peers, according to the .

"We have examples of hospitals that have pneumatic controls that are very much older technology than other digital systems that are currently being installed -- but they are managed so well by the facility operations department that they are outperforming brand new buildings," Reed said. "So it's actually great news because this means that any building, whether it's built 20 years ago, 5 years ago, or 30 years ago, you can improve the operational performance, energy performance, of that building by doing operational best practices."

Start With an Audit

Hospitals can start the process by doing an energy audit, he added. "You look for operational changes on existing equipment, and you can find 10%-to-15% energy savings just by managing your equipment better." Next year, the EPA will launch its Energy Star Next Gen certification to incentivize building owners to use renewable energy and to electrify their facilities, Reed said.

Roberts said that Atrium has signed onto the , which calls for participating healthcare systems to reduce organizational emissions by a minimum of 50% by 2030 -- from a baseline no earlier than 2008 -- and achieve net-zero by 2050. Participants also must develop and release a climate resilience plan for continuous operations by the end of 2023 or within 6 months of signing the pledge. However, Atrium is hoping to go even further and become carbon-neutral by 2030, he said.

And for those who think making these changes will be expensive, Roberts noted that "we have to have payback of 3.5-to-5 years or less with our energy projects ... A financial business case is part of all the projects that we're doing."

And rather than being just something for the hospital itself to keep track of, some hospitals' energy efficiency ratings may soon become public thanks to local and state benchmarking laws that require public disclosure, according to Reed.

"We have over 45 jurisdictions across the country -- primarily cities but a few states as well -- that require mandatory energy benchmarking," he said. "That means that buildings over a certain size will have to report their energy use to their local jurisdiction ... Philadelphia's one of the cities that does it. They have a that you can scroll over buildings and see the score of all the buildings within their jurisdiction."

And last month, said Hardeep Singh, MD, MPH -- co-chief of health policy, quality, and informatics at the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety -- the California legislature that requires the State Air Resources Board to adopt regulations to require the reporting and verification of statewide greenhouse gas emissions and to monitor and enforce compliance with the law. The law requires the state board to make available, and update at least annually, on its website the emissions of greenhouse gases, criteria pollutants, and toxic air contaminants for each facility that reports to the state board.

Make Use of Federal Funds

HHS is also for "greening" healthcare facilities, Singh said. "The goal is that every health system, no matter where you are, should do something ... Get some governance around it and get some people dedicated to the cause, and get moving, no matter how small."

In conjunction with Thursday's event, the Bipartisan Policy Center with several recommendations, including:

• Hospitals should employ C-suite personnel and contract out for additional services dedicated to driving and supporting organization-wide efforts to reduce greenhouse gas emissions.
• Hospitals should reduce their greenhouse gas emissions from anesthetic gases by gradually reducing, with the goal of eliminating, the use of desflurane gas and nitrous oxide -- both of which are particularly potent greenhouse gases.
• Hospitals should reduce their greenhouse gas emissions from food waste by sourcing more locally grown, healthier, and fresher fruit and vegetable options and taking advantage of opportunities for composting or otherwise repurposing food waste and unused food products.

When the staff makes progress in energy efficiency, it's important to acknowledge it, said Roberts. "When we have a hospital that gets Energy Star-certified, we make a big deal about it. They get a luncheon; they get awareness with the hospital president. We try to reward our teammates and celebrate these wins."

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