Conventional wisdom: Making environmentally friendly changes is a luxury that most hospitals can't afford.
Evidence: Making environmentally friendly changes can save hospitals a lot of money – and save the U.S. health care system billions of dollars.
That is the finding of a study published by the Commonwealth Fund last month, “Can Sustainable Hospitals Help Bend the Health Care Cost Curve.” A Commonwealth Fund webinar held yesterday drew on the study’s findings.
Health care facilities generate a large share of the country’s waste and pollution. They create 6,600 tons of waste per day and an estimated 8 percent of all U.S. greenhouse gas emissions and 7 percent of total carbon dioxide emissions. If all U.S. hospitals adopted measures such as improving fuel efficiency from heating and cooling systems and recycling or reusing some supplies in operating rooms, the study estimated that the total savings could exceed $5.4 billion over five years and $15 billion over 10 years.
The estimates were based on data from hospitals that have reduced their environmental footprint over the past five years by reducing their energy use, reducing waste, and making more efficient use of operating room supplies (reprocessing and reusing single-use medical devices and not throwing away unused items from prepackaged supplies formulated for specific surgical procedures). The researchers then extrapolated their findings to all U.S. hospitals based on existing institutional data to estimate the potential for hospital cost savings nationwide.
“Many of the interventions studied did not involve any additional identifiable costs and realized immediate savings,” write the authors. “Given the small costs and the positive return on investment within a short time frame for the sustainability activities studied – as well as their broader environmental and public health benefits – we recommend these innovations for all hospitals.”
The authors also suggest that public funds be allocated to help safety-net hospitals that cannot afford to the costs. “For cash-strapped safety-net hospitals, where even small capital investments are a stress, these interventions can be within reach with the use of federal and state funds to support the cost-saving changes,” they write.
The authors include Susan Kaplan, research assistant professor of the School of Public Health of the University of Illinois Chicago, and Blair Sadler, a senior fellow at the Institute for Healthcare Improvement and a fellow and board member of The Hastings Center.
Accompanying the study are two posts for The Commonwealth Fund Blog written by CEOs of health care systems that had reduced their environmental footprint and costs. George C. Halvorson, chairman and CEO of Kaiser Permanente, which owns and operates 37 hospitals and more than 600 medical centers, writes that Kaiser has saved “tens of millions of dollars over the past few years in the three areas highlighted in the report: energy efficiency, waste minimization, and reprocessing.” Kaiser also aims to divert 40 percent of its waste from landfills by 2015.
Jeffrey Thompson, CEO of Gundersen Health System, based in La Crosse, Wis., discusses the results of a sustainability program launched in 2008. “At the time, our energy costs were rising at an alarming $300,000 a year,” he writes. “Those costs were being passed along to patients in the form of higher health care costs. That wasn’t OK with our board or, most importantly, with our patients.” An energy audit revealed “dozens of energy-saving opportunities.” They involved a $2 million investment, but have yielded more than $1.2 million in savings each year from lower energy costs. Additional savings come from sterilizing and reusing or recycling 95 percent of single-use surgical items in the OR (rather than throwing them away) and from recycling other materials.
The benefits of reducing energy and waste extend beyond saving money. The authors of the Commonwealth study state that these measures may also save lives by reducing the incidence of cancer, liver and kidney disease, and reproductive problems linked to environmental pollutants.
The Commonwealth study was small, and therefore not definitive. The authors call for more research to delineate the savings and other benefits. But with luck it will start a very positive conversation. At a time of bitter disagreement over the sacrifices that will need to be made to avoid the “fiscal cliff,” who can argue with the prospect of cutting health care costs and keeping people healthier by going greener?
Susan Gilbert is the public affairs and communications manager of The Hastings Center and editor of Bioethics Forum.