If sustainability leaders at U.S. healthcare systems had one energy-related wish, it would be that state, federal, and industry rules and practices around advanced energy technologies were better aligned. That misalignment is slowing the deployment of onsite renewable energy, battery energy storage, microgrids, and hydrogen-powered fuel cells that could accelerate the decarbonization of the U.S. healthcare system.
Huge Energy Users
Hospitals and healthcare systems are among the most voracious commercial energy users, using about 2.5 times more energy per square foot than the average commercial building, according to the most current data from the U.S. Department of Energy (view image gallery to see DOE/EIA graphic).
Northwell Health, headquartered on Long Island, is New York’s largest healthcare provider, with 23 hospitals and over 800 outpatient facilities. It has aggressively used efficiency and conservation measures to cut its energy use intensity (EUI) of some facilities by 23% over the last 12 years, Mike Rohan, director of design & construction in the Facility Development group at Northwell, said in an interview. On a blended average, the system has lowered energy use by 14% over that time. And it has set goals to further lower its EUI by over 20% by 2030.
Northwell’s annual energy bill is about $75 million. It is one of the largest healthcare systems in the country. To manage annual energy costs, Northwell and other healthcare systems contacted by EnergyTech have for years been installing energy efficiency and conservation measures.
Across the country, Seattle-based Providence St. Josephs Health System benefits from abundant low-cost hydropower, but it, too, is working to lower energy costs which range from a low of $1.78 per square foot to a high of $9.20 per square foot, Elizabeth Schenk, executive director for environmental stewardship at the St. Joe’s system, told EnergyTech. Schenk said more aggressive deployment of energy efficiency measures would cut natural gas use by 15%, and electric use by 30%, by 2030.
“We’re working hard on energy efficiency and smart energy procurement,” she said.
The Cleveland Clinic, which operates 30 facilities in Ohio as well as hospitals in Florida and Nevada, cut energy outlays 26% between 2010 and 2020, Pat Rios, executive director, buildings and design, told EnergyTech.
Conflicting Codes Complicate Carbon Cutting
Many of those same healthcare systems also are hard at work to decarbonize their energy sources, which for now means additional emphasis on efficiency and conservation measures. But they must step carefully. A contradictory mass of state, federal, and industry regulations sends conflicting signals to healthcare providers, making the decarbonization path a difficult one.
Some states like New York and California have enacted aggressive decarbonization targets. For healthcare systems, meeting those targets will require changes in healthcare regulations.
Right now, healthcare facilities that participate in the Medicare and Medicaid programs are required to have onsite emergency generation available in case grid power goes out. The most recent version of this rule, dating from 2012, effectively mandates hydrocarbon-fueled generation as a backup energy source. There are efforts to change that to allow hospital microgrids, but the Centers for Medicare and Medicaid Services are not yet on board, according to Kara Brooks, sustainability program manager for the American Society for Health Care Engineering (ASHE).
“Antiquated and sometimes conflicting federal, state and local regulations constrain hospitals from reducing their carbon footprints,” she told EnergyTech in an interview.
“The currently adopted codes do not include over a decade’s worth of sustainability technology improvements and energy efficiency initiatives,” she continued. “The older codes do not provide valuable guidance for the use of systems such as fuel cells and stored energy systems, nor do they establish safety standards for the use of microgrid technologies. Without updated (rules) from the Centers for Medicare and Medicaid, most sustainability goals will be difficult to obtain and, in many cases, will create additional hazards for patients, staff, and the public.”
Patient Care is Job #1
Even if they were not constrained by existing federal healthcare rules, sustainability managers say their systems are not inclined to take a chance on advanced energy technologies like renewable energy, batteries, or microgrids if there is a chance it will detract from patient care.
“Would you want to rely on a solar panel and battery if you were on the operating table?” asked Northwell’s Rohan. Solar, batteries, microgrids and hydrogen “have great potential, but they’re not there yet in terms of cost and reliability,” he added.
Instead, healthcare systems increasing their use of electricity, chiefly by switching out gas-powered boilers for ones powered by electricity. By and large, systems are dependent on the fuel mix of the utilities that serve them. In downstate New York, that’s fossil fuels. In the Pacific Northwest, that’s hydropower.
Asked about his top energy wish, Rohan’s said, “The single most beneficial aspect to our collective endeavor to electrify would be a consistent policy, from the Federal government, facilitating a centralized High Voltage DC grid across country, like our interstate highway system. That system would most efficiently allow for remote generation to power our largest loads.
He explained that there is plenty of emission-free electric generation in northern New York State, but a transmission bottleneck prevents that power from getting to downstate customers like Northwell. New York State had ambitious plans for offshore wind, which Northwell could use to produce “green” hydrogen, but once again, transmission challenges remain.
Feet on the Ground, Eyes on the Stars
Sustainability experts continue to pursue decarbonization, despite federal impediments. They were encouraged this summer when the U.S. Department of Health and Human Services created an Office of Climate Change and Health Equity, which pledged to work “to reduce greenhouse gas emissions and criteria air pollution throughout the health care sector.” The office could help change regulations that restrict sustainability efforts, climate activists say.
Kaiser Permanente has focused on greening its electricity supply. As of September 2020, according to a news report from the California Health Care Foundation, all 39 of Kaiser’s hospitals and its 727 medical offices had achieved carbon neutrality. At most Kaiser Permanente hospitals, solar panels provide 25% to 33% of energy needs.
Kaiser Permanente aims eventually to generate enough electricity through solar technology to eliminate the need for diesel-powered backup generators at its hospitals.
Long Island’s Northwell has plans to experiment with natural gas-fueled fuel cells, renewables, batteries, microgrids, and even hydrogen over the next 5-10 years, he said in an interview. It has a solar array at one facility, and hopes to bring solar to three more facilities, depending on the results of a request for proposal that is out.
Seattle-based Providence St. Joseph’s Health last year adopted a goal to become carbon negative by 2030.
The St. Joe’s system starts out with a relatively small carbon footprint thanks to abundant hydropower in the Northwest. Twenty-six of their facilities receive 100% renewable energy already, thanks to utility-supplied power, Schenk said. “We’ll partner with any organization that wants to be a part of decarbonization, but it’s very difficult for hospitals to reduce their carbon footprint through renewable energy alone.”
The St. Joe’s system has no battery energy storage installations and no microgrids, and only a little solar generation. “We’re watching the market and we think those technologies will be very important parts of decarbonization,” Schenk told EnergyTech. “This decade is on fire with renewables, batteries, and microgrids. It’s very exciting.”
(About the author: John Egan is founder and president of Egan Energy Communications. He has more than 30 years of experience with the energy and utility sectors).