Against a Changing Future
Boston Hospitals are apreparing for Tomorrow's Challenges by Cutting Greenhouse Gases Today.
Superstorm Sandy, the hurricane that pummeled the Northeast in fall 2012 and caused more than $75 billion in overall damage, was a wake-up call for many hospitals and health systems across the nation, but particularly those in the Boston area. According to a study by the World Bank, Boston is the eighth-most vulnerable city in the world for coastal flooding and the fourth-most vulnerable in the United States by property value.
“It’s only a matter of time before the next big hurricane comes ashore here, and we need to be prepared,” said Paul Lipke, senior adviser for energy and buildings at Health Care Without Harm.
But while Sandy may have increased the sense of urgency for environmental resiliency, the Boston area has long been a hub of progressive, pro-environment thinking. Now, with the release of a new report from Health Care Without Harm, it’s clear that Boston health care has put its money where its mouth is.
“Boston hospitals are leading other sectors in the city and pacesetting the entire health care industry, demonstrating they can provide exceptional patient care, protect public health, and dramatically reduce greenhouse emissions,” said Gary Cohen, co-founder and president of Health Care Without Harm.
Overachieving In Beantown
Developed for the Boston Green Ribbon Commission’s Health Care Working Group, the report found that Boston hospitals top the nation in greenhouse gas reductions. While Boston and the state of Massachusetts have mandated an aggressive timetable for greenhouse gas emission cuts — 25 percent by 2020 and 100 percent by 2050 — Boston-area hospitals already cut their energy greenhouse gas emissions by 29 percent between 2011 and 2015, and they are on track for a 33 percent reduction by 2020. That’s a 47 percent reduction in greenhouse gases compared to “business as usual” by 2020, and it is equivalent to eliminating the annual greenhouse gas emissions of 42,000 passenger vehicles.
“Health Care Without Harm has been working with Boston hospital facility leaders for over 20 years,” Lipke said. “Starting in 2010, we got them all to agree to put energy data from 2008 onward into EPA’s Portfolio Manager and share it with us to create a sector profile. So when the city subsequently sought to create an energy reporting and disclosure ordinance, as others around the country have done since, our hospitals were way ahead — and strongly supported it.”
One result of that work, Lipke said, is the first and probably only metro-wide health care greenhouse gas and energy assessment anywhere in the United States, accounting for how much energy is being used and from what sources. But the leadership doesn’t stop there.
“Massachusetts, the city of Boston, and its Green Ribbon Commission are all deeply committed to understanding, mitigating, and reducing the region’s climate vulnerabilities,” Lipke said. “When we combine that with our concentration of world-famous hospitals and biomedical research facilities committed to their communities, you get a potent combination. It helps explain why we also got 115 leaders to spend a day analyzing how hospitals can best help anchor their community’s health and climate resilience.”
The Green Ribbon Commission comprises 35 CEOs, including Partners HealthCare’s David Torchiana, MD, and Boston Medical Center’s (BMC) Kate Walsh, who support implementation of the city’s Climate Action Plan. The effort helps the city, businesses, institutions, and residents reduce their greenhouse gas emissions, use renewable energy, and prepare for the effects of climate change.
It’s important work, and given Boston’s vulnerability, the specter of Sandy is never far from people’s minds.
“We can’t ignore what happened down in New York and the impact [Sandy] had on the health care delivery system,” said John Messervy, corporate director of design and construction at Partners HealthCare, Massachusetts’ largest health care facility, with hospitals and affiliates across much of the state. “We have 19 million square feet, and half of that is in areas that have been identified as prone to flooding from either extreme precipitation or from sea-level rise combined with storm surge.”
Bob Biggio, senior vice president of facilities and support services at BMC, shares the same concerns. “When you look at the locations of most of the large Boston hospitals, we’re one of the most vulnerable hospitals, so it’s definitely an area that we’ve been focused on,” he said. “And I think our position as a safety-net hospital really makes it incumbent on us to be able to protect that population if a major disaster were to happen.”
But working on ways to reduce their impact on climate change doesn’t just help them meet the area’s health care needs in times of crisis; it also helps protect patients’ health at any time.
“I think as a health care organization, we’re seeing the impact of climate change — particularly emissions and air quality — on our patients, especially with increasing cases of emphysema, of cardiac conditions, of asthma,” Messervy said. “Put simply, as a health care organization, we don’t want to be contributing to the problems that we are treating our patients for.”
Partners Healthcare: Responding to the Challenge
In 2010, Partners HealthCare formulated a three-pronged strategy to reduce its carbon footprint: Reduce energy consumption by 30 percent, deploy on-site generation, and move strategically in the direction of greening the energy supply.
According to Messervy, energy reduction efforts have already yielded a 21 percent reduction through 2016, though some individual hospitals have been able to boost the reductions to over 30 percent.
“If you’re really focused on reducing energy, there are opportunities,” Messervy said. “And although it’s not without investment, the paybacks we are finding on those capital investments are on the order of two to four years.”
The ongoing challenge, he said, is maintaining those reductions.
“You can’t walk away from the management of the building operations and expect those reductions to stick,” he said. “It takes active management on a daily basis to continue to realize those savings.”
Like many urban hospitals, the roofs of the buildings are pretty much completely occupied by mechanical equipment and emergency generators, so the opportunities for on-site power generation are fairly limited. However, Partners has utilized parking garages at three different locations to deploy photovoltaic (PV) arrays, and at Spaulding Rehabilitation Hospital Cape Cod, the organization has also deployed an on-ground PV array as well as carport-mounted PVs over the parking lot.
“So between these installations, we’re able to generate about six megawatts of power, which is a small amount compared to our overall demand. But nevertheless, it helps, and it’s a statement of our intent and our values,” Messervy said.
A lot of attention has also been paid to Partners’ commitment to greening its energy supply, particularly the move to purchase 75 percent (around 22.6 megawatts) of the output of a New Hampshire wind farm. It is reportedly the largest, direct-delivery renewable energy purchase made in the Northeast.
Scheduled to be completed in 2019, the $54 million Antrim Wind project is expected to equate to the removal of more than 10,000 cars from the road.
Through TransCanada, Partners’ wholesale energy provider, the system is also able to source 100 percent non-carbon-based fuels for the balance of its power supply, with the exception of one hospital tied into a district energy plant.
Furthermore, Partners is also taking advantage of a holdover from the Industrial Revolution — New England’s longstanding mill tradition — to harness low-impact hydropower from small turbines deployed along the rivers. Unlike large-scale hydro projects, these small turbines do not interfere with water flow or inhibit fish passage.
“Those turbine installations are still in place, so there’s been a lot of work done by private developers and property owners to refurbish or replace those turbines with more efficient turbines and continue to generate power from the river flows,” Messervy said.
Boston Medical Center: ‘If You Don’t Start, You’ll Never Finish’
When BMC decided to pursue a resiliency and energy efficiency program, it was coming off a couple of years of very large losses. Yet, even on the brink of receivership, the move had support not only from the top but also from within.
“I think the fact that we are a safety-net hospital helped us look at it more closely,” Biggio said. “When you talk to our staff and our clinicians, it really is embedded in their DNA.”
Having good intentions and being able to afford to see them through are two different things, however. So Biggio began by focusing on energy efficiency and driving down energy costs.
“I think having that be the first area of focus aligned with the financial struggles we were having by being able to reduce our energy bills and therefore help us through that challenge,” Biggio said. “Then to be able to use some of those investments and the wins from that process [and] make further investments — that perhaps might not have had quite as big a payback, and maybe had a bit more risk associated with them — helped us continue our successes in reducing the carbon footprint of the organization.”
That approach allowed Biggio to evaluate the infrastructure of all of BMC’s buildings and consider how he could interconnect them to better utilize the more advanced technologies used in the newer buildings. By doing that, Biggio said, the hospital was able to achieve efficiency without having to make as large a capital investment as might otherwise have been required.
Case in point: BMC actually had bids in hand of approximately $5.25 million to install new emergency generators and a cooling tower in the power plant. But by stepping back and looking at ways to cross-connect buildings and better leverage the existing technology in some of the buildings, the organization was able to take the project down to about $750,000 while saving $250,000 a year in energy costs.
Finding these kinds of efficiencies has proved particularly important to BMC, which is the product of the 1996 merger of Boston City Hospital and Boston University Hospital. The two hospitals were located just a block away from one another and had several redundancies. In 2012, the board approved a consolidation plan.
“We developed a plan that would help us consolidate the campuses into a single footprint, and then we could essentially sell off the excess real estate in the campus we vacated to help us pay for the consolidated campus,” Biggio said. “In doing so, we were able to reduce the footprint of the hospital by about 400,000 square feet while simultaneously expanding our capacity to see patients.”
Biggio said that 400,000 square feet equates to about $3.75 million in energy spend that the hospital will no longer have to account for once the consolidation is complete, which is projected to be in 2018.
Overall, Biggio estimates the consolidation effort will realize approximately $25 million a year in operating efficiencies.
Also making headlines is BMC’s involvement in a cooperative power purchase agreement with Summit Farms, a North Carolina solar farm. Like Partners’ purchase of wind power, the solar purchase proved to be a complex transaction.
“I think the complexity is in the fact that you can’t really bring the power up to Boston, so in essence, we continue to contract for our power as we always have up here in Boston, but we’ve committed to purchase the power at Summit Farms for 25 years,” Biggio said. “We keep the renewable energy certificates as part of that purchase, and an agent then sells the power into the grid on our behalf in North Carolina.”
Biggio encourages others looking to make strides toward cutting greenhouse gases to consider similar strategies, including working with utility companies and aggressively searching out grant opportunities. BMC recently received a $3.7 million grant from the state of Massachusetts for working with the city on a combined heat and power unit that, besides powering inpatient facilities, will also provide backup power to the regional communications equipment serving Boston Fire, Boston Police, the Massachusetts State Police, and Boston EMS in the event of a major disaster.
“That collaboration was good for us financially, but it’s also good for the community in the event of a disaster like Superstorm Sandy,” Biggio said.
And then there are the tangential benefits to consider — things like public relations, donor interest, and employee recruitment.
“I don’t think we really expected all of those additional benefits when we started,” Biggio said. “But we’ve definitely seen them, and I don’t think people should underestimate how important they are.”
Do No Harm
While ensuring that patients have access to medical care during an emergency is of primary concern to hospital leaders, both Messervy and Biggio also feel strongly that hospitals and health systems have an obligation to minimize the harmful environmental effects that are a byproduct of their operation.
“We’re experiencing climate change, and we’re experiencing worsening air quality and greenhouse gases daily. The consequences are reflected in many of the patients we see in our emergency rooms every day, being treated for chronic medical conditions that are amplified by aspects of climate change. So there’s a growing sense, especially in the health care sector, that health care has a role to play in setting a course to reduce emissions,” Messervy said.
Biggio agrees. “There’s certainly no better way to keep your community healthy than by starting with the environment and improving the environment in which you live,” he said.