Best Practices for Green Practices

An environmentally friendly practice can also be friendly to your bottom line, proponents say.

BY RENÉ LUTHE, SENIOR ASSOCIATE EDITOR

With concern for the planet gaining prominence in public consciousness for the past few years, many ophthalmologists have wondered what they can do to make their medical practices “greener.” Quite a lot, it turns out. Better still, these programs can actually save a practice money. From building new offices with the latest in alternative energy innovations to installing weather-proof windows to using low-cost devices that help reduce paper consumption, there is something for everyone to adopt if they so choose. Ophthalmology Management spoke with some who have seized the initiative in bringing the green movement to medical practice. Here are their tips for creating a smaller environmental footprint — and a bigger bottom line.

Green From Top to Bottom

Gregory Katz, MD, of Huron Ophthalmology in Ypsilanti, Mich., got the opportunity to go thoroughly green when he and his partners created a new building to accommodate their expanding practice. “The four of us are relatively young guys, in our 30s and 40s, and we just thought it was the right thing to do,” he explains. The result? Twenty-three geothermal wells dug under the new building provide much of the energy needed for heating and cooling, energy-rated glass windows to keep heat and air conditioning inside and skylights to reduce the need for electric lighting. The large capital expenditures that green technologies often require upfront will begin to pay for themselves in little under seven years, according to Dr. Katz.

The geothermal wells are dug 350 feet into the earth, where the temperature is a relatively stable 50 degrees. They bring that temperature up into the building so that in the winter, for example, the practice only needs to heat the air from 50 degrees to 70 degrees, rather than from what, during a Michigan winter, is often a much lower temperature.

“Right now, it's 29 degrees here, and it frequently gets down to 0, so heating from 50 to 70 degrees saves a tremendous amount of money,” Dr. Katz explains. “In the summer, the wells bring up air that cools the building with very little energy expenditure. I think almost 90% of our temperature control is provided almost for free because of this geothermal system.”

The high fees required for geothermal energy may take less than seven years to pay off if energy prices continue to rise, according to the practice's accountant.

The large number of windows installed along the outer perimeter of the building, where the patient waiting rooms and administrative offices are located, allow natural sunlight to replace electric lighting. Similarly, skylights placed over tech areas function the same way. Motion sensor lights in the rooms also help save electricity by shutting off the light when the room is not in use — Dr. Katz says that together, these measures have resulted in an approximately 10% reduction in the practice's electricity bill.

Gordon Barlow, practice administrator at Augusta Eye Associates in Fisherville, Va., says that when his five-office practice wanted to create a green building, they consulted the LEED (Leadership in Energy and Environmental Design) Green Building Rating System, developed by the US Green Building Council (see sidebar). It provides a suite of standards for environmentally sustainable construction. Points are amassed for adhering to various standards; the higher the number of points a building can attain, the higher its level of certification.

Many local governments have adopted LEED incentive programs, which include tax credits, tax breaks, reduced fees, priority or expedited permitting, free or reduced-cost technical assistance, and low-interest loans.

“We are in the process of defining which level we think we can achieve,” Mr. Barlow says. “The way it works is that you start out hoping you're going to be a platinum level building, but you're probably not going to be the first time, because you're not that experienced at it. But you get points, and everything we can do without raising our cost a lot, we're going to do.”

While most practices may not be in the position to build an entirely new office, smaller additions, such as an optical shop, may be on the horizon for them. Here too there are opportunities for environmentally-friendly measures that also save you money.

Richard Winig, president of Eye Designs, recently designed an optical for a Florida ophthalmologist. He installed low-voltage LED (light-emitting diodes) lighting in much of the room, including for back-lit signage. Yet the project also demonstrated some of the trade-offs of green lighting alternatives in certain settings, he points out. Low-voltage lighting simply does not provide the intensity, and the color correctness, needed to make a product “pop” in a retail environment. So he also used standard, less energy-efficient halogen bulbs in the lighting scheme.

“In certain areas, function outweighs environmental concerns,” Mr. Winig explains. “In a retail area, lighting and color correctness and intensity are just critical for selling the product.”

A More Modest Proposal

Because new buildings are typically not a practical option for most physicians, suggestions for retrofitting existing buildings can help you be kind to the environment and enjoy savings. According to Cody Gale, chief executive officer of Denver Green Buildings, in Colorado, lighting is one of the easiest and most cost-friendly ways to begin greening your practice.

The world is already familiar with compact fluorescent lights (CFLs) and the energy they save. Many practices seem to have incorporated them already. Mr. Barlow reports that his practice's three offices converted to CFLs last year.

“They cost a couple of dollars more,” he allows, “but you see the savings in less than a year. And that's not counting the labor and inconvenience of having to change the incandescent bulbs more frequently.”

LEDs are another energy-saving option, says Mr. Gale, and they are even more efficient than CFLs. Either alternative offers the virtues of a quick return on investment (ROI). Mr. Gale cautions that the rate of ROI depends largely on the size of the space, but typically takes less than two years.

And doctor's offices, he claims, are well suited to incorporating more task-specific lighting rather than the higher-consumption overhead, ambient lighting. The reception area, for instance, is a prime example. “Moving the administrative personnel from overhead lighting to smaller, task-oriented lighting that's right down on the desk or right around the workspace can result in not only energy-efficiency gains, but also increased productivity because it's easier to work under that lighting and it can be controlled more easily,” he says.

Motion-sensor lighting systems save energy too, and help get around the issue of occupancy behavior — because no matter how ingenious and potentially economical a solution is, Mr. Gale points out, people have to be willing, and remember, to use it. Dr. Katz reports that if his sensors do not detect movement in a room for a period of five minutes, the lights automatically go off; they turn on again when the detect movement. Between the motion sensors and the skylights, he says, his practice's electricity bills are down 10%.

Another inexpensive lighting option is to install auto-dimming ballasts. “They have huge potential to save energy,” says Mr. Gale. These include sensors that automatically adjust output based on the amount of natural light available in the room.

“Say your reception room, for example, has great big windows that bring in quite a bit of daylight, but you still have your normal lights overhead. An auto-dimming ballast will actually dim your light output, so you're not having a light that is right next to the window put out a lot of lumens if you don't need it.” he explains. As natural light wanes throughout the day, the sensor increases the overhead output accordingly.

Get Smart

Much green technology is trending toward automatic adjustments and controls in other areas in addition to lighting, according to Mr. Gale — the so-called “smart” systems. Critically for those interested in environmentally friendly living, heating ventilation and cooling (HVAC) can also be addressed. Lighting and HVAC smart systems often inter-operate to adjust output levels based on room occupancy. In a less-utilized space, such as an operating room or a patient exam room, a smart system could potentially turn off lights and reduce ventilation in air changes per minute. “And in spaces where there's actually no one there for 12 hours, say, at night, the savings can be pretty large,” Mr. Gale mentions.

The feasibility of implementing a smart HVAC/lighting system depends on the size of the space. For a facility of only approximately 5,000 square feet, Mr. Gale explains, such a system would likely not make sense. But for offices of 25,000 or more square feet, they can be very helpful.

The drawback to smart systems, however, is the same as with many other green innovations — a steeper price than their non-green alternatives. This is particularly true of smart systems for a medical office, which will have more detailed specifications than for a standard office or retail setting, Mr. Gale says.

“There are a lot more set points for a medical building,” Mr. Gale says. The more set points programmed into a system, the more expensive it is. A combination HVAC/ lighting system could run $15,000 on the low end, he says, all the way up to $75,000, depending on the square footage involved. Thus the ROI takes longer — typically five to 10 years, he says.

Checking Your Own System's Pulse

For larger practices, Mr. Gale points out that there is another option for improving energy efficiency — making sure the HVAC system you already have actually works. Called “retrocommissioning,” it entails engaging an engineer to determine whether your system is actually doing what it was designed to do.

“It provides a picture of ‘as operating’ as compared to ‘as designed’,” Mr. Gale explains. While it seems a common-sense practice, considering how much building owners spend on HVAC systems, Mr. Gale reports that it is seldom done.

For one thing, it's a costly undertaking. As the study usually costs anywhere from $25,000 to $50,000, retrocommissioning only makes sense for larger spaces. ROI is typically six months to two years, says Mr. Gale. However, he believes that for a larger medical practice with a lot of equipment and a fairly complicated mechanical and electrical system, it is a worthwhile investment.

“Usually, nine times out of 10 retrocommissioning is going to be a very cost-effective way to make sure all the technical components are working right,” says Mr. Gale.

Nothing Like the Sun?

What about more flamboyantly green undertakings, such as attaching solar panels to a building in order to reap the benefit's of the sun's clean, and free, energy? How much money could they save your practice? According to Mr. Gale, not very much — at this time. While he recognizes that solar energy is celebrated in the media and is something of a badge of honor in the green movement, there are some important caveats.

“Solar panels are great for the right building,” says Mr. Gale. “But all too often, you see people wanting them, while inside their space, they are flushing their money for their PV [photovoltaic] system down the toilet if the rest of their systems aren't working.”

Inefficient lighting and HVAC systems more than undermine the benefits of “free” energy from the sun. “They're putting a large, $50,000 to $100,000 PV system on the roof. Essentially, that energy is dripping out the ‘leaky pipes' and not being used on anything.”

It makes far more sense, Mr. Gale points out, to make sure the space you have is energy efficient already before laying out that kind of capital.

And even if it is, solar energy's efficiency just ain't there yet when compared with other forms of renewable energy. Still, Mr. Gale expects a significant breakthrough in solar panel efficiencies over the next few years.

“What that means for someone today considering solar is that there's a good chance they could spend $50,000 to $100,000 on a PV system that in two years is going to be so outdated that they're going to wish they had waited,” Mr. Gale warns. “It won't be cost-effective to just go out and change their solar panels to the latest and greatest.”

The Color of Money

For the time being, at least, going green means very real, very now higher upfront costs that lower operating expenses later. “The reality is, you have to weigh the cost against the benefit,” Mr. Winig points out. This reality has caused at least one of his recent clients to put off a green building project until the economy improves.

Christina Vernon Ayers, AIA, LEED, director of Cleveland Clinic's Office for a Healthy Environment, says it is crucial to understand the cost of any project before you begin. Knowing how much you are currently spending on energy and on waste can make a green makeover less daunting, and at least provide a grounded baseline measurement. She reports that the Cleveland Clinic measures energy utilization per square foot every month and tracks its progress over time.

“Having a good set of metrics to understand your progress will help verify the financial savings that come out of most of this work,” she says.

Additionally, practices should focus on the costs of whole projects rather than just first-purchase costs. By considering this factor as well, Ms. Ayers says that they have been able to demonstrate that most of the green projects undertaken by the clinic have resulted in savings for the organization.

“But the only reason we know that is because we're looking at the whole costs and focusing on the metrics that help us tell the story to our organization,” Ms. Ayers explains.

Technology + Common Sense

There are other, less costly ways to save the environment as well as your budget. While much has been written about the virtues of electronic medical records in reducing paper use in medical practices, other innovations are also out there to help with that goal.

Mr. Barlow reports that Augusta Eye uses a fax software program that reduces paper consumption on the composer's end. Developed by a staff member, the Web-based software creates referral letters. A menu offers a number of different, mostly preformatted letters for different consults — diabetic retinopathy, glaucoma, etc. Another menu features a list of physician's names to choose from, and a blank box allows the addition of any necessary text. The message is merged into a letterhead and faxed from a computer.

Additionally, Mr. Barlow says that documents such as the personnel handbook are stored on computer, where it can be added to or amended without requiring new copies to be printed. Another software program allows employees to keep records or request time off, further reducing paper use.

Other practices have a fax system in which incoming faxes go to an electronic file, from which they can transfer medical records to patients' electronic health records without printing, as well as allows junk faxes to be deleted.

Not that all environmentally friendly practices involve technology. Many tips Ophthalmology Management learned from eyecare practices could have come from our Great Depression-surviving grandparents, whose thrift learned during that crisis typically stayed with them the rest of their lives. For instance, in the interest of reducing paper consumption, many practices have taken up that long-lost custom of printing on both sides of the page. One practice reported whittling its three cases of copy paper month habit down to one case approximately every two months.

At Augusta Eye, Mr. Barlow says that they consolidate incoming shipping to save energy. “We use a courier system internally that just once a day consolidates everything — optical delivery, all of our supply delivery — from a central warehouse and delivers to our five offices,” he explains.

The practice enables the company to avoid shipping costs from their suppliers as a result of negotiations. “It's a three-hour round trip for the driver, picking up and delivering, and it just saves a ton of money. We've been able to cut about 11% from our expense lines.”

Ms. Ayers points out that campaigns to instill such thrifty habits as turning off lights in unoccupied rooms and unplugging appliances that aren't constantly in use can also be effective.

Thoughtful Changes

When considering ways to help the environment, there are many cost-conscious ways for medical practices to get in on the act. According to those in the vanguard of the green practice movement, keep a record of costs for utilities and supplies, investigate conservationist alternatives — and don't overlook the little changes in habit that can add up to significant breaks both for our planet and your budget. “If it isn't cost prohibitive, I think you should do it,” says Mr. Winig. OM