In many ways, healthcare is running on “E.” But not when it comes to energy consumption.

The industry is gripped by staffing shortages, cost constraints and supply disruptions, while the pandemic continues to strain operations. Reducing carbon emissions may feel like yet another concern tacked onto the end of that daunting list, but in reality, it will worsen each of those other issues if it remains an afterthought.

“This is not going away. It is only going to accelerate in terms of consequences for any business, but particularly for healthcare.”

Dr. Jay Lemery, University of Colorado School of Medicine

“This is not going away,” said Jay Lemery, MD, Professor of Emergency Medicine at the University of Colorado School of Medicine in Aurora, Co-director of its Climate and Health Program, and a Member of the National Academy of Medicine.

“It is only going to accelerate in terms of consequences for any business, but particularly for healthcare.”

If healthcare maintains business as usual, the sector’s global emissions will exceed an estimated 6 gigatons annually by 2050, according to Health Care Without Harm, an international nongovernmental organization. In the U.S., healthcare’s carbon emissions make up 8.5% of the country’s total.

Because of healthcare’s outsized impact on the environment through harmful carbon emissions, the “E” in ESG is a smart entry point for healthcare organizations newer to the framework. Prioritizing decarbonization in healthcare has the power to dramatically influence the trajectory of climate disaster and mitigate the harm to the very populations it serves. For healthcare organizations themselves, decarbonizing can deliver quick wins that squarely align with overall purpose.

The people whose health suffers most from carbon emissions and rising temperatures are inevitably those with physiological, socioeconomic and geographic vulnerabilities, Lemery said. Knowing this, and healthcare’s obligation to do no harm, urgent action must be taken to decarbonize.

“We know that the burning of fossil fuels creates harmful emissions, and those harmful emissions cause health issues in the people in our surrounding area,” said Alan Eber, Director of Facility Operations for Gundersen Health System, which in 2014 became the first healthcare system in the country to produce more energy than it consumed. “So, our whole goal is to try to reduce those harmful emissions to improve the health of the population around us.”

While decarbonization fits squarely into healthcare organizations’ mission and purpose, it can also be a significant financial asset—and the La Crosse, Wis.-based Gundersen is proof of this. Licensed for 325 beds, it wouldn’t be considered a massive, heavyweight institution with limitless resources to devote to emission reduction. Nonetheless, it prioritized and accelerated that process before it was even on others’ radars.

“There are enormous benefits to how much we have reduced our carbon footprint,” Eber said.

“There are enormous benefits to how much we have reduced our carbon footprint.”

Alan Eber, Gundersen Health System

It was nearly 15 years ago that Gundersen took a hard look at the trajectory of its fossil fuel energy costs and realized if the upward trend continued, it would affect the system’s bottom line and the cost of services to patients. By switching to wind, wood chips, landfill-produced methane gas and cow manure to generate power, Gundersen has reduced its emissions of carbon monoxide, particulate matter and mercury by more than 95% from 2008 to 2016.

“We would have spent $5.1 million more [annually] to provide power for all of our health system if we didn’t do what we have done,” Eber said. “It cost us money to get to that point, but we have recouped every dime spent on our energy initiatives. Our final break-even point happened in 2021. Now, everything that we recoup is a net gain for our organization.”

The rationale that motivated Gundersen to take action back in 2008 still resonates all too well today, amid record fuel prices that have a domino effect on supply and operating costs for health systems. Yet, as of 2018, only about 10% of hospital systems have attempted energy efficiency efforts as bold as Gundersen’s, a hospital energy expert at UnitedHealth Group’s Optum Advisory Services told U.S. News World Report at the time.

“Now that the cost of energy is going up, this is going to be a huge burden on healthcare organizations moving into the future,” Eber told Modern Healthcare Custom Media. “In our organization, because of the investments that we’ve made and all the progress that we’ve made, it’s going to have much less of an impact.”

Achieving the level of financial and operational resilience that Gundersen has—and advancing healthcare decarbonization for the benefit of human health—will require action on four specific fronts, experts in the field say.

According to the New England Journal of Medicine, the major areas to prioritize are:

Encompassing production, transport, and the use and disposal of goods, the U.S. healthcare supply chain is responsible for estimated 80% of sector’s carbon footprint and should therefore be a major consideration in developing decarbonization efforts. Healthcare organizations can also use their purchasing power to brace against future constraints.

Whether you’re talking about the environment or disruption from other things … building resiliency in the supply chain is really important.”

Dr. Elizabeth Baca, Deloitte Consulting

“Whether you’re talking about the environment or disruption from other things, whether it be war like we’re seeing now or other significant events, building resiliency in the supply chain is really important,” said Elizabeth Baca, MD, Specialist Leader for Health Care and Life Science Strategy at Deloitte Consulting.

While clinicians are the ones treating the health consequences of carbon emissions, they haven’t traditionally been given the resources to become experts on the issue and conduits of change. This is another area of opportunity for building resilience.

“When we’re asking our hospitals to divest in oil and gas and can’t speak about that—if we remain siloed in patient care—then we can’t be effective,” said Lemery, who was involved in creating the climate medicine diploma at the University of Colorado School of Medicine. “We have to be expert communicators.”

Providing this kind of education will also give clinicians and healthcare employees a sense of control and empowerment they might be lacking currently, as they grapple with relentless understaffing, burnout and other discouraging elements of the job.

Decarbonization will be made possible in part through policies, financing and common metrics that incentivize effective, equitable action. While sky-high oil and gas prices are already causing leaders to rethink renewable energy use, they should also be looking at what’s coming down the pike from a regulatory standpoint, Lemery said.

“We know it’s coming,” he said. “If hospital systems are expected through things like CMS reimbursement to be able to demonstrate a lower carbon footprint, you’ll have people taking notice. There’s no more, ‘We should do the right thing,’ or, ‘We could do that next week’—it’s, ‘Oh, man, we have to do this now, because our reimbursement is being linked to compliance with decarbonization metrics.’”

Finally, only through systemwide commitment and change can national hospital emissions be reduced to more sustainable levels. For a positive outcome, these actions must be integrated into enterprise-wide strategy, according to Baca.

“It’s not just having a document that’s your climate strategy, it’s thinking about your entire operations,” Baca said. “If you’re doing a revenue cycle management project or digital transformation, all of those things should have a climate lens. This is how we’re going to get to transformation: by nesting this into business and your bottom line.”