A new congressional report on how health systems are dealing with the climate crisis details an industry stuck reacting to extreme weather events and falling behind on decarbonization goals.
Greenhouse gases released from the healthcare sector make up 10% of total U.S. emissions, and they continue to grow. According to the report, carbon dioxide, methane, nitrous oxide, and fluorinated gas emissions rose 6% between 2010 and 2018, resulting in the loss of 388,000 disability-adjusted life-years. The House Ways and Means Committee published these findings in conjunction with a hearing on the subject Thursday.
These gasses contribute to a destabilizing climate that increasingly affects healthcare providers, according to the information they presented to Congress.Between 2000 and 2017, there were 114 climate-related hospital evacuations, half of which involved more than 100 patients. The causes included hurricanes, wildfires, extreme flooding, intense heat waves and strong winter storms, all of which can damage critical infrastructure.
Providers will have to decarbonize while building resilience to volatile weather patterns to prevent shutdowns and lapses in patient care, the report concluded. This will require improvements in private and public infrastructure, new policies, decarbonization guidelines, tax incentives and grant funding for technology advancements, industry groups advised lawmakers.
In response to questions from the Ways and Means Committee, 54 of 62 providers reported experiencing at least one extreme weather event in the past five years, with more than half experiencing five or more. Recovering from these events cost these providers between $29,000 and $22 million.
Despite this, only about one-third of respondents have climate action plans. Six of the 13 trade associations that responded have written guidance for responding to extreme weather events, although none focus on mitigation and resilience strategies.
Community health systems and independent hospitals often face the brunt of these issues and are the least likely to be prepared for them. Parinda Khatri, CEO of Knoxville, Tennessee-based Cherokee Health Systems, testified to lawmakers that a heat wave shut down a clinic's air conditioning unit, which forced it to close for 10 days. Nearly 1,000 patients missed scheduled appointments and $20,000 worth of medications spoiled as a consequence, she said.
"As a nonprofit safety-net organization, we're used to obstacles and doing things that are hard, often with minimal resources," Khatri said. "Preparing for the growing risks presented by climate change is a formidable and new challenge. Unfortunately, health center funding has not kept pace with the need beyond infrastructure improvements."
Less than half of the respondents are prepared to meet sustainability and federal, state or local decarbonization targets. A similar number lack the technology to track their emissions.
Most providers have established working groups to shape environmental strategy. The most common goals are increasing renewable energy usage, achieving carbon neutrality, decreasing greenhouse gas emissions, eliminating chemicals of concern, increasing recycling and reducing water use, according to the report.
Providers have focused on internal operations and the supply chain to meet these goals. For example, companies are looking to use sustainable medical equipment and to enhance recycling and waste management. Internally, they are assessing emissions related to their workforces, such as transportation and food waste, installing LED lighting, and identifying more renewable energy sources.
Kaiser Permanente achieved carbon-neutral status in 2020 by improving energy efficiency in operations, increasing utilization of renewable energy sources and carbon offset purchasing, the Oakland, California-based company reported.
In other examples of environment-related actions, Boston Medical Center operates a 750-square-foot farm on its roof and a 650-acre solar farm in North Carolina. Seattle Children's Health partners with not-for-profit organizations that plant trees to offset emissions.
Stanford Medicine Children's Health of Palo Alto, California, built two 55,000-gallon rainwater collection systems to use for landscaping. And Oakland-based University of California Health established facilities to divert approximately 50% of its organic waste and methane from landfills, with a long-term goal of becoming waste-free.
To reduce its workforce's carbon footprint, Intermountain Healthcare of Salt Lake City installed electric vehicle charging stations. Gunderson Health System of La Crosse, Wisconsin, and Baltimore-based Johns Hopkins Medicine offer cash incentivizes for employees to purchase homes near their workplaces to reduce transportation costs and emissions.
Return on investment
Health systems reported the most significant barrier to decarbonization and climate resiliency is finding the money to invest in the efforts. Providers cited the lack of capital funds, tax incentives, rebates, grants, renewable energy options and public transportation as obstacles.
Most the respondents' sustainability projects are supported by rebates from local utility companies, federal and state tax rebates and grants from local governments or private entities. Providers who have initiated such efforts reported long-term savings.
Boston Medical Center redesigned its clinical campus in 2018, which cut greenhouse gas emissions by 90% and reduced electricity consumption, saving the hospital approximately $25 million annually, for example. Pueblo Community Health Center in Colorado halved its utility costs by implementing energy efficiency technology. After participating in the Department of Energy's Better Buildings Challenge, Ascension of St. Louis reduced energy costs by 32% and saved $95 million across two campuses in four years.
But piecemeal sustainability programs aren't enough, healthcare executives and other testified Thursday. Congress and federal agencies should fund, formalize and standardize the decarbonization process, and move along the goal of net-zero emissions, witnesses told the committee.
"Healthcare itself is a leading contributor to pollution and climate change against the mission to first do no harm, and mitigating healthcare pollution is a fundamental requirement for safe and high-quality healthcare delivery," said Jodi Sherman, founding director of the Yale Program on Healthcare Environmental Sustainability in the Yale Center on Climate Change and Health. "Voluntary measures are insufficient to transform the healthcare sector, and legislative action is urgently required to compel decarbonization in accordance with science-based targets and timelines and to avoid 'greenwashing.'"
The Centers for Medicare and Medicaid Services should establish guidelines and standards for decarbonization that are linked to reimbursement, Sherman said. The Food and Drug Administration should establish sustainability rules, such as requiring product manufacturers to reclaim and recycle packaging, she said.
Healthcare providers submitted a range of policies they recommend to build climate resiliency and reduce their carbon footprints, including raising funding for the Hospital Preparedness Program, expanding renewable energy sources and building microgrid capacity. They also seek greater funding and incentives to invest in renewable energy and emission-tracking infrastructure. Finally, providers suggested increased investment in public transportation, climate-related risk tracking by the Centers for Disease Control and Prevention and higher CMS reimbursements for providers addressing climate issues.
"Inaction is affecting care and, given the projections we are facing, it will make the ability of the community to rely on its healthcare infrastructure—to know you can go to the emergency department and you can have surgery—even less likely in the future, unless we act," said Paul Biddinger, chief preparedness and continuity officer at Boston-based Mass General Brigham.