Greening your practice: Cutting costs while conserving energy

Physicians are discovering that going green can save some green. Conversely, the desire to save some green can help them go green.

Take, for example, Richard Schoor, MD, a Smithtown, N.Y., urologist. He drives a 1999 Honda Accord on his daily commute, mostly because it uses less gas than, say, an SUV. The fact that it's also better for the environment is a bonus.

When Dr. Schoor saw his practice's energy bills triple in one year, he began taking small steps to cut energy consumption and met daily with his staff to ensure they were, too.

"I began cutting costs by turning off the lights when patients were out of the office and putting the computers on power-saving mode. You need to try and save every penny you can these days," Dr. Schoor said. "I don't keep the temperature ice cold in the summer or too hot in the winter, and when at all possible, I open the windows for fresh air. I'm on the second floor so there is no issue with people looking in."

While he has not seen a dramatic drop in his energy bills, he said they have remained steady, while energy costs for his colleagues have continued to climb.

Dr. Schoor is feeling good about how saving energy helps the environment and has taken other steps to reduce waste. His office has gone paperless, even though it would cost less to use paper than computers. And he says the practice has been vigilant about ensuring only medical waste goes into the medical waste bags, which also saves on disposal costs.

He would like to do more. "I could ride my bicycle to work. I'd do it in a heartbeat. The problem is, the area of Long Island where I live and practice is a pedestrian-unfriendly area."

Dr. Schoor is one of many physicians who are going green -- in their offices and their habits. They are recycling, conserving and eliminating the toxins around them.

Some of the measures are simple and free; others are more complex and costly. In all cases, environmental experts and physicians agree that everyone in the office needs to get on board.

Andrew Quirk, the Atlanta-based vice president for national health care for Skanska, a worldwide builder, said he is not aware of any studies done to quantify the financial advantages of medical offices going green. However, he said if you look at sustainable products in general, physicians can expect a 60% savings in energy costs while incurring just a 5% increase in upfront costs. "Not only is going green good for the environment, it is the right thing to do and it is good for business. Patients are looking for green doctors, as are younger physicians and nurses. This is the first wave of graduates that expects sustainability in a practice," Quirk said.

Physicians and other experts say there are five key areas in which doctors can become greener: office waste, medical waste, utilities, office design and transportation.

Office waste

Some of the most common, low-cost sustainable measures being taken by environmentally conscious physician practices deal with garbage.

Among the strategies are going practically paperless, shredding and recycling the paper that is still used, replacing disposable cups and cutlery with reusable ones, and providing alternatives such as a tea service and cold, filtered water fountains to bottled water and canned soda.

Missouri's Cape Girardeau Surgical Clinic Inc. took a big step toward eliminating paper in the office. It no longer offers handouts in the waiting room, but instead provides a laptop computer for patients to look up medical conditions. The clinic also invested in a projector and screen to present journal articles for discussion.

"We used to print the articles and hand them out to our seven physicians. Now we share the information without killing so many trees," the clinic's practice administrator, Sarah Holt, PhD, said.

Practice Greenhealth, a membership and networking organization for health care institutions that have made a commitment to eco-friendly practices, offers other tips: Re-evaluate your cleaning systems to make sure they don't emit volatile organic compounds, reduce the use of pesticides, purchase plastic bags and tubing free of PVC, and recycle out-of-date electronic equipment.

Medical waste

Practice Greenhealth also calls for private practices to avoid unnecessary incineration of waste products, pointing out that the U.S. Environmental Protection Agency identifies medical waste incineration as the third largest known source of the highly toxic dioxin, a known carcinogen.

Like hospitals, many medical offices designate separate bins for regular trash, recyclables and medical waste. Educating staff on what constitutes medical waste can result in less material requiring incineration. Given that medical waste costs more to dispose of than office waste, experts say there's a financial incentive to keep facial tissues and tongue depressors out of that bin.

Physicians should eliminate all mercury from their practices, including thermometers, according to Practice Greenhealth. The organization says mercury-free products are readily available and cost competitive.

Skanska's Quirk said physicians should get together as a group and demand green products from their suppliers. "Five years ago, they would have had to pay a premium for that, but prices have come down and are about the same price as non-environmentally friendly products today," he said.

Utilities

Saving energy can be as simple as shutting off the lights and computers at night, or switching to the more expensive, but more energy-efficient, CFL lightbulbs, notable for their ice cream-swirl shape.

Or it can mean turning down the thermostat a couple of degrees in the winter and up a few degrees in the summer. Practice Greenhealth also points out that properly designed landscaping not only reduces maintenance costs, but also can help whittle heating and cooling bills.

Install low-flow plumbing fixtures and open the blinds, suggests Quirk. These measures not only are good for the environment, they're good for the office's public relations. "A patient may not be acutely aware that they are saving money when they flush the toilet," he said, "but they are aware when you flood a room with daylight."

Dr. Schoor also recommends water-saving toilet flushers, pointing out that in a medical office, the toilet can be flushed as many as 50 times a day.

Office design

Both new and existing medical offices can become certified as environmentally friendly by following LEED standards, developed by the U.S. Green Building Council, a nonprofit organization whose board members include builders, architects, and representatives from environmental organizations and other corporate entities.

But Quirk noted that ratings under LEED -- Leadership in Energy and Environmental Design -- merely convey a formal recognition that a building is sustainable. "There are things we can do in everyday life that will ease the burden on the environment just as well."

From the paint on the walls to the furniture and carpeting in the waiting room, some products are less toxic than others.

Robin Miller, MD, an internist in Medford, Ore., said her practice used paint that doesn't give off fumes, and carpeting made without chemicals.

Justin Hurley, spokesman for Portland, Ore.-based Asante Health Systems, said his organization is looking at installing soy-based linoleum floors, and buying furniture and carpeting with more environmentally friendly materials. Asante is in the midst of a 16-month master plan that addresses the carbon footprint, or environmental impact, of its hospitals and 68 outlying properties, including physician offices.

"We are looking to be LEED-certified with our new construction, too," Hurley said. "I feel like this is the first time in history that our buildings have the power to create social change."

Transportation

Brian Gross, MD, a cardiologist in Medford, Ore., rides a Segway scooter to work. Dr. Miller traded in a Mercedes SUV for a Honda hybrid car and walks the five minutes from home to office whenever possible. Other physicians say they sometimes ride bicycles to the office.

Alternatives to gas-guzzling cars are growing. Physicians are choosing sporty scooters, smaller, more fuel-efficient vehicles, or even hybrid SUVs.

But shop judiciously when choosing a hybrid vehicle, experts say. Gas mileage varies, and not all hybrids still qualify for a tax credit. The Internal Revenue Service credit is based on the number of vehicles from a particular manufacturer that are sold. The credit for certain Toyota and Lexus vehicles have been eliminated. However, as least through 2008, you can get a $3,000 credit for a Ford Escape Hybrid 2WD, $2,200 for a GMC Yukon Hybrid and $2,350 for a Nissan Altima Hybrid.