LEED for health care: Worth it?

The recently released LEED version 3 has undergone some significant changes, but for the health care industry the new changes do not go far enough.

The U.S. Green Building Council’s LEED, or Leadership in Energy and Environmental Design, is widely recognized as the preeminent green building certification standard in the U.S. A dozen municipalities have even incorporated LEED standards into their building codes.

But for health care facilities that have very specific requirements—especially 24-hour facilities such as hospitals and acute care facilities—it is important to understand how these facilities perform in the long run versus non-LEED buildings in order to understand the return on investment for these projects.

One of the least-known flaws in the LEED rating system is that it is a predictive system and therefore has no performance requirement. As such, the USGBC does not track the performance of LEED buildings as part of the certification process. With most hospitals averaging a 3.6 percent margin, according to the American Hospital Association, the financial performance of these buildings are a key selling point for the adoption of LEED in health care.

According to Marie E. Coleman, communications coordinator for the USGBC, 853 health care facilities were registered and 64 were certified as of April 2. Almost half (29) of the 64 health care facilities certified were certified in 2008—so this trend is accelerating. The best sales pitch for getting a LEED rating are the studies that the USGBC has sponsored that indicate that LEED buildings decrease operating costs by 8 percent to 9 percent, consume 26 percent less energy, and improve return on investment by 6.6 percent.

When I asked specifically about health care facilities, the USGBC responded that they are not aware of any specific follow-up studies regarding how LEED health care buildings perform versus non-LEED buildings. So if USGBC is not conducting any studies and are not aware of how these facilities are performing, it's difficult to ascertain how successful these facilities are once they are built or renovated.

According to Coleman, "USGBC has partnered with the Green Guide for Healthcare to devise succinct guidelines to ensure a LEED certified health care facility is among the highest performing in its sector."

One of the issues recently raised in deciding to go for the LEED rating is the veracity of the energy-efficiency claim by the USGBC (see Not so green building). An independent study published in 2008 by Henry Gifford on his site contends that LEED buildings consume 29 percent more energy than non-LEED buildings. His findings are summarized in the video available here.

Gifford's findings were based on a methodological dispute with the USGBC regarding the way the New Buildings Institute study used median LEED building energy usage versus mean national building energy usage. In doing so, the impact of a few high energy use LEED buildings was ignored. Gifford also contends that the NBI should have compared LEED buildings to newer buildings in the database since LEED was introduced in 2000 and newer buildings used 10 percent less energy on average.

Gifford made some additional interesting points in the video, including a photo of a high-rise LEED office building that had all of its lights on in Manhattan at 2 a.m. Could the problem be similar to eating five 100 low-calorie cookies when you would typically only eat two 200 calorie regular cookies? In addition, he speculated that poor building construction techniques (i.e. poorly fitted windows) may also contribute to the issue. The argument goes that if I am a construction worker at a LEED building, it doesn't matter how well I fit the windows because nothing I can do will affect how "green" this building is in the end.

Gifford argues that the LEED system should include construction site monitoring and monitoring actual energy usage in the certification process. After Gifford's study was publicized, the USGBC sent out an e-mail to its chapter members refuting Gifford's findings. Gifford's responses are on his Web site, as well.

It's important to understand that there are other qualitative factors for following the LEED rating system, including sustainable building design, renewable materials and indoor air quality. And the third revision of the LEED standards include an emphasis on reducing carbon emissions and introducing a framework to support more building types in the future (see Green building experts work on new global standard). Additionally, the USGBC requires registered projects to switch to LEED v.3 on June 27.

But for those hospitals and other health care facilities that are undertaking the LEED system because of long-term energy savings, however, the results of getting a LEED rating are unknown.

Because the health care industry is a large and growing segment of the U.S. economy, it is critical that the USGBC, the American Society for Healthcare Engineering, and various stakeholders get together and have an honest dialogue about the actual return on investment and without further study, it will remain an unknown quantity.

Camille Schenkel is the CEO of change and process management consulting firm Camille Schenkel LLC. She is also the editor of HealthySpacesRx, which is tracking the consumer-driven changes impacting the health care industry.

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