REPORT: It’s time for hospitals to join fight against global warming – Urges ‘hospital emissions mitigation’ & ‘reducing GHG emissions from anesthetic gases’

Climate change’s toll on human health is undisputed: Cardiovascular diseases, respiratory illnesses, liver diseases, diabetes, preterm births, and behavioral health issues have all been associated with the presence of extreme temperatures.^{[i],[ii],[iii],[iv],[v],[vi],[vii],[viii]} Children, older Americans, and low-income communities remain especially vulnerable.^{[ix],[x],[xi],[xii],[xiii],[xiv],[xv],[xvi]}

The nation’s health care sector has an important role to play in reducing the greenhouse gas (GHG) emissions that are contributing to a warming planet. The United States remains the top emitter of health care GHG emissions globally, accounting for 27% of Earth’s total health care emissions.^[xvii] Hospitals generate the most emissions in the U.S. health care sector at 36%, followed by physician and clinical services at 12%, and prescription drugs at 10%.^[xviii]

This report focuses on the immediate actions that hospitals can take, but BPC recognizes that the GHG emissions originating from health care supply chains must be addressed as well, given that they account for nearly 80% of U.S. health care emissions.^[xix] Although the problem extends well beyond the health care system, addressing the unique features of the health care system’s supply chain—such as the development and manufacturing of health care goods and services (e.g., pharmaceutical drugs and medical devices)—is also essential to lowering emissions and will require input from a much larger set of stakeholders.

Promisingly, experts and policymakers at all levels of government increasingly acknowledge the need to reduce the GHGs emitted by the health care system, starting with the nation’s hospitals.^{[xx],[xxi],[xxii]} Indeed, many hospitals and health care entities have already begun to act.

And now is a propitious time to act: The 2022 Inflation Reduction Act (P.L. 117-169) and the 2021 Infrastructure Investment and Jobs Act (P.L. 117-58) both offer significant incentives for hospitals and health care systems to lower their greenhouse gas emissions.

To help hospitals reduce their emissions in a way that is consistent with both the effects of a changing climate on human health and the nation’s larger transition to clean energy, the Bipartisan Policy Center recommends the following federal actions:

• At least every three years, the Centers for Medicare and Medicaid Services (CMS) should publicly post on its website a report (1) detailing whether CMS deems any building code changes to be “significant” as they relate to the potential for reducing GHG emissions, and (2) describing how hospitals are utilizing categorical and noncategorical waivers granted since the previous report, including whether GHG emissions reductions have resulted.
• The National Institute for Occupational Safety and Health (NIOSH) at the Centers for Disease Control and Prevention (CDC)—in coordination with the National Institute of Environmental Health Sciences (NIEHS) at the National Institutes of Health (NIH)—should research ventilation strategies in hospitals to determine ways to use the lowest energy ventilation while balancing risk reduction from infectious aerosols, given that ventilation technologies represent a significant portion of energy usage within hospitals. NIOSH should publish and promote this research utilizing its existing processes.
• CMS, via the Hospital Inpatient Quality Reporting Program, should require hospitals to report whether they utilize ENERGY STAR Portfolio Manager or a similar measuring tool.
• The Government Accountability Office (GAO) should issue a report detailing the various clean energy workforce development programs within the Departments of Energy, Labor, Agriculture, and Health and Human Services (HHS), and provide recommendations, if warranted, on where programs could be adjusted or developed to strengthen workforce expertise specific to health care settings. A member of Congress will likely need to request that GAO complete this report.

These recommendations are designed for immediate action and implementation, primarily by utilizing existing statutory and regulatory authorities, except for two areas that might require more congressional engagement—(1) at least one member of Congress will need to request a GAO report; and (2) Congress might need to act to provide CMS with the authority to collect information regarding hospital utilization of ENERGY STAR Portfolio Manager or a similar measuring tool.

Given the current congressional environment—and to make it more likely for Congress to act, if necessary—BPC’s recommendation related to ENERGY STAR Portfolio Manager is narrowly tailored and represents simply a first step—that is, only requesting that hospitals report if they are utilizing an energy and emissions measuring tool.

BPC also offers the following best practices for hospitals to begin reducing their GHG emissions:

• Hospitals should leverage federal funding opportunities, including those created by the Inflation Reduction Act. To do so, hospitals are encouraged to follow real-time updates from the HHS Office of Climate Change and Health Equity (OCCHE).
• Hospitals should employ C-suite personnel and, to the extent needed, contract out for additional services dedicated to driving and supporting organization-wide efforts to reduce GHG emissions.
• Hospitals should reduce their GHG emissions from anesthetic gases by gradually reducing, with the goal of eliminating, the use of desflurane gas and nitrous oxide—both of which are particularly potent greenhouse gases. They should also work to reduce their GHG gas emissions from anesthesia-related sources overall.
• Hospitals should reduce their GHG emissions from food waste by:
  • devoting resources to sourcing more locally grown, healthier, and fresher fruits and vegetables options;
  • providing more tailored meal options to patients;
  • taking immediate advantage of opportunities for composting or otherwise repurposing food waste and unused food products.

BPC developed these recommendations through expert and stakeholder interviews and reviews of relevant literature. For hospitals to achieve success, and in addition to supportive federal policies, they will need significant support from their C-suites and other leaders.