Going green can help your budget

A column about keeping your practice in good health

By — Posted July 6, 2009.

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Reducing a medical practice's paper consumption and carbon emissions can improve the bottom line as well as being good for the environment.

Strategies can be both small and large; complex or simple. Various rules governing medical practices can make this challenging. HIPAA demands extra care to ensure that patient papers are well-shredded before going into the recycling bin. Hygiene regulations can limit how much something can be reused even if well-sterilized.

"It's a little more difficult, because a lot of things we do are under regulation," said Jay Portnoy, MD, chief of allergy, asthma and immunology at Children's Mercy Hospitals and Clinics in Kansas City, Mo. He is also immediate past president of the American College of Allergy, Asthma & Immunology.

But experts say it is possible to be greener, and it can be cost-neutral or even financially beneficial.

Small steps include installing energy-efficient light bulbs, switching them off when they are not in use and judiciously setting the thermostat. Some facilities go one step further and use timers to regulate light and temperature. Computers, or at least the monitors, can be turned off when not in use. For instance, those working on this issue at Aurora Health Care in Milwaukee discovered that $29 per year would be saved for each computer that was turned off during evenings and weekends.

"It adds up pretty fast. We could not do it in certain areas of the hospital, but it's a simple thing that a lot of people don't think about," said Gregg Lester, Aurora's director of environmental services.

Bigger steps can include providing care remotely to reduce the environmental impact of transportation. For instance, Dr. Portnoy gives patients who need follow-up consultation the option of doing it by phone.

"This saves the patients having to drive to the clinic where I work," he said.

These appointments are rarely covered by insurance, so most of the time he doesn't bill for them. These visits are, however, shorter. This means that the potential financial hit is balanced out by the opportunity to schedule new patients.

The practice also has recycling bins throughout and is contemplating a switch from compact fluorescent light bulbs to light-emitting diodes. Business meetings that used to involve at least some participants driving to the location are now held online.

"We're doing anything we can do to improve the energy efficiency of the office," Dr. Portnoy said.

He also has an electronic medical record system. This is becoming more common, although it rarely eradicates the need for paper.

For example, Thomas Grogan, MD, an orthopedic surgeon in Santa Monica, Calif., has an EMR system that minimizes paper when circulating information. When meeting with a patient, however, he makes a printout, because he does not want a computer screen to come between them.

His practice also has invested $50,000 in a digital x-ray, reducing the need for film, developing chemicals and paper sleeves to transport them. The old machine is still a backup, but he estimates that the new one will save $18,000 annually.

"In the long term, it makes sense," Dr. Grogan said. He is also a member of the American Academy of Orthopaedic Surgeons' practice management committee.

But while many strategies seem to make sense, experts urged caution.

"There is always a plus and a minus on the impact, and it's not always as easy as it sounds," Lester said.

For instance, there is significant debate over whether to use disposable paper medical gowns or switch to cloth that is laundered. Research from Practice Greenhealth, a networking organization for institutions that want to reduce their environmental impact, states that reusable textiles are less expensive and better for the environment. But physicians expressed concern that they wouldn't be clean enough.

Those who work in this area also said the chemicals, water and electricity used in washing needed to be considered, along with the gasoline needed to transport these items to get laundered.

Being green, however, may get easier. Medical buildings increasingly are being designed with the environment in mind, and a report issued by the American Medical Association Council on Science and Public Health in November 2008 on green initiatives stated that new health care facilities should help reduce the use of resources and contribute to a healthy environment.

Additional AMA policy on this subject also supports sound waste management policies and using sustainable products, food and materials when possible.

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