2017 MHA Michigan Green Healthcare Conference

October 5, 2017

Jeff Thompson, MD

• Integrated Delivery System

– 7,600 Total Employees

– 795 providers employed

– 65 clinics / 7 hospitals

• Western Campus of the University of Wisconsin Medical School

• Residency, Fellowship and Medical Education Programs

About us…

Be the best regionallyand nationally on

environmental stewardshipand sustainability

http://www.lean.org/Workshops

Accomplishments

• Quality- Top 1% outcomes (Healthgrades), Best Breast Care, Senior Care, Bariatric, etc.

• Service – 25th %tile to 90th % tile

• Workplace – EPS , no recruiting holes, in town of 55k 25k job applications per year

Accomplishements

• Affordability – 15 years in a row -- fee increase less than year before, 2.5x increase in cash, new buildings, technology ahead of curve

• No layoffs despite economic downturn and 30% increase Government patients, 30% decrease commercial patients. ($100M/yr swing)

• Growth – mostly "organic" , $400M to $1B+, more important regional centers, community partners

National Climate Assessment

• National Climate Assessment – August 2017

• The National Climate Assessment summarizes the impacts of climate change on the United States, now and in the future.

• A team of more than 300 experts guided by a 60-member Federal Advisory Committee produced the report, which was extensively reviewed by the public and experts, including federal agencies and a panel of the National Academy of Sciences.

U.S. Government Report – August 2017

• Global evidence makes clear that today’s climate is changing rapidly compared to the natural climatic changes that have occurred throughout Earth’s history.

• The frequency and intensity of heavy precipitation and extreme heat events are increasing in most regions of the world, consistent with the expected physical responses to a warming climate.

• Human activities—especially emissions of greenhouse gases—are primarily responsible for the observed changes in climate since the dawn of the Industrial Revolution. There are no alternative explanations or observed natural cycles that can explain recent climate change.

• Atmospheric CO2 levels have now passed 400 parts per million, a concentration last seen about 3 million years ago, when average temperature and sea level were significantly higher than today.

• The world is not reducing emissions enough to limit warming to 2 degrees Celsius relative to preindustrial temperatures by 2100, the goal of the Paris Agreement.

Why Healthcare Providers Should Care

• Pollutants from fossil fuels and disposed waste cause:

– Cancer, liver disease, kidney disease, reproductive issues

– Cardiovascular deaths and stroke1, respiratory disease

• According to the U.S. Department of Energy, hospitals are 2.5 times more energy intensive than other commercial buildings2

• Pharmaceuticals and equipment have even bigger carbon footprint

• Energy costs will eventually escalate

• Reducing waste results in an improved bottom line

2Source: http://www.energy.gov/news2009/7363.htm

1Source: American Heart Association Scientific Statement: DALLAS, May 10, 2010

Population Health

Experience of Care Per Capita Cost

Sustainability

We are the problem…but we can change

2008…

• Electrical power from coal from Wyoming

• Heat from natural gas from Texas

Sources: 1US EPA AP-423U.S. EPA eGRID 9th edition Version 1.0 Year 2010 GHG Annual Output Emission Rates: http://www.epa.gov/egrid

Emissions(1,2,3,4)(lbs.) 2008

Sulfur Oxides(1) 230,144

Nitrogen Oxides(1) 194,911

Carbon Dioxide(3) 72,386,372

Mercury(1) 2.10

Particulates(1) 435,291

Our Journey

The why:

• Decrease pollution

• Decrease operating costs

• Improve our local economy

• Strong corporate citizen and a servant organization

Why would a board allow this plan?

• Consistent with mission

• Best use of portion of savings

• Good ROI (7.7 years)

• Safer than stock or bond market

• Local investment

• Timing

• Early successes

Notable Sustainability Accomplishments

• Recycling rate above 40%

• Reduced cafeteria food waste by 80%

– Keeps approximately 18 tons of food from going to landfill each year

– Donation program for leftover food totaling around 3,400 lbs. of food in 2016.

Locally Grown Foods Initiative

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All Natural:

No Antibiotics

No Hormones

Locally Raised

Chef Tom’s Grade School

Vegetable Program

Hazardous Pharmaceutical Waste Reduction

Disposal cost down 93% ($140,000)

• Energy Conservation should be our first fuel

• $2M Investment 2008-2009, $1.3M Savings/Year

Energy Conservation

Energy Conservation

Pros• Reduces waste

• Opportunities exist everywhere

• Best financial returns

• Easy to implement

• Quick success for momentum

• Can save 20%-30% of energy use

• Builds credibility of stewardship

• Lessens renewable investment

Cons• Not sexy (boiler rooms, rooftops)

• Can’t reduce ourselves to zero

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GHS Energy Consumption

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2016 energy consumption = 199,106,022 kBtu = (44,941,296 kWh + 433,977 therms)

Dramatic improvement despite adding 26% more space over the same period

GHS Energy EfficiencyAggregated Facilities

(Utility purchased kBtu per square foot per year)

59% improvement since 2008

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We will always need to consume some energy to fulfill our mission. Clean, renewable sources of energy can offset this consumption.

Renewable Energy Supply“You cannot reduce your way to zero”

• Proven technologies exist today

• Investment mentality– Expect longer paybacks

– Hedge against inflation

– Highly variable depending upon project specific parameters

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1st U.S. Health System Heated, Powered & Cooled by Local Renewable Energy

Geo-Exchange / Heat Pump

• Geothermal heat pump provides most of the heating and cooling needs of new Hospital

• 156 wells 400 feet deep under a parking lot

• New Hospital 115 KBTU/sq. ft.

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Solar Projects475 kW of Installed P.V. Capacity

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Wind ProjectsLewiston, MN• Project produces 13,000,000 kWh annually

• 2 x 2.475 MW Turbines, 80m towers

• Started production in December 2011

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Cashton, WI• 50/50 joint venture with Organic Valley

• Project produces 13,000,000 kWh annually

• 2 x 2.499 MW Turbines, 100m towers

• Started production in May 2012

Biomass Boiler CHP ProjectRenewable, Locally Sourced, Wood Chip Fuel

• Project generates 1,500,000 therms and 2,250,000 kWh annually

• Produces the majority of heat / steam used by the health system

• On-site electricity production with back pressure steam turbine

• Annual payment to local woodchip suppliers ~$800,000

• Started production in spring of 2013

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Landfill Gas CHP Project• Partnered with La Crosse County Solid Waste Department

• Produces 8,000,000 kWh and 120,000 therms annually

• Annual biogas fuel payment to La Crosse County ~$250,000

• Started production in March 2012

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Dairy Manure Digesters

Middleton, WI

• Project produces ~16,000,000 kWh annually

• Removes phosphorous from groundwater in watershed

• Composted fiber byproduct sold as a soil amendment

• Started operations in December, 2013

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Sun Prairie, WI

• Project produces ~5,000,000 kWh annually

• Protects nearby stream from manure spill

• Fiber byproduct used for animal bedding

• Started operations in April, 2014

Why Is Biogas / Biomass Good for WI?

• Improves air quality vs. the current mix of grid production fuels– Reduces negative health impacts for our communities

• Wisconsin currently imports ~$15B* of fossil fuels annually– Significant job potential for the local economy if we use “homegrown” power sources

• Plentiful low value, renewable, local resources that can be utilized– Landfill gas, breweries, cheese whey, municipal WWTPs, livestock manure, food waste, forestry residues, crop residues, etc.

• Digesters can divert landfill loads – Organic wastes can be processed in digesters

• Improved manure management helps our dairy industry viability

• Improved water quality helps our state’s tourism industry

• Wisconsin has many simultaneous heating and power loads– Biomass and Biogas projects are great for combined heat and power opportunities

• High capacity, base load production vs. other intermittent renewables– Generation blends with current agricultural landscape

– Improved rural grid voltage through distributed generation *Source: Wisconsin State Energy Office

Where is the Financial Payoff

Education / Opportunity

• Solar Hot Water Project (Daycare)

• Brewery Biogas

• Solar PV Panels (improving)

Financial Successes

• Conservation

• +/- Wind Farms

• Landfill Biogas

• Biomass Boiler

• Geothermal Field

• Dairy Biogas

• Solar Hot Water (dialysis)

Organizational Investment Portfolio Return

Cash T-Bills Bonds Stocks 5.8%

Energy Infrastructure Investment

5% of total 10 – 12%

2014: Ceased Fossil Fuel Investment

Emissions(1,2,3,4,5) (lbs.) 2008 2016 % Reduction

Carbon Dioxide(1,3,4) 72,386,372 1,626,831 (98%)

Particulate Matter(1,5) 434,928 11,172 (97%)

Mercury(1,2) 2.39 0.16 (94%)

2016 asthma attacks avoided: 9.3(2)

GHS Fossil Fuel Emissions Improvement

Sources: 1US EPA AP-422Practice Greenhealth’s Energy Impact Calculator Data Sources: http://www.eichealth.org/calctest2.asp#3U.S. EPA eGRID Version 1.0 Year 2007 Summary Tables: http://www.epa.gov/egrid4U.S. EPA eGRID 10th edition Version 1.0 Year 2012 Summary Tables: http://www.epa.gov/egrid5Air pollution from electricity-generating large combustion plants (pdf), Copenhagen: European Environment Agency (EEA), 2008, ISBN 978-92-9167-355-1

Note: The 2016 CO2 value is the net sum after adjusting facility utility energy consumption with clean energy produced by GHS renewable energy projects.

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Energy Independence!1st Day October 14th, 2014

1st Health System In the world to produce more power than it consumed (10/14/14)

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GHS 2016 estimated fossil fuel energy offset = 76%

97 days of energy independence in 2016

Where do you get help?

https://www.noharm.org/ https://practicegreenhealth.org/

Where do you get help?

Prescribe appropriately, safely manage and properly dispose

of pharmaceuticals.

https://www.noharm.org/ https://practicegreenhealth.org/

COP21 ParisDecember 2015

Power of the Pope, the President, the People

Clarity of whose to blame, who gets hurt.

Big Tech, Big Pharma, tiny NGOs, original peoples

Who doesn't get it...the final two....

Most outlandish demand....pay oil states to leave oil in ground.

Most disappointing of the doables....Health deletions.

Best quote... Saudi Prince "the Stone Age did not end because of a lack of stones.”

COP21 ParisDecember 2015

We did not set out to be the greenest health system or stop climate change.

We set out to make the air better for our patients to breathe, control our rising

energy costs and help our local economy.

What will you say to the next generation?

Jeff Thompson, MDExecutive Advisor, CEO Emeritus

jethomps@gundersenhealth.orghttp://jeffthompsonmd.com/

www.gundersenhealth.org