Building green
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Environmentally friendly construction and renovation practices realize cost savings, appeal to patients

During the past decade, “green” has become a buzzword for everything environmentally friendly, from reusable grocery bags to building materials made from recycled or sustainable materials. Environmentally conscious thinking has become increasingly mainstream, and technology has responded rapidly with new ways to stretch existing materials further. In this climate, physicians are increasingly tailoring their office space to make investments in their practices and communities, and seeing substantial long-term cost savings as a benefit. From new construction to updating older practices, physicians in a variety of situations can “go green” now in a financially advantageous way.

Building new, building green

When it came time to trade their current practice for a larger, more updated building, Fort Smith, Ark., dermatologists Sandra Johnson, MD, and her husband Brad Johnson, MD, decided to incorporate as much sustainable technology into their new building as possible. The pair had long been interested in environmentally friendly building, with their pool heated by solar power and their home making use of geothermal energy. In the process of planning a new clinic, they decided to pursue Leadership in Energy and Environmental Design (LEED) status for their building, a designation from the nonprofit U.S. Green Building Council (USGBC) that recognizes sustainable and energy-efficient construction. It’s the current mainstream standard for green building recognition in the U.S., as well as a number of countries abroad.

“I’ve always been interested in the environment, and we built our home with solar panels heating the pool a few years ago. As it turned out, installing a geothermal system was cheaper than a traditional HVAC unit would have been,” Dr. Johnson said. “When it came time to expand, we knew we were going to build a new clinic,” she said. “Our architect is LEED-accredited, so we asked him what things we could do to make our clinic more environmentally friendly. When we really got into it, we decided that we should go for some recognition of the clinic’s green status.”

To do so, Dr. Johnson worked with Michael LeJong, an architect whose experience in sustainable building included a number of local and state government buildings in Arkansas. Those buildings, he said, now often have requirements for green technologies built into the project.

The underlying ethos of sustainable building, LeJong said, is significant reduction in material cost and energy usage over the long term.[pagebreak]

“For the most part, this particular building is fairly conventional. Equipment, even though it’s high efficiency, is pretty much identical to what would go into a conventional building. You’re just seeing a reduction in usage and energy cost,” he said. “Reducing energy usage is the biggest aspect. We try to use really efficient equipment for HVAC. Dr. Johnson’s building has a geothermal unit. We also look at a lot of utilities to see where we can reduce waste without much additional cost. In this particular project, we’re using harvested rainwater to flush the toilets. We’re cutting down on additional water and cost. Low flow fixtures put out the minimal amount of water required.”

Prior to the green building boom of the current decade, environmentally sustainable building materials and technologies often came with a prohibitive price tag, even when measured against the long-term cost benefits. But market forces have driven down costs for consumer-demanded green technologies as materials companies improve both quality and cost at consumer behest. At present, LEED-accredited contractor Travis Beshears said, the cost of building an environmentally friendly facility at the lower end of LEED accreditation is barely much higher than the cost of traditional building.

“A lot of products are going more and more in this sustainable direction. From a product standpoint and what’s going into the building, the cost is pretty minimal now. Don’t get me wrong, if you want to achieve LEED platinum, you’re going to have to buy some special materials. But if you just want to get LEED certified, you can earn points (see sidebar, "LEED accreditation") for doing fairly common things,” Beshears said. “You can go after things that are going to cost a little extra in the beginning and save you in the long run and get points — more efficient HVAC, for example. You’re going to pay a little more and help with your LEED credits, but over the life of the building, it’s going to be a dramatic savings of energy usage for maybe 1 or 2 percent extra cost up front.”

At the more advanced end of green construction, many new buildings now generate some of their own power, whether wind-based, hydroelectric, or solar. Todd Avery, sales manager for solar panel company Aztec Solar Power, said that he’s seen increased demand in the previous two years as the federal government’s solar power subsidies and improved panel efficiency has made the proposition much more attractive for business owners. While the permitting process can sometimes prove a bigger roadblock than the actual installation — Avery said that the typical time frame from deposit to completion of installation is six to eight months — the energy cost reductions are immediate and dramatic.

“It’s a way to levelize your costs, to control the consistent rise of utility costs over the next 15-20 years. We recently had a physician client whose monthly energy bill was about $1,600 per month. With this particular building, we were limited on the amount of panels we could install due to the size of the building. We weren’t able to eliminate his bill, but we were able to reduce it by $500-600 per month. You multiply that by one year, then over the life of the 25-year system, and you’re talking a tremendous amount in savings. And that’s the bottom line, saving money,” Avery said. “The federal government is behind a lot of these installations. Right now, there’s a 30 percent tax credit on total system cost across the board for all residential and commercial installations until 2016.”

Dr. Johnson saw similar energy savings, made even more dramatic when comparing her previous office to the new one.

“Our old clinic was 3,750 square feet this one is about 12,000. Our electric bill only went up by 50 percent,” she said meaning the office’s square footage increased significantly more than its energy consumption. “It’s been really neat to see that happen.”[pagebreak]

Application in existing offices

Even physicians who are currently ensconced in traditionally constructed offices can adapt some sustainable technologies for their practice’s benefit, Beshears said. In fact, he said, it makes more business sense than not doing so.

“The biggest thing in LEED is energy savings, which is applicable to any office. Say you’ve got an existing practice with 20-year-old furnaces. Those are energy hogs compared to today’s standards. Your light fixtures are another area to consider updating,” Beshears said. “The new T-12 florescent light bulbs are much more efficient than even previous generations of florescent bulbs. There are also LED lights, which hardly use any power, and don’t produce as much heat as an incandescent. That’s the first place to start, look at energy savings. If you’re in an old building, look at your windows and see if you can bring down the heat exchange. Most of the new sustainable material has the same lifespan.”

In terms of the most cost savings realized, LeJong said, HVAC and windows are two areas that benefit most from the current generation of technology.

“For an existing office, the most efficient way to reduce usage would be to upgrade your HVAC to a high-energy efficiency unit with high filtering levels for indoor air quality. The other thing to look at should be windows and insulation,” LeJong said. “We now have the ability with some glazing materials to let in all the light, but hardly any heat. You don’t get that solar gain that your units have to overcome. It gives you a lot more energy efficiency than ordinary tinted glass.”

Patients and the community

While the reasoning for most business owners in going green is the financial cost and benefit, Avery said that it’s important not to overlook the benefit of tapping into the current popularity of sustainable building.

“Building green, in addition to making financial sense, also reflects your office being a green business.’ What we’re finding in our industry is that a lot of people now are looking specifically for green companies,” he said. “If I move to a new area and I need a doctor, and I see that this doctor has a green office, I might be more inclined to visit that office because they share my viewpoint.”

Dr. Johnson said that even those patients who don’t particularly have an opinion on environmentally sound construction notice the building’s more unusual touches, like the silo next to the office that collects and recycles rainwater for use in the toilets.

“Our new office was built on farmland. Not every patient comments on the green touches around the office, but they do think it’s a very serene, calm, beautiful building. Some of our patients will ask about something sustainable we have, and they’ll get very interested when we begin telling them. Everything for our office came from within 250 miles. My 10-year-old son picked out our floors, which are made from recycled PVC pipe but look like hardwood. They’re beautiful, and I’m very proud of them,” Dr. Johnson said. “We’ve also had a few new patients come and see us specifically because they were happy we had made this kind of investment in the community.”[pagebreak]

In terms of significant issues with her new office, Dr. Johnson said that the biggest thing to overcome so far was a summer drought in Arkansas running up against the USGBC’s maxim against permanent irrigation. LEED-certified buildings, she said, are expected to be landscaped with plants that can thrive in the building’s natural climate, without the expenditure of additional energy or resources.

“The biggest obstacle we had was not being able to have permanent irrigation, so we chose landscaping that was drought-resistant,” Dr. Johnson said. “But Arkansas had a hot dry summer. We had to bring out some hoses to irrigate this summer and lost some of our landscaping. But that’s really the biggest problem that we’ve had.”

In terms of water recycling, LeJong said that most regions welcome the alternate uses for naturally collected rainwater, so long as it’s meant for non-potable use.

“Most of our municipalities are very open to these new ideas. There are projects I’ve heard of that have had delays trying to re-filter water for potable usage,” LeJong said. “For landscaping and urinal usage, they haven’t had any problems. It’s clean, filtered before it comes in, and put back into the wastewater systems. There are no chemicals or on-site treatment.”

Dr. Johnson said that the green building and accreditation process was more than worth the expense.

“Another thing we’re proud of is increasing awareness in our community on spending a little more time and energy to do something sustainable and positive in the community,” she said. “It’s a very good message to give our patients and our community. Dermatologists are a very blessed profession, and I think we need to lead by example. Everything about this experience has been very positive for us.”

LEED accreditation

The Washington, D.C.-based United States Green Building Council (USGBC) is a nonprofit that promotes sustainable building practices through its Leadership in Energy and Environmental Design (LEED) accreditation, a tiered system that recognizes buildings constructed with an eye to energy savings, indoor air quality, and a lessened impact on the surrounding environment. The levels of LEED certification for new construction are based on the number of points scored in the following categories:

  • Sustainable sites: 24 points, including site selection, development density, stormwater design, and proximity to alternative transportation.
  • Water efficiency: 11 points, including water use reduction, water efficient landscaping, and utilizing innovative techniques for dealing with wastewater.
  • Energy and atmosphere: 33 points, including energy performance, refrigerant management, and on-site renewable energy.
  • Materials and resources: 13 points, including construction waste management, recycled and regional materials, and recycling.
  • Indoor environmental quality: 19 points, including low-emitting building materials, thermal design, and indoor air quality management planning.
  • Innovation and design: 6 points.

Once scored, buildings fall into one of the following categories:

  • LEED-certified: 40-49 points
  • Silver: 50-59 points
  • Gold: 60-79 points
  • Platinum: 80+ points

Source: LEED 2009 for New Construction and Major Renovations Rating System With Alternative Compliance Paths for Projects Outside the U.S. (Updated October 2011)

Upgrading existing offices

Practice owners who aren’t looking to build a new facility can still incorporate green technology and realize cost savings by selectively upgrading current systems.

  • HVAC/air filtration: Upgrading furnace and air conditioner technologies can offer significant savings during winter and summer months.
  • Windows: New glazing technologies allow for windows that let light into the office without any of the accompanying heat exchange.
  • Lighting: New compact florescent and LED technologies use far less energy than that required by incandescent bulbs and even earlier-generation florescent bulbs.
  • Solar panels: In addition to reducing the office’s monthly power bill through on-site electricity generation, solar panels currently qualify home and business owners for a tax credit equal to 30 percent of the total system cost. Panels require a southern exposure for best results.
  • Sharps/hazardous disposal: Machines are available that allow physicians to dispose of sharps and red-bag waste in-office. Waste is placed in the countertop-sized machine, processed to a sterile, non-hazardous condition, and can safely be disposed of with the regular trash.
  • New flooring: Recycled PVC flooring has the appearance of hardwood, is quickly installed without glue, and can be easily cleaned and individual planks replaced if necessary.

Green features

Arkansas dermatologist Sandra Johnson, MD, incorporated a number of green features into her practice, reducing energy usage and overall impact on the environment. For more information about each feature and additional photos of the inside and outside of the building, click here.



LEED accreditation
Upgrading existing offices
Green features