Once all the easy things are done, facility executives still have as many options as their creativity allows. Renewable and alternative energy options are gaining momentum in the health care sector, both to reduce reliance on grid energy and also to curb greenhouse gas emissions. Solar and wind power are getting second looks from facility executives who may have considered them too expensive in the past. And facility executives are getting creative about the financing, as well. "Some are using power purchasing agreements, and many are finding utility and government incentives," says Crawley.
However, one of the more widely used alternative energy strategies in the health care sector is combined heat and power (CHP), or cogeneration. Because of the huge energy and steam demands of health care facilities, CHP is a natural fit, say experts.
For instance, New York-Presbyterian Hospital, a 2,242-bed hospital in New York City, just completed a 7.5-megawatt CHP plant that will provide at least 60 percent of the hospital's power needs. The hospital received a $1.1 million grant from the New York State Energy Research and Development Authority (NYSERDA) to offset the cost of the project.
As another example, the 170-bed, LEED Platinum-certified Dell Children's Medical Center in Austin, Texas, gets 100 percent of its power from a 4.5-megawatt, natural gas-fired combined heat and power plant. The local utility, Austin Energy, paid the $18 million cost of the plant, with assistance from a $1 million DOE grant. The hospital also uses heat from the plant to produce steam and chilled water, and Austin Energy sells steam to other nearby properties.
Gundersen Lutheran also recently built a CHP plant, but its story is a bit more unconventional. The organization paid to have the plant built at a nearby brewery.
Before the CHP plant was built, City Brewery constantly flared off its waste methane into the air, earning the nickname of "The Eternal Flame." Now, that methane is captured, cleaned and turned into fuel for a generator. The electricity generated, about 3 million kWh per year, flows directly into the grid. But Gundersen Lutheran gets credit on its energy bill — about 8 to 10 percent of its energy, says Zarecki. City Brewery uses the heat captured from the system in one stage of the brewing process.
Gundersen Lutheran is also looking into developing wind sites and using a biomass boiler. Lastly, the organization is conducting a feasibility study on a hydrokinetic project on the nearby Mississippi River, which would produce 29 million kWh per year. The organization's goal is to be energy neutral by 2014.
Not every health care organization will be willing to commit itself to such aggressive energy goals. Reducing energy is a journey, not a destination, says Weldy, so the important thing is setting an achievable goal, achieving it, and then setting a more aggressive goal. Health care facilities are constantly changing, with new equipment added and spaces being reconditioned, so being flexible is important as well. As Zarecki says, "We have a good solid plan, but I'm sure we'll learn more and things will change, and so will the plan."
At the end of the day, working on energy efficiency in hospitals goes well beyond just saving energy — it hits on two other major topics, health care costs and climate change. "We're working on both of them at once with energy efficiency," says Zarecki. 
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Alternative Energy Strategy for Health Care: Cogeneration
