Energy $aving $olutions for Hospitals

1
Energy aving olutions for Hospitals

• How Combined Heat and Power Systems are saving
  hospitals millions of dollars in operations and
  capital while helping protect the environment and
  public health.

Texas Hospital Association Audiocast November 1,
2005Austin, Texas
2
Purpose of Todays AudioCast

• Describe CHP and its Value Proposition in
  Hospital Settings
• Encourage Hospital Executives to Evaluate CHP in
  their Facilities
• Provide Information on How to Move Forward with
  CHP

3
Introductions

• Moderator
• Robert Moroz, AIA, LEED AP, President
• Healthcare Facilities Consultation and Planning
  Austin, Texas
• Speakers
• Dan Bullock, Director
• Gulf Coast CHP Applications Center The
  Woodlands, Texas
• Ed Mardiat, DBIA, Principal and Director of CHP
  Development
• Burns McDonnell Engineering Company Kansas
  City, Missouri
• Kim Shinn, P.E., LEED AP, Director of Sustainable
  Design
• TLC Engineering for Architecture Brentwood,
  Tennessee
• Gail Vittori, LEED AP, Co-Director
• Center for Maximum Potential Building Systems
  Austin, Texas

4
What is Combined Heat and Power (CHP)?

• Combined Heat and Power Plants
• Recycle normally wasted energy into steam
  and/or chilled water for use by the hospital
• Generates Electricity for a hospital on site
• Provides 100 Primary (Normal) Power
• Provides 100 Emergency backup power
• Are up to 250 more efficient at turning input
  energy into useful energy than are conventional
  electric utility plants

5
Why Hospitals?

• CHP Best User Profile is
• Coincident electrical and thermal loads
• 24 hour/day, 7 day/week, 365 day/year operation
• Low Seasonal Variation in loads
• High Power Reliability Needs
• Hospitals fit the Best User Profile for
  Combined Heat and Power applications

6
How Typical Power Delivery Works
Centralized Generation Model
.02 BTU Loss
.65 BTU Loss
.33 BTU In
.35 BTU In
1 BTU In
Power Plant
Distribution System
Hospital

• Conventional Power Plants convert about 35 of
  their primary input fuel into electricity the
  remainder is lost up the stack. An additional
  6 efficiency drop occurs in transmission to the
  site. Overall, at the Hospitals meter, the
  result is roughly a 33 efficient primary fuel
  conversion to useful energy.

7
How CHP Works
CHP Model
.25 BTU Loss
1 BTU In
.75 BTU In
CHP Plant
Hospital
Combined Cooling, Heating and Power Plants can
be 75 efficient at primary fuel conversion to
useful energy and, because they are located on
site, have no transmission loss. This is a
42 savings in primary energy utilization
compared to the Typical Power Delivery Model.
8
CHP Electric Generation Equipment

• Gas Turbines

Reciprocating Engines
Microturbines
9
CHP Heat Recovery Systems
Steam and Hot Water Exhaust Gases
10
CHP Thermally Activated Technology
Absorption Chillers
Desiccant Dehumidification
11
CHP Technology is Proven
Average System Size 2 MW Median System Size
230 kW

• Installed in gt 200 Hospitals in the U.S. today

12
CHP installed in Hospitals in Texas
13
Who Benefits?

• Patients
• Hospitals
• Capital Partners
• Utility Companies
• The Public
• Federal, State and Local Governments
• The Environment

14
Benefits to Patients

• In local and regional disasters, patient
  transfers and evacuations can be deadly.
• Loss of power puts patients currently undergoing
  critical procedures at risk.
• Brown outs and Voltage Sags can shut down
  sensitive diagnostic equipment and interrupt
  non-critical procedures
• A facility that can remain fully functional can
  avoid these risks to its patients.

15
Benefits to Hospitals

• More Reliable Normal Power It is bad enough now
  when a hospital has to go on emergency power, but
  when a hospital converts to fully digital Medical
  Records, RFID/Bar Code Scan Drug delivery,
  Computerized Physician Order Entry, etc., Health
  care delivery stops if the lights go out.

16
Benefits to Hospitals (continued)

• Higher Quality Normal Power Local generation
  provides fewer sags and surges. Moving from
  normal power to grid backup is measured in
  cycles, not seconds.
• Island Power In the event of a grid failure
  due to natural, technical, or terrorist causes,
  your strategic community asset will remain in
  operation when needed most.

17

Benefits to Hospitals (continued)

• More Backup Power CHP supplies 100 of the
  Hospitals needs not just Life Safety
  requirements. (FYI, Texas Licensing Code does
  not require Chillers to be on Backup.)
• More Reliable Backup Power Probability of
  failure of the traditional Hospital grid plus
  backup is 67 according to Primen Perspectives
  RX for Health Care Power Failures, DE-PP-24,
  11/2003

18
Intangible Benefits to Hospitals

• Sustainable Design Green Guide for Health Care
  (GGHC) points and Leadership in Energy
  Environmental Design (LEED)
• Public Relations
• Positive Press Coverage
• Community Support
• Philanthropic edge Foundations are becoming
  interested in Green Buildings

19
Economic Benefits to Hospitals

• Initial Capital Savings A CHP plant owned by a
  capital partner allows a hospital to redirect
  its own capital (that would otherwise have been
  spent on chillers, emergency generators,
  switchgear, boilers, pumps and the Physical Plant
  Building to contain this equipment) towards its
  core healthcare mission thus potentially saving
  millions of dollars in construction costs.

20
Economic Benefits to Hospitals (continued)

• Operating Cost Savings At the hospitals
  option, capital savings can be traded for long
  term operating cost savings by
• Increasing hospital equity in return for lower
  power and thermal rates
• Using portions of capital savings to improve the
  energy performance of the hospital itself through
  demand side energy conservation improvements

21
Benefits to Capital Partners

• The Numbers Pencil from the Investors
  perspective
• Low Risk of investing in a Utility-Like venture
• Investors are comfortable with Longer Returns
  on Investments
• Investing in these types of energy projects is
  their Core Business

22
Benefits to Utility Companies

• Demand Side Management costs less than
  constructing new conventional power plants.
• Places Velvet Handcuffs on a large customer in
  deregulated utility markets
• Useful to Utilities for grid power management
• Avoids Utility Investment where the grid is
  insufficient due to congestion or in rural areas
  where it is underdeveloped.

23
Benefits to the Public

• Helps reduce respiratory illnesses
• Less NOx, SOx, and PM
• Reduces green house gas emissions
• Less than half CO2 emitted per kWh
• Improved trade balances
• More domestic, less imported energy
• Energy efficiency is good public policy!

24
Benefits to Federal, State, Local Government

• CHP Adopters
• VA Hospitals, Prisons, Emergency Responders
• Disaster Preparedness
• Creates powered islands for sanctuary, medical
  care, public safety
• Homeland Security
• Enhances communications, service delivery, and
  recovery in affected areas

25
Benefits to the Environment

• Because CHP plants are so efficient at
  recycling waste energy, they produce 1/3 of the
  pollution just due to lower fuel usage per unit
  of useful energy produced.
• CHP plants typically burn natural gas which,
  while not a perfect fuel, is far preferable to
  coal, lignite or oil in terms of particulate and
  green house gas pollution

26
What is the Green Guide for Health Care?

• A quantifiable sustainable design toolkit to help
  hospitals plan facilities that are
  environmentally friendly while enhancing patient
  and staff safety and well being.
• The GGHC supports the use of Combined Heat and
  Power as a strategy for Hospitals for improving
  their emergency power systems and response
  capabilities during disaster situations.
• Free download of the Guide at www.gghc.org

27
GREEN GUIDE FOR HEALTH CARE
A self-certifying guidance document for
harnessing best practices in the health care
industry.
28
Center for Maximum Potential Building Systems,
www.cmpbs.org
Convener
Merck Family Fund, www.merckff.org
Sponsors
Hospitals for a Healthy Environment,
www.h2e-online.org NYS Research and Energy
Development Authority, www.nyserda.org
sponsors
29
industry
tool
The Green Guide for Health Care seeks to reward
those organizations that voluntarily steward the
environment in the interests of human health. It
also creates incentive for the healthcare and
related industries to change their practices,
build sustainable environments, and enhance their
overall accountability and performance.
30
overview
design attributes
Long ownership mean owners realize life cycle
implications of their construction choices.
1
24/7 operations with patients in place require
intensive coordination and redundancy of all
services at all times.
2
Health care facilities are often multiple
building campuses of varying ages, conditions,
systems
3
The design and operation of health care buildings
is highly regulated with intense economic and
life safety oversight
4
31
overview
operational attributes
The H2E is a voluntary program designed to help
health care facilities enhance work place safety,
reduce waste and waste disposal costs and become
better environmental stewards and neighbors.
5
Operational issues, such as mercury elimination,
have defined industrys environmental stewardship
32
overview
construction attributes
Construction frequently occurs within or adjacent
to occupied buildings (where health is fragile,
or steadiness of hand required)
6
Infection Control Risk Assessment (ICRA)
protocols to minimize the impacts of construction
on occupants demonstrate leadership to the wider
sustainable building industry
7
Healthcare construction managers can evolve a
rigorous, sustainable set of practices for the
healthcare industry that may inform wider
construction practice
8
33
Section / Category Name
Pre-Req. / Max. Total
1 Integrated Design 2 Sustainable Sites 3
Water Efficiency 4 Energy Atmosphere 5
Materials Resources 6 Indoor Environmental
Quality 7 Innovation
2 - 2 1 - 18 1 - 7 3 - 19 2 - 24 2 - 22 0 -
4 11 - 94
construction manual
34
Section / Category Name
Pre-Req. / Max. Total
1 Integrated Operation 2 Energy
Conservation 3 Water Conservation 4 Chemical
Management 5 Waste Management 6
Environmental Services 7 Environmental
Purchasing 8 Innovation
4 - 8 3 - 18 1 - 8 1 - 5 1 - 6 0 - 9 0
- 11 0 - 7 10 - 72
operations manual
35
Intent
Health Issues
Credit Goals
Documentation
Reference Standards
Technologies Strategies
organization
36
registration growth
registration
overview
37
geographic distribution Green Guide for Health
Care Pilot 2.0
As of July 2005
registration
overview
38
profile
growth
profession
35 13 22 3 9 2 16
registration
overview
39
pilot growth
growth
profession
pilot
overview
40
pilot projects
pilot
overview
41
Case Studies

• Montefiore Medical Center, New York, NY
• Critical Access Hospital Prototype
• Dell Childrens Medical Center of Central Texas
  (DCMCCT) Austin, Texas
• Texas Tech Health Science Center (TTHSC)
  Lubbock, Texas

42
Montefiore Medical Center, NYC

• 14 MW Combustion Turbine CHP plant, cost 23
  million and saves 3 million/year
• August 14 Blackout plunged 50 million people into
  darkness in the Northeastern U.S.
• Hospital had full HVAC, kitchen service, surgical
  and full diagnostic support, in all, 95 to 98
  percent of the hospital was unaffected
• We were fully generating and really didnt miss
  a beat Steven M. Safyer, M.D. Senior Vice
  President and CMO

43
Critical Access Hospital Scenario

• 25 bed, Critical Access Hospital, Somewhere,
  Texas
• Assumptions
• 62,500 sq. ft.
• 284 tons of cooling
• 1.875 MMBtu of heating
• 187 kW of electrical load
• Hot Day (ARI, 95º F)

44
Critical Access Hospital Prototype Solution

• UTC PureComfort Microturbine Packaged System
• 139 Tons of free cooling output during hot days
• 252 kW of on-site power generation
• 175º F hot water during cold days
• Grid connect or dual mode
• Inlet silencers for noise reduction
• Ultra-low emissions at less than 9 ppm NOx
• Emergency stand-by generator versus on-site CHP
  generation with heat recovery

45
Dell Childrens Case Study Project Overview

• 32.2 acre brownfield site in the 709 acre Robert
  Mueller Municipal Airport Redevelopment in Austin
  
• 169 Bed Childrens Replacement Hospital
• 470,000 Building Gross Square Foot (BGSF)
• 110M Construction Cost 200M Capital Budget
• 157,000 BGSF 21M Medical Professional Office
  Building with 9M, 900 Car Garage
• 25,300 BGSF, 18M, CHP District Energy Plant

46
Dell Childrens Case Study

• Local Power Utility, Austin Energy, provided 18M
  in capital to construct the CHP Plant.
• 7M Capital Savings accrued to the Hospital from
  not building its own Central Plant
• Hospital has long term contracts to purchase
  power, chilled water and steam from CHP Plant
• Plant expandable to for future growth of Hospital
• Plant will also serve the Urban Campus of the
  709 Acre RMMA Development

47
Dell Childrens Case Study

• Power is generated on site by natural gas fired
  turbines which supply 100 of hospitals energy
• Hospital has two, 100 redundant backups from
  two independent substation feeds off the Grid
• Life Safety Systems back up by diesel generator
• Absorption Chillers produce Chilled Water
• Chilled Water Storage Tank allows peak shaving
• Heat Recovery Equipment produces Steam

48
Texas Tech Case Study Project Overview

• Texas Tech Medical School and Lubbock General
  Hospital on the 1,839 acre Texas Tech Health
  Science Center (TTHSC) campus in Lubbock
• 14M, CHP Electrical Generating Plant
• 47 MW gas turbine coupled with 22 MW steam
  turbine (with 2nd steam turbine on standby),
  produces up to 290 lb/sec of steam
• Local Power Utility, Lubbock Power and light,
  provided the capital to construct the CHP Plant
  in 1990.

49
Texas Tech Case Study

• TTU has long term contracts to purchase power and
  steam from CHP Plant
• Originally constructed with a GE 21 MW LM2500 gas
  turbine, the plant has recently been upgraded

• LPL actually reduced operations in response to
  high gas prices, but was able to continue to
  provide steam to the campus

50
Texas Tech Case Study

• A combined cycle gas turbine steam generation
  plant
• Hospital and academic campuses get electricity
  from the grid
• Two 2.5 MW diesel generators provide backup
• Steam turbine-driven Chillers produce Chilled
  Water
• Heat Recovery Equipment produces Steam for both
  campuses

51
Why ALL Hospitals should consider CHP

• Hospitals with high dependence on Information
  Systems
• The largest facility in a Community
• Facilities with Level III Trauma Centers
• Critical Access Hospitals which operate the only
  Emergency Department in a region
• Facilities contemplating major renovations/expansi
  ons
• Hospitals considering replacement of their
  Physical Plant Equipment
• Those desiring Capital Infusion or Operating Cost
  Savings
• Facilities in areas subject to frequent power
  disruptions
• Hospitals serving disaster prone Communities
• -Terrorist -Natural -Technical

52
Who owns and pays for CHP at a Hospital?

• Hospital
• Self Funding
• Federal, State and Local Grants
• Low Interest Loans for Publicly owned facilities
• Hospital Authority Bonds
• Capital Partners
• Local Power Utility
• Local Natural Gas Utility
• Third Party Investors
• Energy Services Companies (ESCos)

53
Financing Mechanisms

• Off Balance Sheet Financing
• Protect the Balance Sheet of the Borrower/Lessee
  from underlying debt
• Financing Alternatives
• Operating leases defined by FASB 13
• Capital leases Note and Security
• True lease Hybrid offering purchase option
• Leverage lease Bond equivalent with no
  purchase option only lease renewal

54
Outsourcing Alternatives

• Finance, design-build, own and operate
• Local utility company
• Energy Services Company (ESCO)
• Terms and conditions will vary
• Energy services agreement
• Commodity sales agreement
• Public private partnerships
• Public and private entities partner to benefit
  the community

55
Typical Outsourcing Business Structure
56
CHP at Existing Hospitals

• May need to first consider current energy usage,
  efficiency, and age or condition of existing
  equipment- chillers, boilers, HVAC, lighting,
  controls, emergency generators, etc.
• Energy conservation measures create savings that
  may offset the capital cost of implementing CHP
• ESCos offer performance contracting where they
  will guarantee the annual energy savings and
  incorporate CHP as part of the energy
  conservation measure program

57
Frequently Asked Questions

• Zoning Restrictions
• Neighborhoods
• Pro or Con
• Noise
• Aesthetics/Cost
• Size/Land Requirements
• Scaling
• how big is too big
• how small is too small
• Who will Operate it?

• Vulnerablity
• Natural Gas Flow in a disaster
• Underground Piping
• On Site Combustible Fuel
• Perceptions of past Technologies
• Co-Gen
• Who will buy the Fuel?

58
How to get Started

• Contact or visit a hospital that currently has a
  CHP installation and kick the tires
• Form your team
• CHP Consultant
• Local Utility (Electric and possibly Natural Gas)
• Internal Staff
• Screening Analysis/Energy Conservation Audit
• Current Energy Utilization
• Possible Energy Conservation Measures in existing
  facility
• Preliminary Assessment of Value to the Hospital
• Go/No Go Decision to continue to Feasibility

59
How to get Started (continued)

• Feasibility Study
• Engineering
• Business Structure/Capital Source Options
• Hospital Self Finance
• 3rd Party
• Local Utility as Capital Partner

• Delivery System Options
• Convention Design/Bid/Build
• Design/Build
• Combinations
• Financial Proforma Scenarios
• Operating Savings
• Capital Savings

• Go/No Go Decision to proceed to Design

60
Typical CHP Project Development
Phase 1
Stakeholder Involvement Options1. Self Fund
Project2. Outsource/Leaseback Project3. Put
the Project on the Shelf GO/NO GO
2 Weeks
Report
ScreeningAnalysis
Report NPV Economic Analysis Preliminary
Lease Agreement
Phase 2
4 Weeks
Feasibility Study
Report GMP for Final Design Construction
Lease Agreement
Phase 3
3 Months
Preliminary Design
Phase 4
Pre-Purchase
6 to 9 Months
Final Design
Pre-Construction Services
Construction Phase Services
Environmental Permits
61
Resources and Contacts

• Gulf Coast Regional CHP Application Center
• List of Hospitals using CHP in Texas and US
• Independent CHP assistance, resources,
  information and Links
• List of Engineering Firms, Developers, Equipment
  Suppliers, Vendors
• www.gulfcoastchp.org
• Green Guide for Health Care
• Copy of Green Guide for Health Care free download
• www.GGHC.org
• Hospitals for a Healthy Environment at
• www.h2e-online.org

62
Resources and Contacts (continued)

• United States Combined Heat and Power Association
  at http//uschpa.admgt.com
• US Department of Energy - Energy Efficiency and
  Renewable Energy Distributed Energy Program at
  http//www.eere.energy.gov/de/
• US Environmental Protection Agency - Combined
  Heat and Power Partnership at http//www.epa.gov/
  chp/
• NYS Research and Energy Development Authority at
  www.nyserda.org
• Contact the Panelists last slides in your
  package

63
Questions and Answers

64
About the Speakers

• Daniel Bullock
• Director
• Gulf Coast CHP Applications Center
• 4800 Research Forest Drive
• The Woodlands, TX 77381
• DBullock_at_HARC.Edu
• 281-364-6087

65
About the Speakers

• Ed Mardiat, DBIA
• Principal, Director of CHP Development
• Burns and McDonnell Engineers
• 9400 Ward Parkway
• Kansas City, MO 64114
• EMardiat_at_BurnsMcD.Com
• 816-822-3344

66
About the Speakers

• Robert Moroz, AIA, LEED AP
• President
• Healthcare Facilities Consultation and Planning
• 3301 Texas Star Lane
• Austin, Texas 78746
• BMoroz_at_SWBell.Net
• 512-327-1538

67
About the Speakers

• Kim Shinn, P.E., LEED AP
• Director of Sustainable Design
• TLC Engineering for Architecture
• 6 Cadillac Drive, Suite 200
• Brentwood, Tennessee 37027
• Kim.Shinn_at_TLC-Eng.Com
• 615-297-4554

68
About the Speakers

• Gail Vittori, LEED AP
• Co-Director
• Center for Maximum Potential Building Systems
• 8604 FM 969
• Austin, TX 78724
• GVittori_at_CMPBS.Org
• 512-928-4786