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Guide to Optimizing Hospital Facility Investments Hospital FACILITY INVESTMENT Guide

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Guide to Optimizing Hospital Facility Investments Hospital FACILITY INVESTMENT Guide Guide to Optimizing Hospital Facility Investments Hospital FaCilitY iNVEstMENt GuidE PREFACE As pure as your healing mission is, no hospital is immune to market forces. In recent years, that’s become clear to anyone who endows, owns or operates healthcare facilities. Fortunately, you may have an overlooked asset: your building itself. Ensuring that your hospital makes the best business decisions on energy-related investments can enhance your bottom line and, ultimately, your ability to deliver the doctors, staff, environment and quality of care the marketplace requires. BetterBricks, an initiative of the Northwest Energy Efficiency Alliance, is funded by your local utility and is here to facilitate high performance hospitals and the benefits they bring. Your State Hospital Association applauds the promise of high performance goals and BetterBricks can help get you there. Together with Northwest Hospitals and industry partners, we provide tools, training and services to help improve energy efficiency, contribute to mission-critical hospital services, improve patient care, support high performance operations and foster a healing environment. This guide will help you as a hospital decision maker maximize your hospital’s investments through sound economic analysis and diverse financing approaches. How does it work? The High Performance Hospital Partnership is a collaboration between BetterBricks, the Northwest electric industry, state and regional hospital trade associations and other partners, including: • The Northwest Energy Efficiency Alliance (NEEA). • Idaho Hospital Association (IHA). • MHA – An Association of Montana Healthcare Providers. • Oregon Association of Hospitals and Health Systems (OAHHS). • Washington State Hospital Association (WSHA). • State hospital engineering societies. • State hospital association affiliate organizations. • Northwest electric utilities. All the benefits of a high performance hospital are well within reach and BetterBricks is here to help you find the right path to get there. To access additional information and resources from us or our industry partners or your local utility, just visit betterbricks/healthcare.com. Hospital FaCilitY iNVEstMENt GuidE ACKNOWLEDGEMENTS This guide was produced by ECONorthwest’s Portland, Oregon office through a contract with the Northwest Energy Efficiency Alliance (NEEA). Curt Nichols was the project’s contract manager for NEEA. Dr. Stephen Grover was the ECONorthwest project manager and primary author of this guide and was assisted by Peter Graven, Alec Josephson, Jonny Holz, Heather Carver and Emily French. Significant additions and revisions were produced by Strategic Equity Associates, LLC of Seattle, Washington through a contract with NEEA. Robert Blakey, Principal, was the primary contributor. The guide benefited from the contributions, review and comment of many others with energy efficiency and health care business and facility management expertise. Ash Awad, Richard Beam, Scott Carroll, Jeff Cole, Aleisha Khan, Neil Moss, Curt Nichols, and Skip Schick provided direction, review, and comments on this paper. While grateful for this guidance and input, ECONorthwest, Strategic Equity Associates, and NEEA are responsible for the content. This guide is intended as a general reference on maximizing your hospital’s investments through sound financial analysis and diverse financing approaches. It is not a substitute for detailed and comprehensive information on the tax and legal implications of these financing methods. Hospitals considering pursuing a project using these methods need to enlist the help of an accountant and an attorney. 3 HOW TO USE THIS GUIDE Hospital FaCilitY iNVEstMENt GuidE HOW TO USE THIS GUIDE PURPOSE This guide is intended to help hospital facility managers, construction project managers, and other decision makers more effectively evaluate the economic viability of energy- related investments in existing facilities, major renovations, and new construction. It also presents a range of project financing options. The purposes of this guide are to help hospital decision makers: • Better understand economic analysis methods and available tools. The particular focus of this guide is on the merits of a life-cycle cost analysis approach. • Develop a common language and methodology for economic analysis that can be used throughout a hospital organization to discuss and assess the financial merits of both energy- and non-energy related investments. • Expand decision makers' understanding of the range of financing options available to them for energy-related projects. Ultimately this guide should be used by hospitals looking to improve their economic position by reducing operating costs through energy savings. This will increase access to capital and help hospital operating margins. “Access to capital is a reflection of one thing - operating efficiency,” says Michael Williams, CEO of Community Health Corp.1 By using the tools presented here, hospitals should be able to improve their bottom line. One thing this guide does not address is quantifying the full range of non-energy benefits that accompany many energy-saving projects. When it is possible to quantify additional savings such as water, sewer, or maintenance expenses, these can be included in the equations presented in this guide. On the other hand, improved system reliability, staff and patient comfort, increased indoor air quality, and other benefits are harder to quantify but are nonetheless important. As such, the results derived using the tools presented in this guide will be conservative, as they do not include the value of these other non-energy benefits. A downloadable version of this guide is available on the BetterBricks website (www.betterbricks.com/healthcare), and copies can also be obtained directly from NEEA. GUIDEBOOK ORGANIZATION This guide is divided into six sections: • Section I (Basic Concepts) provides a brief introduction to the concept of the Time Value of Money (TVM) • Section II (Economic Evaluation Tools) provides a discussion of the basic approaches used to evaluate the benefits of a particular energy efficiency project or activity, and is targeted to those that are unfamiliar with standard economic analysis methods. These methods include net present value, simple payback, internal rate of return, and return on investment, with sample calculations provided for each. 1 Financing the Future Report 4: How Are Hospitals Financing the Future? The Future of Capital Access. Healthcare Financial Management Association (HFMA), page 14 (2004). 4 HOW TO USE THIS GUIDE Hospital FaCilitY iNVEstMENt GuidE • Section III (Life-Cycle Cost Analysis) presents an overview of the Life-Cycle Cost Analysis method. This method utilizes the net present value calculation discussed in Section II to evaluate different energy efficiency project options. The method examines all of the costs that accrue during the life of the project for each project alternative being considered. The Life-Cycle Cost Analysis method is a powerful tool that allows the relative costs of different projects to be compared using a single discounted cost number. • Section IV (Financing Options) describes commonly used financing options, including loans, bond issues, internal capital, and philanthropic donations. The Guide discusses the potential advantages and disadvantages of each financing option and provides simple examples of each method. The Appendix to the guide also describes less common options including operating leases where equipment payments are kept off the balance sheet (and therefore not reported as balance sheet debt), and provides more detail on the financing options discussed in Section IV. • Section V (Performance Contracting) provides an overview of performance contracting and discusses its relationship to project management, completion, and financing. • Section VI (Project Examples) discusses the effects of project delay, how to compare multiple projects, and the advantages of combining multiple energy-efficiency projects into a larger, and more comprehensive project. A general project approach discussion emphasizes the advantages of employing more sophisticated financial analysis tools in helping facility and construction managers evaluate their investment options. A flowchart is presented detailing a proposed process for financial analysis of projects. The Appendices, in addition to providing further detail on the methods discussed, provide tools and lists of some of the resources available to assist hospitals and other commercial customers considering energy efficiency improvements. The list includes state loan programs designed for hospital construction or energy projects, utilities and government agencies that offer commercial energy efficiency programs, and resources and services available through BetterBricks. Utility programs often include loans, direct financial incentives, and tax credits, including tax credits that can be used to the benefit of non-profit organizations. Many of these utilities and government agencies also offer technical assistance for system design and equipment selection. 5 HOW TO USE THIS GUIDE Hospital FaCilitY iNVEstMENt GuidE TABLE OF CONTENTS PREFACE ................................................................................................................. 2 ACKNOWLEDGEMENTS.......................................................................................... 3 HOW TO USE THIS GUIDE.....................................................................................
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