Inpatient health care buildings used 193.3 thousand Btu per square foot in 2018, according to the U.S. Energy Information Administration's Commercial Buildings Energy Consumption Survey. That makes hospitals among the most energy-intensive buildings in the country, in the same tier as food service and food sales, and well above offices, schools, or warehouses.

If you want the number for a whole building rather than per square foot, EIA also reports that hospitals averaged 264,800 square feet. Multiply those two published figures and a typical hospital lands somewhere around 51,000 million Btu a year. That is arithmetic on two averages rather than a measured figure for any specific facility, so treat it as an order of magnitude, not a benchmark. A 900-bed academic medical center and a rural critical access hospital are both in that average and neither looks much like it.

Why Hospitals Use So Much

Three things separate a hospital from any other large building, and all three push energy up.

• It never closes. An office tower coasts nights and weekends. A hospital runs full HVAC, lighting, and equipment load at 3am on a Sunday. There is no unoccupied period to set back into.
• The air cannot be recirculated the way it is elsewhere. Operating rooms, isolation rooms, and sterile processing carry air change requirements and pressure relationships that conditioning systems have to hold continuously. Heating or cooling large volumes of outside air, rather than reusing what is already conditioned, is expensive and it is not optional.
• The equipment load is relentless. Imaging, sterilizers, lab equipment, and the humidity and temperature tolerances that clinical spaces run to are all load that a comparable square footage of office space simply does not have.

The heating figure makes the point cleanly. EIA puts space heating intensity for inpatient health care at 62.6 thousand Btu per square foot, nearly three times the 21.8 reported for outpatient health care. Same broad sector, very different buildings.

Inpatient vs. Outpatient: A Small Share of Buildings, Most of the Load

This is the part that matters if you manage a mixed portfolio. Inpatient facilities were only 6% of health care buildings in the 2018 survey, but they accounted for 68% of the sector's electricity consumption and 82% of its natural gas.

If you run a health system with a handful of hospitals and dozens of clinics, medical office buildings, and outpatient sites, the count of your properties tells you almost nothing about where your spend sits. A procurement strategy built around the number of meters will be aimed at the wrong end of the portfolio. The hospitals are the portfolio.

The Trend Is Actually Good

Energy intensity in inpatient health care fell 16% between 2012 and 2018, the largest percentage decrease of any building type EIA tracks. Lighting retrofits, better controls, and equipment replacement did real work over that period.

Worth being clear about what that does and does not mean for a budget. Intensity is energy per square foot. Health systems have also been adding square footage. Using less per square foot across more square feet does not automatically produce a smaller bill, and it does nothing at all about the price you pay per unit.

Efficiency and Procurement Are Two Different Levers

Hospital energy conversations tend to collapse into efficiency projects, because that is what the engineering team controls. Efficiency reduces how much you consume. Procurement changes what each unit costs. They are independent, and the second one is usually faster.

An efficiency project has a capital request, a design phase, a construction window, and a payback period measured in years. Competitively bidding your supply among licensed retail suppliers changes the rate on your next invoice cycle without touching the building. Neither replaces the other. A hospital that has done excellent efficiency work and never bid its supply is still overpaying, and a hospital with a sharp supply contract and 1990s controls is still consuming more than it needs to.

What Actually Moves the Number for a Health System

• Aggregate the portfolio before you bid. Hospitals, clinics, and medical office buildings bid as one load are a more attractive book to a supplier than each site negotiating alone. Consolidated volume is leverage.
• Match contract structure to how the institution budgets. Hospitals are one of the clearest cases for budget certainty, since the board approved a number and the energy line has to hold. That usually argues for a fixed component, sometimes through a block-and-index structure rather than an all-or-nothing decision. Our breakdown of fixed versus variable contracts works through the tradeoff.
• Stagger contract end dates across the system. Putting every facility on the same expiration date means the whole portfolio reprices on whatever the market happens to be doing that month. Staggering spreads that risk.
• Audit the bills. A 24/7 facility on complex rate schedules with demand and capacity components is exactly where billing errors hide, and they compound quietly. Utility bill auditing is separate from procurement and often finds money on its own.
• Know whether you have a choice at all. Supplier competition only exists in deregulated markets. A facility on a municipal utility or in a regulated market has no supply contract to bid out, and anyone telling you otherwise is not being straight with you.

Where to Start

Start with twelve months of interval data for your largest facility, not a proposal. Load shape drives what a supplier will quote, and for a hospital that shape is unusual enough that generic pricing is nearly always wrong. Any percentage a broker quotes you before seeing that data is a modeled range, not a forecast, and it should be described that way.

From there the sequence is straightforward: confirm which sites sit in markets with retail choice, aggregate those into a single bid, and compare structures rather than just headline rates.

Sources

• U.S. Energy Information Administration, Commercial Buildings Energy Consumption Survey (CBECS) 2018, health care buildings: eia.gov/consumption/commercial/pba/health-care.php
• U.S. Energy Information Administration, "U.S. commercial buildings continued to increase their energy efficiency as of 2018": eia.gov/todayinenergy/detail.php?id=54059