A new ASC pilot project is aiming to create the industry’s first comprehensive sustainability certification, and cost savings are driving the program.
The GreenCare ASC Certification was developed by Boston-based Harvard Medical School’s Climate Health Organizing Fellowship and uses a 1,000-point framework measuring performance across energy, waste, water, anesthetic gas management and sustainable procurement. Unlike existing healthcare sustainability efforts, the program was built from the ground up with ASC financial realities in mind, structured to show that going green and cutting costs are not competing priorities.
Howard Maunus, MD, a retired gastroenterologist and fellowship participant who helped lead the initiative, told Becker’s that after more than 30 years working in ASCs, he understands the need to always tie sustainability back to savings.
“We didn’t want to replicate The Joint Commission certification exactly, because we felt this had to be tied into cost savings,” he said. “Every expert we talked to stressed the fact that this really wouldn’t go anywhere unless we tied it into financial savings.”
ASCs continue to face significant financial pressures, including rising labor, supply and implant costs and persistent anesthesia shortages. In that environment, any initiative that can’t demonstrate a clear return on investment is unlikely to make it onto an administrator’s agenda.
“When we had these monthly meetings, the first thing that was asked was, ‘What is my distribution?’ And the second thing that was asked was, ‘Is anybody getting sued?'” Mr. Maunus said. “So I definitely understand the pressures ASCs are under.”
The New Jersey pilot is expected to generate $90,000 to $180,000 in potential annual savings, according to project estimates, a figure that Dr. Maunus said may surprise administrators who have assumed utility and waste costs are fixed expenses.
“There’s a perception that facilities take it for granted that there’s not much they can do with utility costs, waste costs, anesthetic costs — that it’s just the cost of doing business, and they don’t have a lot of control over it,” Richard Parker, associate director of life safety and physical environment at the Accreditation Commission for Health Care, told Becker’s. “It’s a missed opportunity, because they’re leaving money on the table.”
Energy efficiency improvements alone, including LED lighting conversions, occupancy sensors and HVAC optimization, could reduce electricity costs by 5% to 10%, or roughly $10,800 to $21,600 annually based on the facility’s current energy spending. And financing options can make even those upfront costs manageable. New Jersey, for example, offers a no-interest loan program for healthcare facilities making energy upgrades.
“We know the return on investment for some of these things — like LED lights — is 12 to 18 months,” he said. “So we know if they do this and have a return on investment in 12 to 18 months, and don’t have to pay anything back for five years with no interest, they’re going to come out ahead.”
Rather than buying new equipment, the pilot focuses on getting more out of what ASCs already use. Eye-drop bottles, for instance, are typically thrown away after a single use even when medication remains inside. The pilot tests two technologies designed to fix that: a sterilization system that allows multi-dose bottles to be safely reused, and a specialized dropper attachment that reduces how much medication is wasted with each drop, stretching each bottle up to 60% further.
The pilot also tests reusable surgical tools in place of single-use plastics. Diamond blades used in eye surgery, for example, can be safely reused when cleaned and sterilized according to ophthalmological society guidelines, rather than discarded after one procedure.
Similarly, a reusable titanium lens inserter replaces disposable plastic ones, cutting plastic waste by up to 80%. And, instead of wrapping surgical instruments in single-use blue plastic sheeting, the pilot uses sealed metal sterilization containers that can be turned around 50% faster between procedures.
Despite the financial case, Dr. Maunus knows what will actually determine whether the certification gains traction across the industry. It isn’t skepticism about the savings, and it isn’t the upfront cost. It’s bandwidth.
“The biggest pressure is time, and finding people to champion this at the surgery centers,” he said.
Part of the challenge is structural. ASC administrators often don’t have the same background as their hospital counterparts when it comes to identifying operational efficiencies.
“In a hospital system, you have a traditional hospital facility manager, and they’re more knowledgeable about energy efficiencies and things like that,” Mr. Parker said. “With an ASC, the challenge is the ASC administrator may not have that background. They may be a nurse or an administrator, and they don’t see the opportunities in the same way a hospital facility manager might.”
To account for that, the program is structured around different levels of implementation, allowing facilities to start small and build momentum through early wins.
“With those wins, it becomes self-sustainable, because if you’re saving money, that helps cover the costs of implementation,” Mr. Parker said. “Then it snowballs, and you can implement new things with the wins you get early on.”
The consultancy model supporting the pilot, where firms are compensated through a percentage of the savings they generate rather than large upfront fees, reinforces that approach, meaning ASCs don’t have to take on significant financial risk to get started.
Pilot results, including cost savings and greenhouse gas reductions, are expected by mid-2026. If the numbers hold, Dr. Maunus believes the model could scale quickly, particularly among large ASC ownership groups managing hundreds of facilities at once, where even modest per-site savings add up to a compelling business case.
