Five years ago, the study “Demystifying First Cost Green Building Premiums in Healthcare” was released, showing that the capital cost premium for green healthcare design was 2.4 percent. “At the time, there were a lot of questions about [green and costs],” says Gail Vittori, co-director, Center for Maximum Potential Building Systems. “We thought the findings would help to be a myth-buster.”

Yet, despite the data and an increasing number of completed projects that have earned LEED certification, concern over cost premiums continued to persist. So Vittori decided to revisit the topic, partnering with Robin Guenther, principal, Perkins+Will (who was involved in the 2008 study), and Breeze Glazer, associate, research knowledge manager, Perkins+Will.

The updated study used a new set of hospital projects, all of which were completed between 2010 and 2012, and were LEED certified for New Construction (LEED NC) by the U.S. Green Building Council. The 15 certified projects represented a range of sizes and geographic locations, as well as new construction and major additions.

The team, which will present its findings during the Healthcare Design Conference (Nov. 16-19, Orlando) in the session “LEED Certified Hospitals: Perspectives on Capital Cost Premiums and Operational Benefits,” conducted interviews with project design teams, and gathered additional input from three national construction firms. So what did they find? “The averages were similar, with some slight variation, but it basically ranged from 0 to 5 percent,” Vittori says.

In fact, the report states that for the 13 sample hospitals greater than 100,000 square feet, the average capital cost green premium was less than 1 percent, while the smaller hospitals reported an average capital cost green premium of 2.1 percent.

So why does the cost concern persist? “For healthcare, green is still relatively new,” Vittori says. “Even with the evidence-based data we’re providing, people hold onto this concern. It’s kind of the risk-averse nature of healthcare, perhaps.”

While the study looked at one aspect of the building value proposition, the authors say there’s a lack of operational benefit data from completed facilities. In the report, only 29 percent of the 15 sample hospitals reported to have completed a post-occupancy evaluation. “We need to get better at teasing out the results,” Glazer says. “To a certain degree, owners are going on faith or anecdotal evidence of the benefits of these buildings, but we need to provide the data to help that increase go further.”

For more information, visit