Growth in healthcare needs challenges providers to reduce operational costs and is expected to increase construction and renovation of healthcare facilities. Meanwhile, concerns regarding the environmental impacts of hospitals have made the healthcare sector one of the most prominent settings for the green building movement. Despite these environmental concerns, the number of studies that document the benefits of sustainable healthcare facilities is limited. In this study, the authors used national cost report data from the Centers for Medicare and Medicaid Services and developed a benchmarking tool for comparing the operation and maintenance costs of healthcare facilities with their peers. The authors then used longitudinal data and compared the annual operation and maintenance cost of 32 Leadership in Energy and Environmental Design (LEED) hospitals to the median cost of non-LEED facilities of comparable type, ownership, and location. Analysis failed to provide any evidence that achieving more LEED credits or LEED certification in general lowers operation and maintenance costs of healthcare facilities. (C) 2016 The Authors. Published by Elsevier Ltd.