Owner groups and Facility Managers of health care facilities interested in reducing operation and maintenance (O&M) expenses for new facilities have often been placed in the difficult position of making cost-benefit assessments without a complete understanding of the cumulative impact of building systems selection on their internal rate of return. This is particularly true when owners are evaluating the initial cost and operational benefit (if any) of obtaining various levels of "Leadership in Energy and Environmental Design" (LEED) certifications for their buildings. Heating Ventilation and Air Conditioning, and Lighting (HVAC&L) loads comprise 51% of the total energy demand in the typical outpatient facility; however, in order to estimate the likelihood of achieving a particular LEED rating for a new building, a "Whole Building Energy Simulation" is necessary to evaluate HVAC&L system performance. The conventional of requiring a design upon which to base an analysis presents owner operators attempting to perform a Lifecycle Cost Analysis (LCCA) early in the concept phase with two unique problems - how to estimate energy use without an actual "design" to model, and how to estimate a system's first cost without knowing its performance requirements. This study outlines a process by which existing energy metrics from the Department of Energy (DOE), Commercial Building Energy Consumption Survey (CBECS), and Energy Star, can be made early during the developer's pro forma phase - without the need for a building design. Furthermore, preliminary business decisions targeted at determining the likelihood of obtaining a particular LEED rating, and specifying the corresponding building systems, can be estimated without the cost required to employ an Architect and Engineer (A&E) team, or the time necessary to develop a design. This paper concludes that regional factors can dramatically affect a building's required level of energy performance, and that the highest performing HVAC&L system, irrespective of cost, will not always provide the best return on investment. Accordingly, the national averages utilized to establish LEED EA1 thresholds do not reflect the cost particularities owners may encounter when developing in various climate zones, and therefor may be less relevant to lifecycle considerations that previously believed.