Cleveland Clinic Indian River Hospital’s highly ranked labor and delivery unit, designed and staffed to handle 1,200 to 1,300 births per year, is currently losing more than $3 million annually due to a lack of babies. More than 1,200 babies per year were born to Indian River County residents in 2023 and 2024, but due to a complex set of demographic, insurance and market factors, nearly 400 moms per year delivered outside our county, draining most of the well-insured moms and babies out of Vero. Fifty-two percent of the babies delivered at the Vero hospital during this period are born to uninsured moms or moms on Medicaid. “The population demographics, which we can’t change here, lend themselves to a community that has a fair amount of Medicaid and uninsured, plus a smaller mix of commercially insured patients,” Cleveland Clinic Indian River Hospital Vice President and Chief Medical Officer Dr. Richard Rothman said. “Also, Medicaid payments have decreased relative to inflation and the uninsured population is unable to fund care, and their delivery. In addition to that, there’s a number of different local and state nuances, immigration status, etc. that all impact the way that we get funded,” Rothman said. So even as Cleveland Clinic invests millions in upgrading its labor and delivery floor, the long-term survival of the unit would appear in jeopardy unless it can persuade more privately insured patients to have their babies here in Vero. The big part of the challenge, however, is that times and approaches to birthing have changed. Back when the vast majority of 32963 readers were having their babies, expectant women went to the hospital to labor with trained nurses or midwives until the “big moment” when the trusty OB doctor they’d seen for months was called in to deliver the baby, either the old-fashioned way, or if needed, by Caesarean section. That is not the way it’s done anymore. Roughly a decade ago, Rothman and his Chief of Obstetrics and Gynecology Dr. George Fyffe explained, the industry shifted to the “hospitalist model” for labor and delivery. Fyffe says the goal was threefold – to reduce maternal and fetal mortality rates, to minimize unnecessary C-sections, and to give women the chance to deliver their babies after having had a single previous C-section birth. But to achieve today’s standard of care, an on-staff OB doctor needs to be in the hospital at all times – not a short drive away. Nurses, midwives, plus a dedicated OB operating room and well-oiled surgical team must be at the ready. A staff anesthesiologist also needs to be on the floor for epidural pain management and emergency C-sections. Cleveland Clinic built upon Fyffe’s progress, developing one of only a dozen labor and delivery units in Florida ranked as High Performing for maternity care by U.S. News and World Report. The hospitalist model, while successful, is much more expensive. It might make economic sense if every mother in Indian River County gave birth at Cleveland Clinic. But the local OB doctors in private practice typically don’t deliver their own patients’ babies anymore. They broker birthing contracts with hospitals in St. Lucie, Brevard, Osceola or Orange counties to deliver their babies for a split of the insurance reimbursements. Rothman explained that “the birth is bundled” meaning insurance companies pay one combined fee for all the prenatal care, labor and delivery – after the baby is born. Who is having babies in Vero? Overwhelmingly it’s patients of the hospital’s Partners in Women’s Health practice, run by Fyffe. Taxpayers and Cleveland Clinic Foundation both subsidize the Partners program, which loses $4.2 million per year even after help from the Indian River County Hospital District. Partners’ babies are born in Vero because continuity of care matters, outcomes are great, and due to the fee bundling. “If they have private insurance and I take care of that patient for 10 months and that patient goes to Lawnwood, with private insurance, this is what I get for it,” Fyffe said, making a zero with his hand. “Zero.” Over the next four years, Cleveland Clinic must get the privately insured moms and babies back in-county. “We’re hopeful that, as we articulate the value to the community – the facilities, the obstetrics team, the good outcomes – they’re going to want to come here,” Rothman said. A small percentage of local expectant mothers birth at a hospital in the Orlando area or Palm Beach County where Level 3 Neonatal Intensive Care or an NICU available. “We have a Level 1 center here, but probably 50 percent of our patients that we take care of here are Level 3 patients, still with low morbidity and mortality,” Fyffe said. “For the majority of moms, they don’t need a NICU. What the majority of moms need is a great place to deliver their baby with a great experience, good outcomes. And we offer that here,” Rothman said. “This is a wonderful place to deliver babies. And one of the safest in the state and the country. George (Dr. Fyffe) was ranked in the top 25 for delivering high-risk minority babies in the country.” Moms who live in the extreme north or south end of Indian River County may find it more convenient to find an obstetrician in South Brevard or in St. Lucie. The hospital must reach those geographic areas better. Home births, roughly 40 per year, also cut into the hospital’s market share. Better awareness about Cleveland Clinic Indian River Hospital and Partners in Women’s Health could go a long way. Not only is the staff trained and experienced with high-risk pregnancies and geriatric (over 35 years old) moms, but the hospital’s maternal-fetal medicine specialists perform procedures like amniocentesis, which some women seek out in South Florida. The planned December big reveal of Cleveland Clinic’s $7 million labor and delivery overhaul, increasing the size of the private birthing and postpartum suites by 50 percent, is a chance to re-introduce Vero to moms and to OB doctors. The private suites feature hotel-room style bathroom and shower facilities, ample space for the obstetrician, nurses, midwives and the on-staff doulas to work. Postpartum suites are designed so babies can room-in with mom in special space-age incubator bassinets. Cleveland Clinic Indian River will have capacity for 17 babies, and five patients in active labor at once, plus an integrated C-section operating theater and three observation beds. Labor and Delivery Nurse Manager Mary Volsky, a 25-year hospital employee, said the new layout increases privacy and comfort for moms, while increasing operational efficiency for the staff. The revamped facilities will also serve the needs of Vero’s gynecological patients. “We want the people on the island who are 60s and 70s to know that this is the best place to deliver their grandchildren and also if they need surgery, it’s also the best place for them to be as well,” Fyffe said. “But sometimes people go outside, not realizing that the diamond in the rough sits right in their backyard.” Fortunately, hospital leaders and the Indian River County Hospital District Board of Trustees have at least begun talking about the labor and delivery dilemma now – before Cleveland Clinic’s lease would allow it to shutter labor and delivery in 2029. Rothman said the entire community has a stake in labor and delivery because it is ultimately a question of what Vero Beach wants to be in 10, 20 or 50 years. “We believe that labor and delivery is foundational to the county’s growth strategy and the community’s needs. We are 100 percent committed to keeping labor and delivery here. That being said, we have to ensure we can do it sustainably. That commitment is, for as long as we can financially sustain it, we’re committed to it.” Rothman estimated it could take 10 or 15 years for growth alone to bump the number of babies born in-county to a break-even number for his labor and delivery unit. “We can continue to deliver really high-quality care, but it comes at a significant cost and the question then is, what is the county’s trajectory for growth?” he said. <em>Photos by Joshua Kodis</em> [gallery ids="218883,218884,218885"]