Marybeth Cunningham looks back on six years of change in Vero healthcare


Marybeth Cunningham was stunned when Indian River Medical Center Foundation president Jan Donlan asked her to run for the Hospital District board.

It was 2014; few people knew who Cunningham was, she claims, even though she had vacationed in Vero since 1972, when her parents bought one of the first golf cottages in John’s Island.

“I remember coming here when I was 16 and 17 and there was nothing there,” she said. “The guys working construction cut a path so my girlfriend and I could get to the beach.”

It was the year before her dad, the late Jim McDonald, would succeed John DeLorean in heading up Chevrolet; McDonald would later become General Motors’ president.

Three decades later, a fund-raising executive with the Vero hospital was asking Cunningham, herself a lifelong automotive executive, to run for a board that held sway not only over the hospital but a dozen healthcare agencies treating the county’s indigent population.

“I couldn’t figure out why she asked me to run,” said Cunningham, who called herself a “no-name person” that had met Donlan only once. “No name” may be aspirational: Cunningham retired as executive director of global operations at Delphi Packard, an electrical parts manufacturer once part of GM, with 20,000 employees in 33 countries.

“Some people I knew in the community – which was not a lot of people – knew my business background. And they knew me. But I had never been to a Hospital District meeting. I had no idea what the district really was.”

That objectivity may have been exactly what the hospital’s problems required. Cunningham ran against Laura Moss, who would eventually win a seat on the Vero city council. Moss regularly sat in on Hospital District meetings. Still, she lost to Cunningham, who took office in January 2015.

That first year of Cunningham’s tenure involved the worst of a drawn-out tussle with hospital management over the funding of care for the indigent. Each side wanted the other to assume more of the cost, and the hospital got caught spending hundreds of thousands of district dollars on management costs, not direct care.

The dispute would eventually involve two teams of negotiators including out-of-town lawyers, and a threat by the district to audit the hospital’s spending. Finally, they settled, avoiding expensive and lengthy arbitration.

But in the process, the precarious financial state of the hospital had become clear. By 2017, Cunningham had risen to chairwoman of the District Board when Indian River Medical Center invited a top hospital consultant from Chicago to speak to both the district and hospital boards.

His outlook was dire: Independent hospitals were closing at an alarming rate, unable to negotiate the generous insurance reimbursement rates of large healthcare systems or to achieve the economies of scale of multiple-hospital entities.

For Cunningham, the message was clear. It was time to take a hard look at the possibility of Vero’s small-town hospital being assumed by out-of-towners.

When longtime hospital CEO Jeff Susi handed in his resignation in early 2017 – just months after he was publicly asked to step down by now-retired Hospital District trustee Michael Weiss – the grim numbers were in for the first quarter: a $4 million dollar loss, eight times the anticipated amount, and more than three times the loss in the same quarter the previous year.

Cunningham called the chairman of the hospital board, Dr. Wayne Hockmeyer. “Can we sit down and talk?” she asked.

They met for lunch at the John’s Island Beach Club.

“That was the first time we really had talked,” recalled Cunningham. “My first impression was that he’s a good guy, and he’s obviously very smart. He’s a virologist, and he did exceptionally well with that.”

Hockmeyer became a billionaire after selling his vaccine company to AstraZeneca. A Midwesterner like Cunningham, he too kept a low profile, walking his two Golden Retrievers around Riverside Park.

“I used to joke with him about being part of John’s Island, like asking him how he learned to tie his sweaters,” said Cunningham, who by preference lives in a mainland neighborhood, though she takes her Westie to the dog park just across the Barber bridge.

What impressed Cunningham most was the respect Hockmeyer showed her as she spoke about how to save what was then Indian River Medical Center. Hockmeyer’s board may have governed the hospital, but the Hospital District was its landlord, with ownership of the property on behalf of taxpayers.

“He treated me with respect and listened and he started out as a partner. I can’t say that for all of the men on the board – or in the world,” she said.

“We knew we had to do this together. It couldn’t be one or the other. There were people who felt the Hospital District should just do this because we own the hospital. And there were other people who thought the hospital’s board should decide because they run the hospital.

But we knew we had to work together.”

As the two boards whittled down their choice of hospital system, the key vote for Cleveland Clinic in February 2018 was not a sure thing. Unlike the hospital board of directors, which voted unanimously to partner with Cleveland Clinic, there was a split on the District Board.

Three of the seven trustees wanted other health systems. They included Barbara Bodner, a physical therapist still on the board; Tracey Zudans, who left the board for personal reasons earlier this year; and Weiss, a Ph.D. chemist who served on the district board for 13 years before resigning last week.

Cunningham watched without flinching as her board cast that 4-to-3 vote, some joking it would keep Cleveland Clinic on its toes during months of negotiations.

Those three trustees did vote to approve the final agreement, a unanimous decision of both boards.

Today, with Cleveland Clinic in place with a lease that could stretch to three decades, the Hospital District is reexamining its role with other responsibilities beyond protecting the hospital asset.

This year, Cleveland Clinic assumed the entire cost of charity care at the hospital and its clinics. And the health system’s policy expanded coverage to a larger group in need – those making 250 percent of the federal poverty level. That was up from 150 percent the district had covered; it now reimburses for care at its participating agencies for those earning up to 200 percent of the poverty line, and may increase it further.

The hospital’s assumption of indigent care meant an increase of $6 million in district coffers or about half its 2020 program expenditures. A recent day-long “visioning” meeting sought to determine how to define the board’s role in light of that change.

At the same time, trustees lowered the millage rate, now 20 percent less than it was in 2016. That move comes as a new law bears down on taxing districts state-wide, adding the burden of an extra audit to prove they fulfill their stated purpose.

“We are being more critical of what (our role) is,” said Cunningham. Some board members seem content to keep the board’s role the same. Others take the population health approach, that the availability of food, housing, healthcare and a safe environment, elements known as the social determinants of health, have as much to do with health as doctors’ visits alone.

“Some of us think we actually have a very broad mandate and are looking at taking a wider view of population health rather than strictly just seeing a doctor,” Cunningham said.

“I think the direction is much more of finding solutions to health care problems rather than just financing activities. If we have a gap here, let’s figure out how to fill it.”

Cunningham has her eye on further expanding mental health care, a cause she has long championed. Over the past year, she oversaw a collaborative effort – tax dollars plus philanthropy – to create an adolescent intensive outpatient treatment program at Cleveland Clinic’s Behavioral Health Center. It reached capacity two months after opening and four months ahead of plan.

Now the District Board is looking to add much-needed in-patient detox beds in the county. “Mental health is one of those things that touches everybody. It’s like cancer: it doesn’t care whether you’re rich or poor, black or white, it’s a problem,” said Cunningham. “And it’s my passion.”

First of two parts

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