Cleveland Clinic addresses losses, plans for future

PHOTO BY BRENDA AHEARN

Vice President and Chief Medical Officer Dr. David Peter admitted to some major shortcomings and far higher-than-expected operating losses at Cleveland Clinic Indian River Hospital in his annual report a week ago to the Indian River County Hospital District.

But he had good news for the community about two major issues that have dogged the Vero Beach medical center since Cleveland Clinic’s takeover in 2019 – a communication system that has frustrated patients trying to reach the hospital, and the Emergency Department.

Responding to District Trustee Dr. William Cooney, who said the Emergency Department was source of “one of the major complaints that we get,” Peter said, “It’s not a facility that we’re proud of.

“We inherited it and we have done the best we can to make it as functional as possible, but this year, in 2023 and 2024, it is our major focus for philanthropy.

“We have sent it out for drawings so that we can improve the efficiency and aesthetics, both of which are challenging in that environment,” Peter said. “We expect within the next year and a half to two years to have a renovation done on the ED which makes it much more efficient, much more attractive and quite honestly, a better facility.”

The first major physical enhancement of the Emergency Department, which Peter called the “Behavioral-health-safe ED,” was scheduled to open Tuesday.

The separate room, equipped with an emergency roll-down door, he said, is designed to separate psychiatric patients from the rest of the Emergency Department if need be for safety.

In the coming year, he said, Cleveland Clinic also plans to spend $2.4 million upgrading the telephone system.

The phone system was a major source of complaints during the pandemic, causing havoc as local residents tried to schedule appointments to get the first COVID-19 vaccines in late 2020 and early 2021.

It still frustrates patients trying to reach members of the local Vero hospital staff.

But in a largely positive report to the Hospital District, which selected Cleveland Clinic from major medical institutions as the best qualified to take over Vero’s community hospital, Peter said all existing services have been maintained and “Cleveland Clinic has strengthened the five areas that we identified for strategic growth.”

He identified those as heart and vascular care, orthopedics, neurosciences, cancer and primary care/urgent care. Peter detailed what he called the “very high-end cardiac services” Cleveland Clinic has brought to Vero, noting that patients have experienced “great outcomes.”

The hospital has brought in head and neck cancer and breast cancer specialists, launched a concierge medicine program, expanded the interventional stroke program, and increased clinic access, especially to indigent patients.

In the area of women’s health, since the Cleveland Clinic takeover in 2019, primary Cesarean section surgeries have decreased dramatically from 31 percent of births to 20.9 percent, and new maternal-fetal health services have been added for at-risk mothers. In 2022, the hospital handled 753 labor and delivery patients.

According to the hospital’s annual report filed with the state Agency for Health Care Administration for calendar year 2022, Cleveland Clinic Indian River Hospital’s 339 physicians treated 305 open-heart cases, 332 neurosurgery cases, 719 radiation-therapy cancer cases and performed 15,832 cardiac catheterization procedures.

Admissions to the intensive care unit numbered 16,049. A total of 4,411 MRIs and 32,684 CT scans were performed, and 1,451 dialysis treatments administered.

After presenting a list of impressive accolades and on-target achievements in quality of care, patient safety and infection control, Dr. Peter dropped the bad financial news.

“Our total operating loss was $69.2 million. We are moving toward sustainability, and correcting that into the future, but I will tell you, it’s a heavy lift,” he said.

After pandemic spending of $401 million on operating costs in 2021, Cleveland Clinic budgeted $370 million for 2022, not expecting the departures, retirements and personnel shortages that would ensue last year. Actual expenditures came in at a whopping $481 million.

Peter said the demand for contract workers, many from out of town, drove up expenses in 2022.

“At one point we had 45 percent of our nurses were travelers. We have 600 nurses and 245 of them were travelers,” Peter said.

Now, fewer than 30 are traveling nurses.

“We have completely stabilized our workforce. Our nursing turnover and vacancy rate is currently lower than both the national and the Florida averages. Those expenses were very real. That’s how the doors stayed open in 2022.”

District Trustee Paul Wescott grilled Peter about the turnover in physicians Cleveland Clinic has seen in the past few years, saying the Ohio-based corporation is “driving doctors out of our community.”

But Chairwoman Marybeth Cunningham said consultants had warned district officials that the systemic changes involved in the transition from a community-run hospital to a corporate hospital would cause a certain number of physicians to retire or to leave Vero.

Significant capital improvements to hospital facilities and equipment were made in 2022, totaling $42.6 million – $35.4 million of which was funded by Cleveland Clinic and $7.2 million of which came from the Indian River Hospital Foundation.

Though Peter said Cleveland Clinic originally budgeted $57.5 million for capital improvements, some of the planned projects couldn’t be completed on schedule in 2022.

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