Cleveland Clinic was selected to take over operation of Indian River County’s largest hospital five years ago in large part because local leaders bought into its world-renowned brand – the stellar reputation and the wealth of resources the number two hospital on the planet would bring to Vero Beach.
The Cleveland Clinic system’s name was seen as a status symbol, a feather in Vero’s cap. Having a Cleveland Clinic hospital in Vero would not only attract top-notch physicians, but also future local residents who would only consider living in a city with access to excellent healthcare.
When decision-makers were dreaming of groundbreaking cardiac care and state-of-the-art cancer treatments being available 10 minutes or so from Vero’s barrier island, it’s doubtful they wasted a minute worrying about Cleveland’s Leapfrog Hospital Safety Grades that are published every spring and fall.
But since the Indian River Medical Center became the Cleveland Clinic Indian River Hospital in 2019, those reports have proved somewhat embarrassing.
Granted, Cleveland Clinic has absorbed eight-figure losses in Indian River County. But persistent poor marks in basic areas that would seemingly cost very little or nothing to improve – such as patient communication and hand-washing – have become downright concerning over the past couple of years.
Overall, Cleveland Clinic Indian River scored a B average on Leapfrog’s most recent exhaustive safety report card. The beleaguered Sebastian River Medical Center – despite being mired in its own serious financial difficulties, staffing issues and sometimes the lack of basic supplies and equipment due to bankrupt parent company Steward Health’s billions in unpaid debts to vendors – also scored a B in the fall grades.
One area not directly related to safety where Cleveland Clinic Indian River unsurprisingly fell in the “below average” range was the grade for transparency in billing.
A growing number of local residents have expressed concerns to the hospital and to Vero Beach 32963 about facility charges tacked onto their bills after a treatment or procedure. These charges are above and beyond what is charged by doctors and surgeons, and compensate the hospital for the overhead costs incurred when a patient has a treatment or procedure at a Cleveland Clinic facility.
The issue with these charges is that, by and large, they are not covered by either Medicare or private supplemental insurance, giving patients a shock when they are told they have to pay these facility charges – which can be amount to hundreds or even thousands of dollars – out of pocket.
Putting Cleveland Clinic Indian River Hospital’s grades side by side against the previously Steward-owned Sebastian River Medical Center, however, did not seem like a totally fair apples-to-apples comparison.
Since the Covid pandemic, the Sebastian hospital has largely offloaded its serious Covid cases to other facilities to enable it to keep performing lucrative elective surgeries.
Cleveland Clinic Indian River, meanwhile, during this time supported one or two dedicated Covid wards and also had Covid patients filling intensive-care unit.
Dr. Richard Rothman and his management staff cite challenges from the Covid era as a factor still dragging down Cleveland Clinic Indian River’s Leapfrog grades. It will take another year for the data – which is developed through self-reporting and patient and employee surveys to some extent, but relies heavily on information collected by the Centers for Medicare and Medicaid Services (CMS) – to fully get beyond the dark days of the pandemic.
And now, Cleveland Clinic has more serious competition locally with Orlando Health – which this fall purchased the Sebastian River Hospital – the new, big player in town.
So it seemed more reasonable to compare how Cleveland Clinic Florida’s five hospitals fared alongside Orlando Health’s seven Florida hospitals graded by Leapfrog.
As a whole, Cleveland’s five hospitals and Orlando’s seven general adult hospitals presumably should have a similar residual drag from the Covid years. And looking at these systems overall, Orlando Health is clearly outperforming Cleveland Clinic.
Orlando Health’s 100-year-old Orlando Regional Medical Center, the flagship hospital of the system, has earned a grade of A each fall and spring for at least three solid years. The Orlando Health executive put in charge of heading up the new Orlando Health East Region which includes Sebastian River, Vice President Ohme Entin, comes directly from the top leadership job at ORMC.
Cleveland Clinic’s Weston Hospital’s Leapfrog safety grade fell from a B to a C in the spring of 2024 and remained a C this fall. Weston, which locals often refer to as the Cleveland Clinic’s Florida “mother ship,” is a teaching hospital and the location of Cleveland’s medical and corporate business leadership in Florida.
“Cleveland Clinic is committed to providing high quality care in all of our hospitals and outpatient clinics,” Cleveland Clinic Florida Spokesperson Raquel Rivas said on Monday.
“We recognize no rating methodology is perfect; therefore, we encourage individuals to use a variety of sources to help identify quality care,” Rivas said. “We are committed to transparency, and our outcomes are readily available on our website, giving patients access to comprehensive data on procedures, volumes, mortality, complications, and innovations.”
Cleveland Clinic Tradition Hospital scored a C, as did Cleveland Clinic Martin North and Cleveland Clinic Martin South.
Indian River County Hospital District Trustee Paul Westcott said he has great confidence that Rothman will lead Cleveland Clinic Indian River Hospital to A status soon, but he explained why Vero Beach residents should care about how Cleveland hospitals in Florida perform as a whole.
“When the trustees brought Cleveland Clinic to our hospital in 2019, it was thought to be a benefit that we were joining a network that undergird our capability. The concern I have is that we are tied to a network of Cleveland Clinic hospitals as our referral destination for treatment,” Westcott said.
“One of the complaints I have received from the community is that people would prefer not having to travel to Weston for care when there are likely treatment options closer, but because they are not part of Cleveland Clinic they are not offered,” Westcott said. “The Hospital District has a responsibility to our indigent patients. They have no choice but to stay within the Cleveland Clinic network. The Hospital District’s responsibility is far more critical for those patients.”
Westcott has urged his fellow trustees to exercise greater oversight with regard to their 75-year tenant to make sure Cleveland Clinic is fulfilling all of its promises to Vero – not just making the capital improvements which are part of the lease agreement on the hospital land and buildings the taxpayers own via the special taxing district.
After reviewing the detailed Leapfrog grades, Westcott, an attorney and mediator by trade, mapped out what he saw as issues across the board at the Cleveland-run Florida hospitals.
These include communication about discharge instructions and medications, intra-staff communication between doctors and nurses, and leadership to prevent safety errors and harmful events. The hospitals also performed worse than one would expect of the world-class Cleveland Clinic in post-surgical infections and complications.
Indian River Hospital is the best of the lot in the Cleveland Clinic Florida family in some of these categories, Westcott noted, crediting Rothman’s leadership, and that of Dr. David Peter before him.
“The other four facilities have consistent areas of concern that directly relate to patient safety. I believe it is important to the Trustees to look into these facilities as our citizens/taxpayers may be directed there,” Westcott said.
Leapfrog grades are sent to the hospitals about six weeks prior to publication, in case hospital leadership wishes to challenge the underlying data.
The fall grades show it is possible to substantially increase a Leapfrog score in a relatively short period, as shown by the Orlando Health Horizon West Hospital. This hospital opened in January 2021, adding a full-service hospital onto an existing standalone emergency department. As recently as this past spring, the facility had a C overall grade. But this fall, its grade rose to an A.
All of Orlando Health’s hospitals owned prior to the fall of 2024 scored an overall A from Leapfrog except for one – Orlando Health St. Cloud Hospital, which improved from a C to a B.
“The ‘A’ grades reflect our unwavering commitment to maintaining the highest standards of safety and quality healthcare for our patients,” said Dr. George Ralls, chief medical officer, Orlando Health. “In keeping with our mission to improve the health and quality of life of the individuals and communities we serve, we will continue to strive towards achieving ‘A’ grades at every Orlando Health hospital.”
Ralls addressed the newly acquired hospitals in Orlando Health’s rapid 2024 expansion, whose grades ranged from A to D.
A statement addressing the new hospitals like Sebastian River said: “Immediately upon assuming operations of these hospitals, Orlando Health began the process of assessments and implementation of focused improvements that will elevate care for our patients to the high standard maintained in facilities throughout the rest of the healthcare system.
“Due to the lag in clinical outcomes data available to national hospital rating services such as The Leapfrog Group, safety grades and quality rankings for these hospitals will be impacted by the previous owner’s data until at least 2027,” Orlando Health said.