With the bad news of his hospital’s operating losses of more than $60 million last year in the rearview mirror, Cleveland Clinic Indian River Hospital’s vice president and chief medical officer, Dr. Richard Rothman, in his annual report to the Hospital District focused on three major capital projects that underscore Cleveland’s commitment to Vero Beach.

Each October, the start of the district’s fiscal year, the hospital’s leader advises its landlord on how Cleveland Clinic is investing in the local community by upgrading facilities, diagnostic equipment and services available to Vero patients.

“I think it’s important to call out that special partnership between Indian River County Hospital District and Cleveland Clinic Indian River Hospital, and it’s allowed us to continue to expand services while the majority of hospitals across the United States are shuttering them,” Rothman said.

But he took the opportunity to point out that taxpayer support through the Hospital District of behavioral health and prenatal health and obstetrics care are critical, as those two areas of hospital operations are not profitable.

Rothman said Cleveland Clinic spent $23 million over and above philanthropic capital projects in 2023, and since taking over Indian River Hospital five years ago, Cleveland Clinic has spent $112 million beyond what has been raised locally by substantial Cleveland Clinic Foundation efforts.

In October 2023, Rothman’s predecessor, Dr. David Peter, told the seven-member district board that raising money to completely revamp Cleveland Clinic’s Emergency Department was his top priority. Rothman said construction of the new ED has begun and is slated for completion in 2026. Also well underway, he said, is an exciting $7 million overhaul of the hospital’s Labor and Delivery Unit.

More than 800 babies were born at Cleveland Clinic Indian River Hospital in 2023, plus nearly 500 so far in 2024 – including two delivered while Hurricane Milton-spawned tornadoes were bearing down on Vero Beach and the barrier island (neither baby was named Milton after the storm).

The hospital had quite an active 2023, Rothman said, with 230,000 outpatient visits, roughly 15,000 surgeries and nearly 25,000 admissions. Plus, Rothman said Vero Beach has “an insatiable demand for diagnostic testing,” prompting Cleveland Clinic to invest heavily in that area, adding a third MRI machine designed to support breast and prostate cancer patients, and setting up a mechanism whereby patients who call to schedule imaging get the first available appointment at either Vero Radiology or the main hospital, depending upon where there is the earliest opening.

“Community hospitals across the nation continue to be challenged by rising costs and low reimbursement rates. As nearby hospitals experience operating losses, our hospital continues to expand its services. We’re expanding services not because it might be financially profitable, but because these areas reflect community needs including prevention, psychiatry, services for aging populations, cardiology, and mammography services.” 

Hospital District Board Chair Marybeth Cunningham, who also serves as a non-voting member on the local Cleveland Clinic board, said she thinks it’s “remarkable” that Cleveland Clinic continues to invest in such important capital improvements, undeterred by multiple years of significant operating losses since taking over the hospital in 2019.

Cunningham said she has been fielding lots of questions from the community and was asked point blank recently by a resident, “Are you nervous at all that Cleveland Clinic is going to pull out of Vero because of the losses? And I said absolutely not,” but she posed the same question to Rothman.

Rothman said he understands the apprehension as headlines are filled with hospitals going under — not to mention the recent bankruptcy of Steward Health Care impacting the North County hospital, but replied, “We are committed to not only fulfill our commitment, but to expand on it.”

Cleveland Clinic is the only thrombectomy-capable stroke center in the county. “What that means is we have the ability to remove a clot from patient’s brains after a stroke. Many facilities across Florida only administer medication. We’re able to go in and take the clot out,” Rothman said, adding that Cleveland Clinic doctors also perform trans-aortic valve replacements, minimally invasive mitrovalve clippings, which he described as “procedures which otherwise would have been done under (general) anesthesia in an open-heart setting.”

Rothman announced plans for $5 million in upgrades to the operating facilities, including $2 million for the sterile processing area and $3 million for a brand-new cardiac catheterization lab to be completed in the spring of 2025.

Michael Kint, the board’s treasurer, asked Rothman to address the community’s concerns about doctor and staff turnover, the misconception that people are “leaving in droves.”

“We continue to see physicians leaving the workforce for reasons that are outside of the control of the Cleveland Clinic,” Rothman said.

“On the physician side, the physician turnover has been high. That being said, we’ve begun to see that stabilize really over the last 12 months. Our number of oncology providers has doubled. Our number of general surgeons has increased.  In fact, another general surgeon will be joining us next month,” Rothman added.

“There’s a national trend for healthcare workers, both nurses and physicians, to leave the workforce and we’re not immune to that here at Cleveland Clinic Indian River Hospital,” Rothman said.

Numerous caregivers have relocated, he said, and the lack of housing options in Vero Beach is a challenge for finding and retaining nurses.

But he added, “We have seen our attrition rates significantly slow and our number of travelers that we have return to pre-pandemic levels.

“We continue to see our attrition rates decline; that’s the result of improved caregiver engagement.”

Despite these challenges, Rothman said Cleveland Clinic Indian River Hospital is considered a four-star hospital in comparison with other hospitals nationwide, and is ranked among Florida’s top hospitals by U.S. News and World Report, which considering that the entire county only has 170,000 people, is quite an achievement.

He said patient outcomes are good, and Cleveland Clinic’s innovative Hospital at Home program is improving patient experiences while managing costs and providing local jobs, as the regional program is headquartered and staffed in Vero Beach.

Rothman said Cleveland Clinic is the largest private employer in Indian River County with 2,500 people on the payroll, and with the addition of 100 Hospital at Home staff, has surpassed the local School District in total employees.