After losing more than $200 million since taking over Indian River Hospital in 2019, Cleveland Clinic saw a dramatic improvement in its bottom line in 2025, ending the year with $28.7 million in losses as compared to $49 million in 2024.

Even more impressive, the hospital’s day-to-day operating loss dropped from $29 million in 2024 to $6.8 million last year, an improvement of 76 percent, or $22.2 million, in one year. The $6.8 million operating deficit is part of last year’s overall $28.7 million loss.

Hospital Vice President and Chief Medical Officer Dr. Richard Rothman said the overall loss figure includes depreciation for capital improvements made to the Vero campus facilities, such as the $7 million spent on revamping the Labor and Delivery Unit and millions invested in the first steps of overhauling the Emergency Department, which goes full steam ahead this year.

It also includes the cost of major equipment purchases, re-plumbing and rewiring some hospital buildings, and a cosmetic re-do of employee break areas to improve the work environment and reduce burnout.

When it leased the hospital buildings from the Indian River County Hospital District, Cleveland Clinic agreed to make much-needed major physical improvements to the hospital in lieu of paying rent and those expenses drag on its bottom line.

“Cleveland Clinic Indian River Hospital continued investing in 2025 to make the hospital the safest place to receive care and increase access for patients, upgrading its imaging center with advanced technologies like 3D mammography with Artificial Intelligence capabilities, high-resolution 3-Tesla MRIs, and cutting-edge CT scanners,” Rothman said. “State-of-the-art heart ultrasounds and new cardiac catheterization suites were also added.”

Meanwhile, Rothman keeps a close eye on his operating bottom line, which has been trending positive for more than a year. Rather than instituting austerity measures and cutting staff, Rothman remained confident he could grow the hospital out of the financial hole that existed when he took over in 2024.

As part of his turnaround strategy, Rothman aggressively recruited out-of-town cardiologists, urologists, oncologists and surgeons, selling them on the lifestyle Vero Beach has to offer. At the same time, Rothman courted beloved local physicians to re-join the Cleveland Clinic team – including some who had departed rather publicly after the 2019 takeover, unhappy with abrupt changes and the new corporate leadership.

Better access to high-quality specialists and surgeons in Vero Beach enabled the hospital to bring in more patients, thereby increasing volume, market share and revenues, without making any major cuts.

“Since Cleveland Clinic acquired Indian River Medical Center in 2019, the number of physicians and advanced practitioners employed by Cleveland Clinic in Indian River County has grown by 170 percent,” Rothman said. “We have added 120 new physicians and over 100 advanced practice providers.

“Cleveland Clinic Indian River Hospital is now the largest employer in the county with more than 2,600 caregivers – an increase of over 30 percent since 2019.”

In 2025, the hospital handled more than half a million patient visits and delivered 850 babies – a 10 percent increase in deliveries over 2024.

“The Scully-Welsh Cancer Center ... added four new hematologists-oncologists, increasing access to cancer specialists,” Rothman said. “The Welsh heart team grew to more than 20 physicians and advanced practitioners specializing in cardiac care.”

So far in 2026, the influx of physicians continues. In February, Cleveland Clinic acquired the Orthopedic Center of Vero Beach with three surgeons and an impressive book of business, bringing the number of orthopedic surgeons in-house to 15.

“The orthopedics department expanded to complement our strong community partnerships with local orthopedic specialists who choose Cleveland Clinic Indian River Hospital for their patients,” Rothman said.

One of the financial challenges Cleveland Clinic faces in Indian River County is a high number of Medicare patients. More than 70 percent of the hospital’s patients are on Medicare, and the hospital loses money on every one of those patients because Medicare reimbursements cover only a fraction of the cost of on-site hospital care.

In response, Dr. Rothman has expanded Cleveland Clinic’s Hospital Care At Home program, which allows patients to go home faster after an illness or surgery but still be monitored 24 hours a day, online and in person, by skilled medical staff located in Vero Beach. Research has shown that shorter stays benefit patients in a wide range of ways – and they are good for the hospital’s bottom line.

“Healthcare costs continue to increase across the country,” Rothman said. “We have asked our teams to continue to find innovative opportunities to reduce the cost of care while maintaining high quality and patient safety.”

The Behavioral Health Center across the street from the main hospital took this challenge seriously. In 2025 the Center moved from a $4 million operating loss to break even for its in-patient and outpatient services.

Rothman also banked on the hypothesis that patient outcomes and satisfaction scores would organically improve with more specialist and surgical options, shorter wait times and shorter hospitalizations.

In turn, improved outcomes and increased patient satisfaction can reasonably be expected to attract new patients and more revenue.

So far, this bold approach has seemed to work.

“In 2025, Cleveland Clinic Indian River Hospital earned recognition as one of Florida’s top hospitals for quality and patient safety from Forbes and was ranked in the top 10 percent of hospitals in Florida by US News,” Rothman said. “The Welsh Heart Center received a Society of Thoracic Surgery 3-star designation, the highest possible score for heart surgery, such as coronary artery bypass graft.”

Rothman said it was important to begin the financial and operational turnaround last year because Vero Beach needs Cleveland Clinic to be successful for the long haul.

“Everything we’ve accomplished over the past year reflects a singular focus – making Cleveland Clinic Indian River Hospital the safest place for patients to receive care while expanding access to the advanced services our community needs,” Rothman said. “From growing our physician team to investing in critical facilities like the Emergency Department, we’re building for the future while never losing sight of the patients and families who rely on us every day.”

The hospital also receives public support. Local taxpayers will contribute $7.1 million to Cleveland Clinic’s Vero operations this fiscal year, via the Indian River County Hospital District.

Because it receives public money, Hospital District Trustee Paul Westcott has pressed for greater transparency in hospital finances and for the district to take a greater oversight role. Upon hearing of the financial progress made in 2025, Westcott said he’s pleased to see Cleveland Clinic bettering hospital finances while continuing to make major capital investments that benefit the whole community.

“I’m really encouraged by the work that the leadership has been doing at the hospital these past couple of years, and this year appears to be the tipping point. Dr. Rothman seems to be finding the sweet spots in getting the hospital into the black real soon,” Westcott said.

When the financial numbers post for Indian River in 2026, Rothman said locals should be prepared to see the hospital’s on-paper overall losses – which include capital depreciation and investments – to be larger than the $28.7 million posted for 2025, because he has two expensive projects underway.

“We recognize the demand for Cleveland Clinic quality and safety of care required an upgrade of our Emergency Department, and in early 2026 we kicked off an $18 million renovation, with the first phase to be completed in the summer of 2026 and the second phase by early 2027,” Rothman said.

To make Cleveland Clinic Indian River more energy efficient and more resilient to hurricanes and tropical storms, “we started a $90 million investment to enhance the central [power] plant at the hospital,” Rothman said.

The Cleveland Clinic Foundation also plans to construct a workforce housing community this year on 14 acres of donated land on U.S. 1 between The Antilles and Grand Harbor, expanding the hospital’s footprint in the county.