State of the Clinic 214
INSIDE 1 Caregivers 5 Cleveland Clinic Clinical Activity 13 Cleveland Clinic Health System 17 Quality 19 Patient Experience 25 Research 28 Education 31 Market Analysis 32 Outreach 34 Financial 39 Completed in 214 4 Future 45 214 Sones Innovation Award
CEO s Address Dear Friends: Welcome to the 214 Cleveland Clinic State of the Clinic Annual Report. This yearly publication delivers key metrics on the full range of our clinical and operational activities. We share these data to be accountable and transparent to the communities we serve. Cleveland Clinic continues to expand to meet the needs of our patients in Northeast Ohio, nationally and abroad. We have three new buildings underway on our main campus: a cancer treatment building, health education campus and hotel. In regional operations, we opened an emergency department in Brunswick, Ohio, and broke ground for a hospital tower in Avon, Ohio. Plans have been announced for a new health and wellness campus in Lakewood, Ohio. In Weston, Florida, we near completion of the Egil and Pauline Braathen Center that will house both the Pauline Braathen Neurological Center and the Maroone Cancer Center. We are especially proud of Cleveland Clinic Abu Dhabi (cover), which will begin offering patient care services in 215. To staff this 2.7-million-square-foot facility, we have successfully completed the largest physician-recruitment effort ever undertaken. Cleveland Clinic Abu Dhabi will have a strong positive impact on the health of its region, and will benefit the people of all our communities. Medical providers everywhere are looking for ways to increase value and lower costs. Cleveland Clinic is at the forefront of data-driven quality and evidence-based care. We are committed to giving every patient the best outcome and experience at an affordable cost. Thank you for your interest in the state of Cleveland Clinic. We wish you the best of health in the year ahead. Sincerely, Delos M. Cosgrove, MD Chief Executive Officer
214 State of the Clinic 1 CAREGIVERS Ohio and Florida Staff 3,5 Florida 3, Ohio 2,5 2, 1,5 1, 5 22 24 26 28 21 212 214 The professional staff and scientists at all locations now number 3,15, which is a 2% reduction from 213. Women on Staff 4 3 % 2 1 1993 21 26 27 28 29 21 211 212 213 214 Women accounted for 36% of all staff in 214.
2 214 State of the Clinic CAREGIVERS Staff Turnover 12 % 1 8 6 4 2 Florida Ohio 22 24 26 28 21 212 214 In 214, professional staff turnover was 7.7% in Ohio and 9.2% in Florida, which included the largest number of retirees in our history. Physician Leaders 3 284 25 2 15 1 69 5 Male 25 29 Female In 214, there were 353 physicians in leadership roles, 2% of whom are women.
214 State of the Clinic 3 CAREGIVERS Spin-Off Companies 8 7 6 5 4 3 2 1 22 24 26 28 21 212 214 Cleveland Clinic continues to generate new businesses based on its own innovations. A total of 71 have been spun off since 21. Patent Activity 3, Filed 2,722 2,5 2, 1,5 1, 5 Granted 715 22 24 26 28 21 212 214 Cleveland Clinic filed 2,722 cumulative patents and had 715 granted through 214.
4 214 State of the Clinic CAREGIVERS Support Staff Growth 45 4 Thousands 35 3 25 22 24 26 28 21 212 214 In 214 the number of caregivers decreased to 42,523 at year-end. Support Staff Turnover 14 12 % 1 8 6 24 26 28 21 212 214 Turnover among caregivers in support roles averaged 13% in 214, which is higher than the national benchmark of 12.5%.
214 State of the Clinic 5 CLEVELAND CLINIC CLINICAL ACTIVITY Patient Distribution Ohio 14% U.S. 15% 7 Counties 72% International.2% In 214, 72% of patients came from Cleveland and the seven adjacent counties. This distribution has remained constant for the past several years. Total Visits to Family Health Centers 3. 2.5 Millions 2. 1.5 1..5. 22 24 26 28 21 212 214 Visits at our family health centers increased by 1% in 214 to over 2.5 million.
6 214 State of the Clinic CLEVELAND CLINIC CLINICAL ACTIVITY Outpatient Visits 6 5 Millions 4 3 2 1 1998 2 22 24 26 28 21 212 214 Outpatient visits for Cleveland and Florida increased 6% in 214 to more than 5.9 million. Same-Day Visits 1,25 1, Thousands 75 5 25 29 21 211 212 213 214 Same-day visits increased by 22% over last year, improving access and exceeding 1.1 million.
214 State of the Clinic 7 International Patients Distribution Other 24% Middle East 4% Central America 4% Asia 5% Mexico 2% Turkey 2% Europe 5% South America 5% Canada 6% Caribbean 7% Currently, 4% of international patients are from the Middle East. International Patients Volume 5 4 Thousands 3 2 1 29 21 211 212 213 214 The number of unique international patients increased by 22% in 214 to 4,431.
8 214 State of the Clinic CLEVELAND CLINIC CLINICAL ACTIVITY Acute Admissions 6 Thousands 4 2 2 22 24 26 28 21 212 214 Acute admissions at main campus decreased by 2% to 53,337. ALOS (Average Length of Stay) 7. 6.5 Days 6. 5.5 5. 24 26 28 21 212 214 The main campus average length of stay increased by 2% to 6.6 days.
214 State of the Clinic 9 CLEVELAND CLINIC CLINICAL ACTIVITY Hospital Transfers 25 2 Thousands 15 1 5 26 27 28 29 21 211 212 213 214 In 214 there were over 25, hospital transfers within the system. Hospital Transfers Percentage of Total Census 35 3 % 25 2 15 1 5 26 27 28 29 21 211 212 213 214 Transfers into our hospital accounted for 33% of our total census in 214.
1 214 State of the Clinic CLEVELAND CLINIC CLINICAL ACTIVITY 5, 4, Critical Care Team Transports Plane Helicopter Ambulance Thousands 3, 2, 1, 28 29 21 211 212 213 214 The critical care transport team continues to transport a significant number of patients into Cleveland Clinic. Average Daily Census 1, 75 5 22 24 26 28 21 212 214 The average daily census at main campus remained consistent in 214 at 969.
214 State of the Clinic 11 CLEVELAND CLINIC CLINICAL ACTIVITY Surgical Cases Inpatient 3 Thousands 2 1 22 24 26 28 21 212 214 Inpatient surgery at main campus decreased 2% in 214 to 25,727. Surgical Cases Outpatient 7 6 5 Thousands 4 3 2 1 22 24 26 28 21 212 214 Outpatient surgical cases remained consistent at main campus in 214 at 64,247.
12 214 State of the Clinic CLEVELAND CLINIC CLINICAL ACTIVITY Case Mix 3. 2.5 Medicare 2. 1.5 1..5. 22 24 26 28 21 212 214 The average case mix at Cleveland Clinic increased slightly to 2.37 while the Medicare case mix decreased slightly to 2.47. Emergency Room Visits Thousands 12 Brunswick 11 Avon Twinsburg 1 Main Campus 9 8 7 6 5 4 3 22 24 26 28 21 212 214 In 214, Cleveland Clinic opened a freestanding emergency department at Brunswick Family Health Center, which had 6,486 visits. Total emergency room visits at main campus, Twinsburg, Avon and Brunswick increased by 11% to 112,42. Main campus visits increased by 2% to 62,852.
214 State of the Clinic 13 CLEVELAND CLINIC HEALTH SYSTEM Acute Admissions 16 14 Thousands 12 1 2 22 24 26 28 21 212 214 Adult acute admissions across the system decreased by 3% in 214 to 14,63. ALOS (Average Length of Stay) 5.5 5. Days 4.5 4. 22 24 26 28 21 212 214 Systemwide, length of stay increased slightly to 5.28 days in 214.
14 214 State of the Clinic CLEVELAND CLINIC HEALTH SYSTEM Occupancy 1 8 % 6 4 2 22 24 26 28 21 212 214 The combined system occupancy rate declined slightly to 66.9% in 214. Acute Patient Days 1, 8 Thousands 6 4 2 22 24 26 28 21 212 214 The number of acute patient days across the system decreased 2% in 214 to 745,.
214 State of the Clinic 15 CLEVELAND CLINIC HEALTH SYSTEM Surgical Cases Inpatient 75 Thousands 5 25 22 24 26 28 21 212 214 Inpatient surgery across the system decreased by 3% to 55,56 cases in 214. Surgical Cases Outpatient 15 Thousands 1 5 22 24 26 28 21 212 214 Outpatient surgical cases decreased slightly in 214 to 137,86.
16 214 State of the Clinic CLEVELAND CLINIC HEALTH SYSTEM Emergency Room Visits 5 Thousands 45 4 35 3 22 24 26 28 21 212 214 Emergency room visits across the system increased 5% to 497,681. Emergency Departments Door to Doctor Time 5 Minutes 4 3 2 Target = 3 minutes 1 14 minutes 21 211 212 213 214 The time it takes a patient to be seen by a physician in the emergency department (ED) is a key quality metric. Cleveland Clinic EDs averaged 17.8 minutes in 214.
214 State of the Clinic 17 QUALITY All-Cause Readmissions 15 % 1 Goal 13% 5 212 213 214 Reducing all readmissions will be a major focus in 215. CCHS Patient Safety Indicators 25 per Month 2 15 1 5 Goal 69 211 212 213 214 A lower combined number of patient safety events is a prime goal in 215.
18 214 State of the Clinic QUALITY Hospital-Acquired Infections per Month 45 4 35 3 25 2 15 1 5 Goal 15 213 214 The combined infection rate continues to decrease over time. Hospital-Acquired Infections C. Difficile 15 per Month 1 5 Goal 5 213 214 The reduction of C. difficile infection will be an important patient safety goal in 215.
214 State of the Clinic 19 PATIENT EXPERIENCE Web Contact Requests 65 55 Thousands 45 35 25 15 5 22 24 26 28 21 212 214 The number of people visiting and requesting additional information from our website and live chats remains strong. Online Appointment Requests 7 6 Thousands 5 4 3 2 1 22 24 26 28 21 212 214 Appointment scheduling requests via the Internet reached 62,14 in 214, a 1% year-over-year increase.
2 214 State of the Clinic PATIENT EXPERIENCE Social Media Facebook Thousands 1,4 1,239,461 1,2 1, 8 6 4 2 211 212 213 214 Increasing numbers of people are interacting with us through social media. Our Facebook fan numbers continue an impressive increase to more than 1.2 million. Social Media Twitter Thousands 4 35 3 25 2 15 1 5 211 212 213 214 344,152 Twitter chats are more successful than ever this year. Our total number of followers has exploded to over 34,.
214 State of the Clinic 21 PATIENT EXPERIENCE MyChart Users 2,5 2, 1.97M Thousands 1,5 1, 5 24 26 28 21 212 214 MyChart enables patients to have an active role in monitoring their healthcare. Since 212, all patients with an appointment have been enrolled in the application. DrConnect Users 8, 7, 6,867 6, 5, 4, 3, 2, 1, 26 27 28 29 21 211 212 213 214 DrConnect provides referring physicians with access to data on their patients referred to Cleveland Clinic.
22 214 State of the Clinic PATIENT EXPERIENCE Caregiver Survey 1 Percentile Rank 8 6 4 59 66 2 Engagement 25 29 Safety In 214 the annual caregiver survey included both engagement and safety and will provide new data points for external comparison and rankings. CC Complaints and Grievances Rate per 1, 5. 4.5 4. 3.5 3. 2.5 2. 1.5 1..5. 21 211 212 213 214 The rate of patient complaints and grievances is gradually trending downward.
214 State of the Clinic 23 PATIENT EXPERIENCE CCHS Patient Satisfaction 1 8 Percentile Rank 6 4 2 28 29 21 211 212 213 214 The percentage of patients rating Cleveland Clinic health system hospitals in the top performing categories continues to rise but is still well below our 9th percentile goal. CCHS HCAHPS Percentile Rank 1 8 6 4 82 71 7 66 62 52 5 National Average 32 2 D/C Info Room Clean Nurse Comm Pain Manage Meds Comm Staff Response Doc Comm Quiet The HCAHPS domain scores continue to make steady improvement but are still below the 9th percentile goal.
24 214 State of the Clinic PATIENT EXPERIENCE 1 8 CCHS Outpatient Satisfaction Cleveland Clinic CAHPS Database Average % Best Response 6 4 2 Access Provider Communication Primary Care Specialty Care Provider Rating Office Support CAHPS is the outpatient patient experience survey. The results for 214 exceed the national average for communication and overall provider rating. CCHS Volunteer Hours 21 16 11 Thousands 6 1 27 28 29 21 211 212 213 214 Volunteers provided over 19, hours of service to our patients and facilities in 214.
214 State of the Clinic 25 RESEARCH Total Research Funding $ Millions 3 25 2 15 1 5 Other Cleveland Clinic Corporate Federal 24 26 28 21 212 214 Total research funding from all sources was $255 million in 214. This represents a 3% increase over last year. NIH Funding 12 1 $ Millions 8 6 4 2 24 26 28 21 212 214 NIH funding decreased 5% from the previous year, totaling $92 million in 214.
26 214 State of the Clinic RESEARCH Research Staff 16 14 12 1 8 6 4 2 2 22 24 26 28 21 212 214 Research staff numbers in Lerner Research Institute remained nearly flat at 149 in 214. LRI Publications 1,6 1,4 1,2 Books Chapters Articles 1, 8 6 4 2 24 26 28 21 212 214 Lerner Research Institute generated over 1,5 publications in 214.
214 State of the Clinic 27 RESEARCH Research Activity 2.5 2. Thousands 1.5 1..5. 22 24 26 28 21 212 214 Research activity was nearly consistent with last year, at slightly more than 2,1 projects.
28 214 State of the Clinic EDUCATION Cleveland Clinic Health System Residents and Fellows 2, 1,8 1,6 1,4 1,2 1, 24 26 28 21 212 214 There were 1,757 clinical and research residents and fellows across the system in 214. CME Activities 2, 1,5 1, 5 26 26 28 28 21 21 212 212 214 The number of CME activities sponsored by the Education Institute make Cleveland Clinic s CME program one of the largest in the United States.
214 State of the Clinic 29 EDUCATION Lerner College of Medicine Applications 2, 1,5 1, 5 25 27 29 211 213 215 The medical school received 1,476 applications for 32 positions in the incoming 215 class. Lerner College of Medicine Comparative MCAT Scores 13 12 11 1 Wash Univ Univ Penn 25 Yale Harvard Univ Chicago Cleveland Clinic Columbia 29 Johns Hopkins Duke The 213 MCAT scores of accepted medical students at Lerner College of Medicine remained among the top seven in the United States.
3 214 State of the Clinic EDUCATION Lerner College of Medicine MCAT Scores 12.5 12. 11.5 11. 1.5 1. 9.5 9. 25 27 29 211 213 215 Nat l Avg. MCAT scores of accepted applicants continue to surpass the national average. Cleveland Clinic Academy Participants 2,5 2, 1,5 1, 5 27 28 29 21 211 212 213 214 Enrollment in classes at Cleveland Clinic Academy remained high, with four new class series added in 214.
214 State of the Clinic 31 MARKET ANALYSIS Cleveland Clinic Health System Market Share Cuyahoga County 55 % 5 45 4 24 26 28 21 212 214 Market share in Cuyahoga County decreased slightly in 214 to 45.5%. National Brand Awareness 4 3 % 2 1 24 26 28 21 212 214 Brand awareness is determined utilizing a survey that measures our name recognition. In 214 the percentage of people who responded positively increased to 37%.
32 214 State of the Clinic MARKET ANALYSIS Competitive Brand Awareness 1 8 Johns Hopkins Mayo Clinic % 6 4 Cleveland Clinic 2 Mass General 24 26 28 21 212 214 Although our name recognition has steadily increased, it remains substantially behind that of industry leaders. OUTREACH Community Benefit 213 * 8 653 6 $ Millions 4 2 26 2725 28 29 2721 29 211 212 213 The community benefit provided across the health system continues to increase each year. It totaled $653 million in 213. *Year of the most recent available data.
214 State of the Clinic 33 OUTREACH 2. United Way Goal = $1.9 Million 1.5 $ Millions 1..5. 24 26 28 21 212 214 In 214, Cleveland Clinic caregivers contributed more than $1.9 million to United Way. Community Benefit 213 Total $653 Million * Research $7M Clinical Services $361M Education $222M Cleveland Clinic provided over $653 million in community benefit in 213, including $361 million in clinical services. *Year of the most recent available data.
34 214 State of the Clinic FINANCIAL Total Operating Revenue 7 6 $ Billions 5 4 3 2 1 2 22 24 26 28 21 212 214 The total revenue increased by 4% to $6.7 billion in 214. Operating Revenue Allocation Patient Patient Revenue $262M 91% Grants 3% Philanthropy 1% Other 5% Ninety-one percent of revenue came from patient care in 214.
214 State of the Clinic 35 FINANCIAL Operating Income 5 4 $ Millions 3 2 1-1 2 22 24 26 28 21 212 214 Total operating income increased 6% to $466 million in 214. Operating Income Health Information Technology Incentive $22M Patient Revenue $262M Patient Revenue $4M Philanthropy $21M Intellectual Property/ Business $23M Of the $466 million in operating income in 214, $4 million came from patient care.
36 214 State of the Clinic FINANCIAL Days Cash on Hand 4 3 Days 2 1 24 26 28 21 212 214 Days cash on hand continued to improve, ending the year at 376 days. Philanthropy 3 25 $ Millions 2 15 1 5 22 24 26 28 21 212 214 Pledges and gifts totaled a record high of $255 million in 214.
214 State of the Clinic 37 FINANCIAL Malpractice Costs 14 12 $ Millions 1 8 6 4 2 22 24 26 28 21 212 214 Malpractice costs in 214 increased slightly to $57 million. Cash, Investments and Debt $ Billions 8 7 6 5 4 3 2 1 Cash and Investments Debt 1998 2 22 24 26 28 21 212 214 Total cash and investments increased to $6.9 billion in 214, while outstanding debt increased to $3.7 billion during the same time period.
38 214 State of the Clinic FINANCIAL Uncompensated Care 3 25 Charity Bad Debt $ Millions 2 15 1 5 24 26 28 21 212 214 Uncompensated care totaled $211 million in 214. This 27% reduction from last year reflects an increase in Medicaid patients due to Medicaid expansion throughout Ohio and a resulting decrease in self-pay patients. Long-Term Investments $ Billions 7 6 5 4 3 2 1 2 22 24 26 28 21 212 214 Long-term investments remained positive at $6.5 billion in 214. The investment strategy continues to be balanced between risk and reward and strives to exceed industry benchmarks.
214 State of the Clinic 39 COMPLETED IN 214 Brunswick Family Health Center Emergency Department The new $2 million ED includes 18 treatment spaces, including two fully equipped critical care rooms, separate entrances for patients and ambulances, imaging, laboratory services, and a rooftop helipad for quick transport of critical patients. Global Center for Health Innovation Cuyahoga County s new exhibition facility welcomed the 214 Cleveland Clinic Medical Innovation Summit; Patient Experience: Empathy + Innovation Summit; Martin Luther King Jr. Holiday Community Breakfast; and the VeloSano bike race, which brought 8 cyclists downtown.
4 214 State of the Clinic We are considering not only our duty to the patient of today, but no less our duty to the patient of tomorrow. George Crile Sr., MD Co-Founder, Cleveland Clinic FUTURE FUTURE Cleveland Clinic Abu Dhabi Cleveland Clinic Abu Dhabi Almost 3, Caregivers, including 175 physician staff, have joined Cleveland Almost 3, Clinic caregivers, Abu Dhabi, including a world-class 175 physician multispecialty staff, have hospital joined in Cleveland Abu Dhabi, Clinic UAE. Abu The Dhabi, hospital the Persian will provide Gulf s patients premier in specialty the region direct medical access center to and the world s first best all-digital healthcare hospital. providers Patients and Cleveland are now Clinic s being cared unique for model in the of new care, facilities. reducing their need to travel abroad for treatment.
214 State of the Clinic 41 FUTURE Avon Hospital Ground was broken for a 126-room hospital of the future designed for expedited stays, enhanced experience and operational efficiency. The $143 million, 221,5-square-foot neighbor to the Richard E. Jacobs Health Center will open in 216. Select Rehabilitation Hospital Avon Cleveland Clinic is partnering with Select Medical to open a 6-bed adult rehabilitation hospital near the Richard E. Jacobs Health Center. Select Medical will construct the building, scheduled to open in 215.
42 214 State of the Clinic FUTURE Cancer Treatment Building Ground was broken for a 377,-square-foot, seven-floor center to consolidate all outpatient cancer services. The $276 million project will optimize patient experience and physician collaboration, and connect with other main campus buildings by skyway. The Egil and Pauline Braathen Center, housing the Pauline Braathen Neurological Center and the Maroone Cancer Center This five-story, $9 million facility opened in February 215. The 143,-square-foot building includes a neurointerventional lab, radiosurgery, chemotherapy and radiation oncology, as well as a pharmacy, rehabilitation gym, resource center, art therapy, and more.
214 State of the Clinic 43 FUTURE Health Education Campus A new home for Case Western Reserve University s schools of Medicine, Dental Medicine and Nursing and the Lerner College of Medicine is being designed by Foster + Partners. With four stories and a central atrium, it will promote interdisciplinary learning. Holiday Inn A private developer will build a 274-room hotel on a site leased from Cleveland Clinic, at Euclid Avenue and East 86th Street. The nine-story, 175,-square-foot replacement for the Guesthouse should open in 216.
44 214 State of the Clinic FUTURE Lutheran Hospital Emergency Department This $17.5 million expansion doubles the current ED to 14, square feet and raises the bed total to 21, all private. It also adds entrances, behavioral health capacity, enhanced triage and emergency decontamination. It will open in 215.
214 State of the Clinic 45 214 Irene Katzan, MD SONES INNOVATION AWARD RECIPIENT Irene Katzan, MD, of the Neurological Institute, created the Knowledge Program (KP), an initiative to improve the collection of discrete clinical information within the Epic system and make it retrievable for research, quality improvement and patient care. KP gathers data before outpatient visits and consolidates them into a single database for analysis with Epic documentation. Today, 74 centers are using Dr. Katzan s innovation for an expanding range of beneficial results. The F. Mason Sones Award is named for the innovator whose discovery of moving cine-coronary angiography at Cleveland Clinic launched the modern era of cardiovascular care. It comes with a $5, prize.
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