State of the CliniC | 2014

State of the CliniC | 2014

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 2014

40 future

45 2014 Sones Innovation award

Ceo’S aDDReSS

Dear friends:

Welcome to the 2014 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 2015. to staff this 2.7-million-square-foot facility, we have successfully completed the largest physician-recruitment effort ever under-taken. 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 afford-able 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, MDChief Executive Officer

2014 State of the Clinic | 1

CaReGIVeRS

the professional staff and scientists at all locations now number 3,150, which is a 2% reduction from 2013.

Women accounted for 36% of all staff in 2014.

0

10

20

30

40

%

Women on Staff

1993 2006 2007 2008 2009 2010 2011 2012 2013 20142001

#

Ohio and Florida Staff

2002 2008200620040

500

1,000

1,500

2,000

2,500

3,000

3500

3,500 ■ Florida■ Ohio

20122010 2014

2 | 2014 State of the Clinic

CaReGIVeRS

In 2014, there were 353 physicians in leadership roles, 20% of whom are women.

0

50

100

150

200

250

300

Physician Leaders

2005Male 2009Female

284

69

#

0

2

4

6

8

10

12

%

Staff Turnover

2002 2004 2006 2008 2010 2012 2014

Florida

Ohio

In 2014, professional staff turnover was 7.7% in ohio and 9.2% in florida, which included the largest number of retirees in our history.


Cleveland Clinic filed 2,722 cumulative patents and had 715 granted through 2014.

CaReGIVeRS

0

500

1,000

1,500

2,000

2,500

3,000

#

Patent Activity

2002 2004 2006 2008 2010 2012

Filed 2,722

Granted 715

2014

0

10

20

30

40

50

60

70

80

#

Spin-Off Companies

2004 2006 2008 2010 20122002 2014

Cleveland Clinic continues to generate new businesses based on its own innovations. a total of 71 have been spun off since 2001.


#Thousands

Support Staff Growth

2006 20122010200825

30

35

40

45

201420042002

6

8

10

12

14

%

Support Staff Turnover

2006 2008 2010 2012 20142004

In 2014 the number of caregivers decreased to 42,523 at year-end.

turnover among caregivers in support roles averaged 13% in 2014, which is higher than the national benchmark of 12.5%.

CaReGIVeRS


U.S. 15%

International 0.2%

7 Counties 72%

Ohio 14%

Patient Distribution

0.0

0.5

1.0

1.5

2.0

2.5

3.0

# Millions

Total Visits to Family Health Centers

20042002 2006 2008 2010 2012 2014

In 2014, 72% of patients came from Cleveland and the seven adjacent counties. this distribution has remained constant for the past several years.

Visits at our family health centers increased by 10% in 2014 to over 2.5 million.

CLeVeLaND CLINIC CLINICaL aCtIVItY

U.S. 6%

International 0.4%

7 Counties 77%

Ohio 17%

Patient Distribution



0

1

2

3

4

5

6

#Millions

Outpatient Visits

2002 20042000 2008 20102006 20121998 2014

outpatient visits for Cleveland and florida increased 6% in 2014 to more than 5.9 million.

0

250

500

750

1,000

1,250

# Thousands

Same-Day Visits

2009 2010 2011 2012 2013 2014

Same-day visits increased by 22% over last year, improving access and exceeding 1.1 million.


0

1

2

3

4

5

#Thousands

International Patients – Volume

2009 2010 20122011 20142013

the number of unique international patients increased by 22% in 2014 to 4,431.

Currently, 40% of international patients are from the Middle east.

South America 5%

Middle East 40%

Caribbean 7%Canada 6%

Europe 5%

Turkey 2%

Mexico 2%

Asia 5%

Central America 4%

Other 24%

International Patients – Distribution



0

20

40

60

#Thousands

Acute Admissions

20022000 2004 2006 2008 2010 2012 2014

5.0

5.5

6.0

6.5

7.0

#Days

ALOS (Average Length of Stay)

20062004 2012 201420102008

acute admissions at main campus decreased by 2% to 53,337.

the main campus average length of stay increased by 2% to 6.6 days.

0

5

10

15

20

25

30

35

%

Hospital Transfers –Percentage of Total Census

2006 2007 2008 2009 2010 2011 2012 20142013



0

5

10

15

20

25

#Thousands

Hospital Transfers

2006 2007 2008 2009 2010 2011 20142012 2013

0

5

10

15

20

25

30

35

%

Hospital Transfers –Percentage of Total Census

2006 2007 2008 2009 2010 2011 2012 20142013

In 2014 there were over 25,000 hospital transfers within the system.

transfers into our hospital accounted for 33% of our total census in 2014.



the average daily census at main campus remained consistent in 2014 at 969.

0

1,000

2,000

3,000

4,000

5,000

#Thousands

Critical Care Team Transports

2008 2009 2010

■ Plane■ Helicopter■ Ambulance

2011 2012 20142013

the critical care transport team continues to transport a significant number of patients into Cleveland Clinic.

500

750

1,000

#

Average Daily Census

2004 2006 2008 2010 2012 20142002



Inpatient surgery at main campus decreased 2% in 2014 to 25,727.

0

10

20

30

#Thousands

Surgical Cases – Inpatient

20042002 2006 2008 2010 2012 2014

outpatient surgical cases remained consistent at main campus in 2014 at 64,247.

#Thousands

Surgical Cases – Outpatient

2002 2004 2006 2008 2010 2012 20140

10

20

30

40

50

60

70



the average case mix at Cleveland Clinic increased slightly to 2.37 while the Medicare case mix decreased slightly to 2.47.

0.0

0.5

1.0

1.5

2.0

2.5

3.0

#

Case Mix

2006 2008 2010 2012 2014

Medicare

20042002

In 2014, 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 112,042. Main campus visits increased by 2% to 62,852.

#Thousands

Emergency Room Visits

2004 2006 2008 2010 2012 201430405060708090

100110120 ■ Brunswick

■ Avon■ Twinsburg■ Main Campus

2002


CLeVeLaND CLINIC HeaLtH SYSteM

adult acute admissions across the system decreased by 3% in 2014 to 140,603.

Systemwide, length of stay increased slightly to 5.28 days in 2014.

100

120

140

160

#Thousands

Acute Admissions

2000 2004 2006 2008 2010 2012 20142002

4.0

4.5

5.0

5.5

#Days

ALOS (Average Length of Stay)

2012201020062004 20142002 2008



0

20

40

60

80

100

%

Occupancy

2006 2008 2010 2012 201420042002

the combined system occupancy rate declined slightly to 66.9% in 2014.

0

200

400

600

800

1,000

# Thousands

Acute Patient Days

2008 2010 2012 2014200620042002

the number of acute patient days across the system decreased 2% in 2014 to 745,000.



0

25

50

75

#Thousands

Surgical Cases – Inpatient

2004 2006 2008 2010 2012 20142002

Inpatient surgery across the system decreased by 3% to 55,560 cases in 2014.

outpatient surgical cases decreased slightly in 2014 to 137,086.

0

50

100

150

#Thousands

Surgical Cases – Outpatient

2004 2006 2008 2010 2012 20142002



300

350

400

450

500

# Thousands

Emergency Room Visits

2002 20062004 2008 2010 20142012

emergency room visits across the system increased 5% to 497,681.

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 2014.

0

10

20

30

40

50

Minutes

Emergency Departments –Door to Doctor Time

2010 2011 2012 2013 2014

Target = 30 minutes

14 minutes


QUaLItY

0

5

10

15

%

All-Cause Readmissions

Goal ≤ 13%

20132012 2014

0

50

100

150

200

250

#per

Month

CCHS Patient Safety Indicators

Goal ≤ 69

2011 2012 2013 2014

Reducing all readmissions will be a major focus in 2015.

a lower combined number of patient safety events is a prime goal in 2015.


QUaLItY

05

1015202530354045

#per

Month

Hospital-Acquired Infections

Goal ≤ 15

2013 2014

0

50

100

150

#per

Month

Hospital-Acquired InfectionsC. Difficile

Goal ≤ 50

2013 2014

the combined infection rate continues to decrease over time.

the reduction of C. difficile infection will be an important patient safety goal in 2015.


PatIeNt eXPeRIeNCe

5

15

25

35

45

55

65

#Thousands

Web Contact Requests

20042002 2006 2008 2010 2012 2014

20042002 2006 2008 2010 2012 20140

10

20

30

40

50

60

70

#Thousands

Online Appointment Requests

appointment scheduling requests via the Internet reached 62,140 in 2014, a 10% year-over-year increase.

the number of people visiting and requesting additional information from our website and live chats remains strong.


PatIeNt eXPeRIeNCe

0

200

400

600

800

1,000

1,200

1,400

#Thousands

Social Media – Facebook

2011 2012 2013 2014

1,239,461

0

50

100

150

200

250

300

350

400

#Thousands

Social Media – Twitter

2011 2012 2013 2014

344,152

twitter chats are more successful than ever this year. our total number of followers has exploded to over 340,000.

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.


PatIeNt eXPeRIeNCe

2004 2006 20080

500

1,000

1,500

2,000

2,500

#Thousands

MyChart Users

2010 2012

1.97M

2014

2006 2007 20080

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

#

DrConnect Users

2009 2010 2011 2012 2013

6,867

2014

MyChart enables patients to have an active role in monitoring their healthcare. Since 2012, all patients with an appointment have been enrolled in the application.

DrConnect provides referring physicians with access to data on their patients referred to Cleveland Clinic.


PatIeNt eXPeRIeNCe

0

20

40

60

80

100

Caregiver Survey

2005Engagement 2009Safety

5966

PercentileRank

0.00.51.01.52.02.53.03.54.04.55.0

Rateper

1,000

CC Complaints and Grievances

2010 2011 2012 2013 2014

In 2014 the annual caregiver survey included both engagement and safety and will provide new data points for external comparison and rankings.

the rate of patient complaints and grievances is gradually trending downward.


PatIeNt eXPeRIeNCe

0

20

40

60

80

100

PercentileRank

CCHS Patient Satisfaction

2009 2010 2011 20142012 20132008

0

20

40

60

80

100

PercentileRank

CCHS HCAHPS

D/CInfo

RoomClean

NurseComm

DocComm

Pain Manage

MedsComm

8271 70 66 62

52

StaffResponse

Quiet

50

32

NationalAverage

the HCaHPS domain scores continue to make steady improvement but are still below the 90th percentile goal.

the percentage of patients rating Cleveland Clinic health system hospitals in the top performing categories continues to rise but is still well below our 90th percentile goal.


PatIeNt eXPeRIeNCe

20

40

60

80

100

%Best

Response

CCHS Outpatient Satisfaction

Access ProviderCommunication

OfficeSupport

ProviderRating

PrimaryCare

SpecialtyCare

■ Cleveland Clinic■ CAHPS Database

Average

■

■

■

■ ■

10

60

110

160

210

#Thousands

CCHS Volunteer Hours

2007 2008 2011 201420132009 2010 2012

Volunteers provided over 190,000 hours of service to our patients and facilities in 2014.

CaHPS is the outpatient patient experience survey. the results for 2014 exceed the national average for communication and overall provider rating.


total research funding from all sources was $255 million in 2014. this represents a 3% increase over last year.

ReSeaRCH

NIH funding decreased 5% from the previous year, totaling $92 million in 2014.

0

20

40

60

80

100

120

$Millions

NIH Funding

2004 2006 2008 2010 20142012

0

50

100

150

200

250

300

$Millions

Total Research Funding

2004 2006 2008

■ Other■ Cleveland Clinic ■ Corporate ■ Federal

2010 2012 2014


0

20

40

60

80

100

120

140

160

#

Research Staff

200620042002 2008 2010 2012 20142000

Research staff numbers in Lerner Research Institute remained nearly flat at 149 in 2014.

Lerner Research Institute generated over 1,500 publications in 2014.

0

200

400

600

800

1,000

1,200

1,400

1,600

#

LRI Publications

2006 2008 2010

■ Books■ Chapters■ Articles

2012 20142004

ReSeaRCH


Research activity was nearly consistent with last year, at slightly more than 2,100 projects.

0.0

0.5

1.0

1.5

2.0

2.5

#Thousands

Research Activity

20042002 2006 2008 2010 2012 2014

ReSeaRCH


there were 1,757 clinical and research residents and fellows across the system in 2014.

eDUCatIoN

1,000

1,200

1,400

1,600

1,800

2,000

#

Cleveland Clinic Health System Residents and Fellows

20082004 2006 2010 2012 2014

0

500

1,000

1,500

2,000

#

CME Activities

2006 2008 2010 2012 2012 20142006 2008 2010

the number of CMe activities sponsored by the education Institute make Cleveland Clinic’s CMe program one of the largest in the United States.


the medical school received 1,476 applications for 32 positions in the incoming 2015 class.

the 2013 MCat scores of accepted medical students at Lerner College of Medicine remained among the top seven in the United States.

eDUCatIoN

0

500

1,000

1,500

2,000

#

Lerner College of Medicine –Applications

2007 2009 2011 2013 20152005

10

11

12

13

Lerner College of Medicine Comparative MCAT Scores

WashUniv

UnivPenn

2005Yale ClevelandClinic

2009UnivChicago

Harvard JohnsHopkins

Columbia Duke

#


eDUCatIoN

MCat scores of accepted applicants continue to surpass the national average.

enrollment in classes at Cleveland Clinic academy remained high, with four new class series added in 2014.

0

500

1,000

1,500

2,000

2,500

#

Cleveland Clinic Academy Participants

2008 2009 2010 2011 20142012 20132007

9.0

9.5

10.0

10.5

11.0

11.5

12.0

12.5

Lerner College of Medicine MCAT Scores

Nat’lAvg.

2007 2009 2011 2013 20152005

#


MaRKet aNaLYSIS

40

45

50

55

%

Cleveland Clinic Health SystemMarket Share – Cuyahoga County

200820062004 2010 2012 2014

10

20

30

40

%

National Brand Awareness

20062004 2012 201420102008

Brand awareness is determined utilizing a survey that measures our name recognition. In 2014 the percentage of people who responded positively increased to 37%.

Market share in Cuyahoga County decreased slightly in 2014 to 45.5%.


0

200

400

600

800

Community Benefit 2013

2005 2007 2009

$Millions

2006 2008 2011 2013

653

2007 2009 20122010

MaRKet aNaLYSIS

0

20

40

60

80

100

%

Competitive Brand Awareness

2012 201420102008

Johns HopkinsMayo Clinic

Cleveland Clinic

2006

Mass General

2004

although our name recognition has steadily increased, it remains substantially behind that of industry leaders.

oUtReaCH

The community benefit provided across the health system continues to increase each year. It totaled $653 million in 2013. *Year of the most recent available data.

*


0.0

0.5

1.0

1.5

2.0

$Millions

United Way

2014

Goal = $1.9 Million

2006 2008 2010 20122004

Community Benefit 2013Total $653 Million

Education $222M

Research $70M

Clinical Services $361M

In 2014, Cleveland Clinic caregivers contributed more than $1.9 million to United Way.

Cleveland Clinic provided over $653 million in community benefit in 2013, including $361 million in clinical services. *Year of the most recent available data.

oUtReaCH

*


0

1

2

3

4

5

6

7

$ Billions

Total Operating Revenue

20022000 2004 2006 2008 2010 20142012

Operating Revenue Allocation

Patient Revenue $262MPatient Revenue 91%

Other 5%

Grants 3%

Philanthropy 1%

the total revenue increased by 4% to $6.7 billion in 2014.

fINaNCIaL

Ninety-one percent of revenue came from patient care in 2014.


-100

0

100

200

300

400

500

$ Millions

Operating Income

200420022000 2006 2008 2010 2012 2014

Operating Income

Patient Revenue $262MPatient Revenue

$400M

Philanthropy $21M

Health Information Technology Incentive

$22M

Intellectual Property/Business

$23M

fINaNCIaL

of the $466 million in operating income in 2014, $400 million came from patient care.

total operating income increased 60% to $466 million in 2014.


20082006 2010 20140

100

200

300

400

Days

Days’ Cash on Hand

20122004

2008200620042002 2010 2012 20140

50

100

150

200

250

300

$Millions

Philanthropy

Days’ cash on hand continued to improve, ending the year at 376 days.

fINaNCIaL

Pledges and gifts totaled a record high of $255 million in 2014.


fINaNCIaL

0

1

2

3

4

5

6

7

8

$Billions

Cash, Investments and Debt

1998 2000 2002 2004 2006 2012 20142008 2010

� Cash and Investments� Debt

total cash and investments increased to $6.9 billion in 2014, while outstanding debt increased to $3.7 billion during the same time period.

0

20

40

60

80

100

120

140

$ Millions

Malpractice Costs

200620042002 2008 2010 2012 2014

Malpractice costs in 2014 increased slightly to $57 million.


fINaNCIaL

0

50

100

150

200

250

300

$Millions

Uncompensated Care

2006 2010 20122008

■ Charity ■ Bad Debt

20142004

Uncompensated care totaled $211 million in 2014. 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.

$Billions

0

1

2

3

4

5

6

7

Long-Term Investments

20022000 2004 2006 2008 2010 2012 2014

27 27 -9 -30 -31 17 7 6 11 9 -24 11.5 11.5% ReturnLong-term investments remained positive at $6.5 billion in 2014. the investment strategy continues to be balanced between risk and reward and strives to exceed industry benchmarks.


CoMPLeteD IN 2014

Global Center for Health Innovation

Cuyahoga County’s new exhibition facility welcomed the 2014 Cleveland Clinic Medical Innovation Summit; Patient experience: empathy + Innovation Summit; Martin Luther King Jr. Holiday Community Breakfast; and the VeloSano bike race, which brought 800 cyclists downtown.

Brunswick family Health Center emergency Department

the new $20 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.


fUtURe

“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., MDCo-founder, Cleveland Clinic

Cleveland Clinic abu Dhabi

almost 3,000 caregivers, including 175 physician staff, have joined Cleveland Clinic abu Dhabi, the Persian Gulf’s premier specialty medical center and world’s first all-digital hospital. Patients are now being cared for in the new facilities.


FUTURE

“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., MDCo-Founder, Cleveland Clinic

Cleveland Clinic Abu Dhabi

Almost 3,000 Caregivers, including 175 physician staff, have joined Cleveland Clinic Abu Dhabi, a world-class multispecialty hospital in Abu Dhabi, UAE. The hospital will provide patients in the region direct access to the world’s best healthcare providers and Cleveland Clinic’s unique model of care, reducing their need to travel abroad for treatment.


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, 221,500-square-foot neighbor to the Richard e. Jacobs Health Center will open in 2016.

Select Rehabilitation Hospital — avon

Cleveland Clinic is partnering with Select Medical to open a 60-bed adult rehabilitation hospital near the Richard e. Jacobs Health Center. Select Medical will construct the building, scheduled to open in 2015.


fUtURe

Cancer treatment Building

Ground was broken for a 377,000-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, $90 million facility opened in February 2015. The 143,000-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.


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, 175,000-square-foot replacement for the Guesthouse should open in 2016.

fUtURe


Lutheran Hospital emergency Department

this $17.5 million expansion doubles the current eD to 14,000 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 2015.

2014 State of the Clinic | 452014 State of the Clinic | 45

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 cardio-

vascular care. It comes with a $50,000 prize.

irene Katzan, MD

2014

NoteS

NoteS

9500 euclid ave. | Cleveland, oH 44195

Please visit our website at clevelandclinic.org.

14-CCC-1320

Documents

State of the CliniC | 2014