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STATE OF THE CLINIC | 2016
“Avon is a new kind of hospital for a new era in healthcare. The design reflects everything we’ve learned about 21st-century care.”
— Toby Cosgrove, MD CEO and President
INSIDE
1 Caregivers
5 Cleveland Clinic Health System
14 Cleveland Clinic Main Campus
18 Quality & Safety
21 Patient Experience
27 Research
30 Innovation
31 Education
35 Market Analysis
36 Outreach
39 Financial
44 Cleveland Clinic Abu Dhabi
46 Completed Growth
49 Future Growth
54 2016 Sones Innovation Award
CEO’S ADDRESS
Dear Friend:
We are pleased to present the 2016 State of the Clinic Annual Report. This booklet is published each year in conjunction with our annual State of the Clinic address as part of our commitment to transparency, and to provide an overview of Cleveland Clinic’s performance across a range of key metrics.
Cleveland Clinic continues to serve a growing number of patients at all locations. We opened a new, full-service hospital in Avon, Ohio. We will be dedicating our new main campus cancer building in March 2017, as work continues on the Cleve-land Clinic–Case Western Reserve University Health Education Campus on Euclid Avenue. At Cleveland Clinic Florida, building is underway for a new bed tower for our hospital in Weston.
This year, for the first time, Cleveland Clinic is ranked the No. 2 hospital overall in U.S. News & World Report’s annual “Best Hospitals” survey. We rank No. 1 in Cardiology & Heart Surgery; No. 2 in Urology, Nephrology, and Gastroenterology & GI Surgery; No. 3 in Diabetes & Endocrinology, Gynecology, Pulmonology, Rheumatology, and Orthopaedics; No. 6 in Neurology; and No. 8 in Cancer, Geriatrics and Ophthalmology; and are the No. 1 hospital in Ohio.
Cleveland Clinic is building for the future of patient care and the future of our communities. Looking ahead, we are transforming healthcare for the value-based era, expanding access, improving quality and working to make healthcare more affordable.
Our goal is to give every patient the best outcome and experience. Thank you for your interest in Cleveland Clinic.
Sincerely,
Delos “Toby” M. Cosgrove, MDCEO and President
2016 State of the Clinic | 1
CAREGIVERS
The percentage of women on Cleveland Clinic’s professional staff rose to 37% in 2016.
0
10
20
30
40
%
Female Professional Staff
2007 2008 2009 2010 2011 2012 2013 2014 20152006 2016
37%
In 2016, the number of professional physician staff and scientists at all locations increased by 4% to 3,584.
#
Professional Staff
2004 2010200820060
500
1,000
1,500
2,000
2,500
3,000
3500 4,000
3,500
■ Florida■ Ohio
20142012 2016
3,584
2 | 2016 State of the Clinic
CAREGIVERS
0
2
4
6
8
10
12
%
Professional Staff Turnover
2004 2006 2008 2010 2012 2014 2016
10%Florida
5.5%Ohio
In 2016, staff turnover dropped to 5.5% in Cleveland; in Florida, the rate was 10%.
6
8
10
12
14
%
Caregiver Employee Turnover
2006 2008 2010 2012 201620142004
11%
Turnover among main campus caregivers in support roles averaged 11% in 2016. Cleveland Clinic turnover is lower than the national benchmark of 13.4%.
2016 State of the Clinic | 3
CAREGIVERS
25,000
30,000
35,000
40,000
45,000
50,000
55,000
#
Caregiver Employees
2000 2002 2004 2006 2008 2010 2012 2014 2016
51,487
In 2016, the number of caregivers increased to 51,487 at year-end. Akron General joined the health system in 2015.
52
56
60
64
68
Caregiver Survey
20052014 20092015
59th
68th
%-ileRank
66th
68th■ Engagement■ Safety
In the annual caregiver survey from 2014 to 2015, caregiver impressions of both engagement and safety culture improved. The next caregiver survey will be completed in 2017.
4 | 2016 State of the Clinic4 | 2016 State of the Clinic
CAREGIVERS
Registered nurses across the health system totaled 11,862 in 2016.
In 2016, advanced practice providers across the health system totaled 1,623.
0
600
1,200
1,800
Advanced Practice Providers
20052010 20092012 2016
1,623
#
2014
8,000
9,000
10,000
11,000
12,000
Nurses
2005 2014 20092015 2016
11,862
20132012
#
2016 State of the Clinic | 5
CLEVELAND CLINIC HEALTH SYSTEM
U.S. 16.6%
International 0.2%
7 Counties 70.1%
Ohio 13.1%
Patient Distribution
In 2016, 70% of patients came from Cleveland and the adjacent seven counties. Patients from the rest of the United States increased in 2016.
0
1
2
3
4
5
6
7
8
#Millions
Outpatient Visits
1998 2000 2002 2004 2006 2008 2010 2012 2014 2016
7.1M
The total number of outpatient visits for Cleveland Clinic health system exceeded 7.1 million in 2016, an increase of 7%.
6 | 2016 State of the Clinic
CLEVELAND CLINIC HEALTH SYSTEM
In 2016, adult acute admissions across the health system decreased slightly to 161,674 and observations increased to 58,385, for a total of 220,059.
0
50
100
150
200
250
#Thousands
Acute Admissions and Observations
2002 2006 2008 2010 2012 2014 20162004
■ Observations■ Acute Admissions
220,059
CCHS average length of stay remained consistent from 2015 to 2016 at 5.2 days.
4.0
4.5
5.0
5.5
#Days
Average Length of Stay
2010200820042002 2012 2014 20162000 2006
5.2Days
2016 State of the Clinic | 7
CLEVELAND CLINIC HEALTH SYSTEM
0
25
50
75
#Thousands
Surgical Cases – Inpatient
2006 2008 2010 2012 2014 20162004
59,760
Inpatient surgery across the system decreased slightly to 59,760 cases in 2016.
Outpatient surgeries across the system increased slightly to 147,850 in 2016.
0
50
100
150147,850
#Thousands
Surgical Cases – Outpatient
2006 2008 2010 2012 2014 20162004
8 | 2016 State of the Clinic
CLEVELAND CLINIC HEALTH SYSTEM
0
100
200
300
400
500
600
700
# Thousands
Emergency Department Visits
2004 20082006 2010 2012 20162014
652,196
In 2016, emergency visits across the system increased to 652,196. Akron General joined the health system in 2015.
0
500
1,000
1,500
2,000
2,500
#
Average Daily Census
2006 2008 2010 2012 2014 2016
2,302
2004
The health system had an average daily census of 2,302 in 2016.
2016 State of the Clinic | 9
CLEVELAND CLINIC HEALTH SYSTEM
The time it takes a patient to be seen by a physician or licensed independent practitioner in the emergency department (ED) is a key quality and throughput metric. Across the system, the EDs averaged 11.7 minutes in 2016, below the national target of 12 minutes.
0
10
20
30
#Minutes
Emergency Departments Door to Doctor Time
Target = 12 Minutes
11.7Minutes
2013 2014 2015 2016
0
50
100
150
200
250
300
350
#Minutes
ED Length of Stay Arrival to Admission
Goal ≤ 175 Minutes
2013 20152014 2016
265Minutes
The time it takes a patient to be admitted to the hospital from the emergency department continues to decrease.
10 | 2016 State of the Clinic
CLEVELAND CLINIC HEALTH SYSTEM
0
1,000
2,000
3,000
4,000
5,000
6,000
#Thousands
Critical Care Team Transports
2010 2011 2012
■ Plane■ Helicopter■ Ambulance
2013 2014 20162015
5,652
In 2016, the critical care transport team transported more than 5,600 patients to Cleveland Clinic.
0
50,000
100,000
150,000
200,000
#Thousands
Urgent and Express Care Visits
2008 20102009
■ Express Care■ Urgent Care
20122011 20142013 2015 2016
192,173
In 2016, express care visits increased by 76% to 133,333 due to the opening of six new sites — Wadsworth, Solon, Broadview Heights, downtown Cleveland, Mentor and Olmsted Township. Urgent care visits across the system increased to 58,840.
2016 State of the Clinic | 11
CLEVELAND CLINIC HEALTH SYSTEM
0
5
10
15
20
25
30
#Thousands
Hospital Transfers
2008 2009 2010 2011 2012 2013 20162014 2015
28,613
Hospital transfers increased to more than 28,600 in 2016.
In 2016, external transfers from other hospitals into CCHS dropped by 10% to 9,157 due to hospital consolidation across Northeast Ohio. Akron General is now a part of Cleveland Clinic health system, and its patients are counted as internal transfers.
0
2,000
4,000
6,000
8,000
10,000
12,000
#
External Transfers into CCHS
2013 2014 2015 2016
9,157
2012
12 | 2016 State of the Clinic12 | 2016 State of the Clinic
CLEVELAND CLINIC HEALTH SYSTEM
0
250
500
750
1,000
1,250
1,500
#Thousands
Same-Day Visits
2008 2010 2012 2014 2016
1.3M
In 2016, same-day visits increased 10% to almost 1.3 million.
There were 9,700 virtual visits completed in 2015-2016, peaking at almost 1,400 per month. These include Express Care Online and postop visits, Telestroke acute stroke response, neurological inpatient consults, dermatology tele-triage, patient-requested second opinions and nutrition consults.
0
200
400
600
800
1,000
1,200
1,400
#per
Month
Virtual Visits
2014
1,394per Month
2015 2016
2016 State of the Clinic | 13
CLEVELAND CLINIC HEALTH SYSTEM
Shared medical appointments bring patients with common diagnoses together in a setting that encourages asking questions and sharing concerns and experiences. In 2016, shared medical appointments grew 40% to over 17,700 visits.
0
6,000
12,000
18,000
#
Shared Medical Appointments
2010 2011 2012 2013 2016
17,759
2014 20152009
A care path is an established, multidisciplinary care plan used to optimize the value of care by reducing unnecessary practice variation. As of 2016, 131 care path guides had been developed, with 35 care paths piloted and 17 fully embedded in the electronic health record.
0
20
40
60
80
100
120
140
Care Paths
20052014 2009 2016
35
131
17
2015
#
■ Guides Developed■ Pilots■ Technically Enabled
14 | 2016 State of the Clinic
CLEVELAND CLINIC MAIN CAMPUS
0
1
2
3
4
5
#Thousands
International Patients
2008 2010 20162012 2014
4,582
In 2016, main campus unique international patients decreased 7% to 4,582.
The Middle East continues to account for nearly half of all international patient visits.
South America 7%
Middle East 49%
Caribbean 8%
Canada 8%
Asia 7%
Turkey 2%
Central America 4%
Europe 6%
Mexico 2%Other 7%
International Patients – Distribution
2016 State of the Clinic | 15
CLEVELAND CLINIC MAIN CAMPUS
0
10
20
30
40
50
60
70
#Thousands
Acute Admissions and Observations
20042002 2006 2008 2010 2012 2014 2016
■ Observations■ Acute Admissions 63,681
In 2016, main campus acute admissions totaled 52,020 and observations totaled 11,661.
5.0
5.5
6.0
6.5
7.0
#Days
Average Length of Stay
2006 2010 2012 2014 20162008
6.9 Days
In 2016, the main campus average length of stay increased 2% to 6.9 days.
16 | 2016 State of the Clinic
CLEVELAND CLINIC MAIN CAMPUS
The 2016 average daily census at main campus decreased 2% to 982 patients.
0
200
400
600
800
1,000
#
Average Daily Census
2006 2008 2010 2012 2014 2016
982
2004
Cleveland Clinic’s average case mix index increased to 2.44 while the Medicare case mix increased slightly to 2.53 in 2016.
0.0
0.5
1.0
1.5
2.0
2.5
3.0
#
Case Mix
2008 2010 2012 2014 2016
Medicare
20062004
2.53 2.44
2016 State of the Clinic | 17
CLEVELAND CLINIC MAIN CAMPUS
Inpatient surgery at main campus decreased 2% in 2016 to 24,889 cases.
0
10
20
30
#Thousands
Surgical Cases – Inpatient
20062004 2008 2010 2012 2014 2016
24,889
In 2016, main campus outpatient surgeries increased 2% to 67,299 cases.
#Thousands
Surgical Cases – Outpatient
2004 2006 2008 2010 2012 2014 20160
10
20
30
40
50
60
7067,299
18 | 2016 State of the Clinic18 | 2016 State of the Clinic
QUALITY & SAFETY
10
11
12
13
14
15
%
All-Cause Readmissions
Goal ≤ 13%
20152014 2016
13.2%
All-cause readmissions continue to be a focus area for quality efforts. In 2016, readmissions decreased slightly to 13.2%.
0
50
100
150
#per
Month
Patient Safety Indicators
Goal ≤ 78
2013 2014 2015 2016
87per Month
Cleveland Clinic continues to work to reduce patient safety indicators, which are a set of measures that screen for adverse events. Our performance in these metrics is, on average, better than the national risk-adjusted average, though we continue clinical and documentation enhancements to improve further.
2016 State of the Clinic | 19
QUALITY & SAFETY
0
10
20
30
40
50
#per
Month
Hospital-Acquired Infections
Goal ≤ 2016
per Month
2014 2015 2016
Hospital-acquired infections continue to decrease steadily toward our enterprise goal of 20 or fewer infections per month.
0
25
50
75
100
#per
Month
Hospital-Acquired InfectionsC. difficile
Goal ≤ 40
51per Month
2014 2015 2016
Improvements continue to be made toward our goal of 40 or fewer C. difficile infections per month.
20 | 2016 State of the Clinic20 | 2016 State of the Clinic
QUALITY & SAFETY
50
60
70
80
90
100
%
Hand Hygiene
92%
2014 2015 2016
Goal = 100%
Hand hygiene is the most effective intervention to stop the spread of infections. Hand hygiene compliance continues to increase, reaching 92% in 2016.
The Accountable Care Organizations (ACO) composite measures how Cleveland Clinic compares in selected screenings, vaccinations, disease management and process measures. As of 2016, Cleveland Clinic ranks at the 71st percentile compared to other ACO health systems.
0
25
50
75
100
%-ile
ACO Composite
Goal = 50th %-ile
2012 20142013 2015
Goal = 90th %-ile
71st
2016
2016 State of the Clinic | 21
PATIENT EXPERIENCE
5
15
25
35
45
55
65
#Thousands
Web Contact Requests
20062004 2008 2010 2012 2014 2016
63,377
In 2016, there were over 63,000 web requests and live chats for additional information on the clevelandclinic.org website.
20062004 2008 2010 2012 2014 2016
71,529
0
10
20
30
40
50
60
70
80
#Thousands
Online Appointment Requests
Online appointment scheduling requests increased to over 71,500 in 2016, a 7% increase from 2015.
22 | 2016 State of the Clinic
PATIENT EXPERIENCE
0
1,000
2,000
3,000
#Thousands
Social Media
2012 2013 2014 2015 201620112010
2.8M
Increasing numbers of people are interacting with us through social media. The combined number of Cleveland Clinic Facebook fans and Twitter followers totaled 2.8 million at the end of 2016.
2008
2,000
0
4,000
6,000
8,000
10,000
#
DrConnect Users
2010 2012 2014
8,917
2016
DrConnect now provides over 8,900 referring physicians with secure online access to real-time information about their patients’ treatment progress while at Cleveland Clinic.
2016 State of the Clinic | 23
PATIENT EXPERIENCE
2008 20100
500
1,000
1,500
2,000
2,500
#Thousands
MyChart Users
2012 2014
2.2M
2016
Beginning in 2013, all patients with an appointment were automatically enrolled in MyChart. Nearly 2.2 million patients had MyChart accounts in 2016.
0
1,000
2,000
3,000
4,000
#Thousands
MyChart Messages
2010 2012 201620142008
3.5M
MyChart allows patients to send a secure message about a nonurgent medical concern to their established providers.
24 | 2016 State of the Clinic
PATIENT EXPERIENCE
0
20
40
60
80
100
%-ileRank
HCAHPS Patient Satisfaction
2008 2010 20142012
Goal = 90th %-ile 79th
2016
In 2016, patients rated Cleveland Clinic in the 79th percentile in patient satisfaction surveys. The goal is to reach the 90th percentile of all hospitals nationwide.
0
20
40
60
80
100
%-ileRank
HCAHPS Rate Hospital
2009 2010 2013 201620152011 2012 2014
92ndMain
Campus
93rdFlorida
56thRegional Hospitals
90th %-ile
Main campus and Florida are rated at the top of all U.S. hospitals in HCAHPS scores, in the 92nd and 93rd percentiles respectively.
2016 State of the Clinic | 25
PATIENT EXPERIENCE
0
20
40
60
80
100
%-ileRank
HCAHPS Patient Experience Domains
DischargeInfo
Pain Manage
NurseComm
StaffResponse
RoomClean
DocComm
83rd
72nd 71st 69th
59th 58th
MedsComm
Quiet atNight
55th
26th
NationalAverage
Steady improvement continues in the HCAHPS domain scores toward the 90th percentile goal. Discharge information ranks the highest at the 83rd percentile.
4 Stars93%
HCAHPS Physician Ratings5 Stars
7%
Physician star ratings show how individual physicians score on HCAHPS inpatient and outpatient surveys. All Cleveland Clinic physicians scored an average 4- or 5-star rating (of 5 available stars).
26 | 2016 State of the Clinic
PATIENT EXPERIENCE
0102030405060708090
100
%Best
Response
Outpatient Experience
Access ProviderCommunication
OfficeSupport
ProviderRating
PrimaryCare
SpecialtyCare
■ Cleveland Clinic■ CAHPS Database Average
■
■
■
■
■
CG-CAHPS is the outpatient experience survey. Cleveland Clinic is above the national average and continues to improve in all domains of outpatient satisfaction.
0.0
0.5
1.0
1.5
2.0
2.5
3.0
Rateper
1,000
Complaints and Grievances
2012 2013 2014 2015 2016
1.1
The rate of patient complaints and grievances continues to trend downward, now at 1.1 per 1,000 patient encounters.
2016 State of the Clinic | 27
RESEARCH
0
20
40
60
80
100
120
140
160
#
Research Staff
200820062004 2010 2012 2014 20162002
137
In 2016, the Lerner Research Institute had 137 research staff.
Research activity increased 12% to 2,474 active projects in 2016.
0.0
0.5
1.0
1.5
2.0
2.5
#Thousands
Research Activity
20062004 2008 2010 2012 2014 2016
2,474
28 | 2016 State of the Clinic
RESEARCH
#
High-Impact Publications
2012 2015201420130
200
400
600
800
1,000
1,200
1,400
2016201120102009
1,269
High-impact publications are those in the highest-rated scientific journals. In 2016, Cleveland Clinic researchers published 1,269 high-impact findings.
0
1,000
2,000
3,000
4,000
#
Journal Publications
2011 2012 20152013 2014 2016
3,817
Cleveland Clinic had 3,817 journal publications in 2016.
2016 State of the Clinic | 29
RESEARCH
Total research funding from all sources was $260 million in 2016. This represents a 4% increase from 2015.
0
50
100
150
200
250
300
$Millions
Research Funding
2006 2008 2010
■ Other■ Cleveland Clinic ■ Corporate ■ Federal
2012 2014 20162004
$260M
NIH funding for Cleveland Clinic research projects was $102 million in 2016, an increase of 4% from the prior year.
0
20
40
60
80
100
120
$Millions
NIH Funding
20062004 2008 2010 2012 20162014
$102M
30 | 2016 State of the Clinic
INNOVATION
Since 2000, Cleveland Clinic has filed 3,681 cumulative patents with 1,178 granted.
0
1,000
2,000
3,000
4,000
#
Patent Activity
2004 2006 2008 2010 2012 2014
Filed 3,681
Granted 1,178
2016
0
20
40
60
80
#
Spin-Off Companies
2006 2008 2010 2012 20142004 2016
77
Since its founding in 1997, Cleveland Clinic Innovations has spun off 77 companies from internally generated ideas.
2016 State of the Clinic | 31
EDUCATION
The Lerner College of Medicine received 1,796 applications for 32 positions in the 2017 class.
0
500
1,000
1,500
2,000
#
Lerner College of MedicineApplications
2009 2011 2013 2015 2017
1,796
2007
The average MCAT score of accepted Lerner College of Medicine applicants for the 2016 class continues to be above the national average.
9.0
9.5
10.0
10.5
11.0
11.5
12.0
12.5
Lerner College of Medicine MCAT Scores
2008 2010 2012 2014 2016
12.3
# NationalAverage =
10.5
32 | 2016 State of the Clinic
EDUCATION
There were 1,958 clinical and research residents and fellows in 107 accredited training programs across the health system in 2016.
1,000
1,200
1,400
1,600
1,800
2,000
#
Residents and Fellows
20102006 2008 2012 2014 2016
1,958
The 2015* MCAT scores of accepted Lerner College of Medicine medical students remain among the highest in the nation.
10
11
12
13
Lerner College of Medicine Comparative MCAT Scores
WashUniv
UnivPenn
2005 YaleClevelandClinic
2009UnivChicago
Harvard JohnsHopkins
Columbia Duke
#
12
*indicates that the most recent validated year for MCAT scores data is 2015
2016 State of the Clinic | 33
EDUCATION
0
500
1,000
1,500
2,000
#
Continuing Medical Education Activities
2008 2010 2012 2014 2012 20162006 2008 2010
1,568
In 2016, over 220,000 participants took part in 1,568 continuing medical education activities sponsored by the Education Institute.
60
80
100
%
Board Pass Rate
2011 2012 2013 20162014 20152010
93%
In 2016, Cleveland Clinic residents and fellows achieved a board pass rate of 93%.
*indicates that the most recent validated year for MCAT scores data is 2015
34 | 2016 State of the Clinic
EDUCATION
0
50
100
150
200
250
#
Civic Education Interns
2010 2011 2012 2013 20162014 20152009
216
In 2016, Cleveland Clinic welcomed 216 high school, college and graduate civic education interns across the system. The Stokes Scholars Summer Internship Program, a workforce readiness program for at-risk Cleveland high school students, launched in 2016.
0
1,500
3,000
4,500
#
Global Leadership and Learning Participants
2006 2008 2010 2012 2014 2016
4,442
In 2016, 4,442 caregivers across the system participated in Global Leadership and Learning courses designed to build professional competencies and leadership skills.
2016 State of the Clinic | 35
MARKET ANALYSIS
0
20
40
60
80
100
%
Brand Awareness
2014 201620122010
Johns Hopkins
Mayo Clinic
Cleveland Clinic
2008
Mass General
2006
31%
39%
86%
80%
Brand awareness is measured by a survey of name recognition. Nationwide, 39% of the general population recognize Cleveland Clinic.
30
35
40
45
50
55
%
Market Share – Cuyahoga County
201020082006 2012 2014 2016
45.5%
Cleveland Clinic hospital inpatient and outpatient market share in Cuyahoga County remained consistent at 45.5%.
36 | 2016 State of the Clinic
OUTREACH
0
100
200
300
400
500
600
700
$Millions
Community Benefit 2015*
20152007 2009 2011 2013
$693M
The Community Benefit provided across the health system continues to increase each year. It totaled $693 million in 2015.
Community Benefit 2015*Total $693 Million
Education $257M
Research $67M
Clinical Services $369M
Cleveland Clinic provided over $693 million in community benefit in 2015, including $369 million in clinical services.
*indicates that the most recent validated year for Community Benefit data is 2015
2016 State of the Clinic | 37
OUTREACH
*indicates that the most recent validated year for Community Benefit data is 2015
390
410
430
450
470
490
510
Index#
Energy Usage
2011 2012 2013 2014 2015 2016
438
Cleveland Clinic is committed to reducing energy usage by 20% by 2020. Our progress improves air quality, making our patients, caregivers and communities healthier.
0
10
20
30
40
50
%
Recycled Waste
2008 2010 2012 2014 2016
35%
By engaging caregivers to minimize waste sent to landfills, we are protecting the environment, reducing costs, and improving land, air and water quality in our communities.
38 | 2016 State of the Clinic
OUTREACH
4
5
6
%
Supplier Diversity
2010 2011 2012 20152013 2014 2016
6%
Supplier diversity continued to increase in 2016, reaching 6% of supply chain and construction spend going to women, minority and small business enterprises.
0
50
100
150
200
250
300
$Millions
Uncompensated Care
2008 2012 20142010
■ Charity Care ■ Bad Debt
20162006
$164M
Cleveland Clinic provided $164 million in uncompensated care in 2016. The Affordable Care Act, Medicaid expansion and increased access to insurance have reduced the number of self-pay patients, accounting for the decrease from prior years.
2016 State of the Clinic | 39
FINANCIAL
Operating revenue increased 12% to $8 billion in 2016.
0
1
2
3
4
5
6
7
8
$ Billions
Operating Revenue
20042002 2006 2008 2010 2012 20162014
$8B
Operating Revenue Allocation
Patient Revenue $262MPatient Revenue 90%
Other 6%
Grants 3%
Philanthropy 1%
Patient care continued to account for 90% of operating revenue in 2016.
40 | 2016 State of the Clinic
FINANCIAL
Earnings from Operations
Patient Revenue 90%
Health Information Technology Incentive 2%
Intellectual Property/Business 6%
Philanthropy 2%
Of the $243 million in earnings from operations in 2016, $218 million came from patient care.
0
100
200
300
400
500
$ Millions
Earnings from Operations
20042002 2006 2008 2010 2012 2014 2016
$243M
Unaudited earnings based on current operations totaled $243 million in 2016. Cleveland Clinic is experiencing the effects of nationwide healthcare transformation, with rising pharmaceutical costs and insurer changes.
2016 State of the Clinic | 41
FINANCIAL
20160
80
160
240
320
400
#Days
Days Cash on Hand
2006 2008 2010 2012 2014
349
2004
Days cash on hand measures Cleveland Clinic’s financial strength. In 2016, this metric increased to 349 days.
0
1
2
3
4
5
6
7
8
$Billions
Cash, Investments and Debt
2000 2002 2004 2006 2008 2014 20162010 2012
� Cash and Investments� Debt
$4.3B
$7.9B
Total cash and investments increased to $7.9 billion, as outstanding debt rose to $4.3 billion. Cleveland Clinic uses debt to invest in capital growth.
42 | 2016 State of the Clinic
$Billions
0
1
2
3
4
5
6
7
8
Long-Term Investments
200420022000 2006 2008 2010 2012 2014 2016
$7.1B
Long-term investments totaled $7.1 billion at the end of 2016. This increase from the prior year is attributable to strong cash flow from operations and positive investment returns.
0
20
40
60
80
100
120
140
$ Millions
Malpractice Costs
200820062004 2010 2012 2014 2016
$61M
Malpractice costs increased slightly to $61 million in 2016.
FINANCIAL
2016 State of the Clinic | 43
FINANCIAL
2010200820062004 2012 2014 20160
50
100
150
200
250
300
$Millions
Philanthropy
$222M
Pledges and gifts from generous donors increased 26% to $222 million in 2016.
0
100
200
300
400
500
600
700
$Millions
Care Affordability Savings
2014 2015 2016
$634M
Care Affordability, the enterprise-wide cost transformation initiative, has delivered over $634 million of cumulative financial benefit.
44 | 2016 State of the Clinic
CLEVELAND CLINIC ABU DHABI
0
500
1,000
1,500
2,000
2,500
3,000
#
CCAD Caregiver Employees
2014 2015 2016
2,932
Since its opening in 2015, the number of Cleveland Clinic Abu Dhabi (CCAD) caregivers has increased to 2,932 in 2016. CCAD caregivers represent 77 nationalities.
0
50
100
150
200
250
300
#
CCAD Professional Staff
2014 2015 2016
252
The number of physicians at Cleveland Clinic Abu Dhabi increased to 252 in 2016. 24% of CCAD physicians have been trained or worked at Cleveland Clinic in Ohio.
2016 State of the Clinic | 45
CLEVELAND CLINIC ABU DHABI
0
200
400
600
800
1,000
1,200
1,400
1,600
#per Day
CCAD Outpatient Visits
Jan-16 May-16 Jul-16 Sept-16 Nov-16Mar-16
1,184per Day
Outpatient visits per day for Cleveland Clinic Abu Dhabi averaged 1,184 as of December 2016. Currently, patients travel from over 60 countries for care at CCAD.
020406080
100120140160180
#per Day
CCAD Inpatient Census
Jan-16 Mar-16 May-16 Jul-16 Sep-16 Nov-16
156per Day
Cleveland Clinic Abu Dhabi’s inpatient census averaged 156 patients per day as of December 2016.
46 | 2016 State of the Clinic
COMPLETED GROWTH
105th Street Caregiver Parking Garage
The nine-story caregiver parking garage was completed in November 2016. The project included additional features to enhance caregiver safety. The pedestrian skyway across East 105th Street will be completed in fall 2017.
20
22
24
26
28
30
SquareFeet,
Millions
Facility Square Footage
2012 20152013 2014 2016
28.5M
Cleveland Clinic continues to grow, reaching 28.5 million square feet of facility space in 2016.
2016 State of the Clinic | 47
Avon Hospital Roseann Park Family Tower
A new five-story “hospital of the future” has opened adjacent to the Richard E. Jacobs Health Center in Avon, Ohio, with 126 beds, six operating rooms, an intensive care unit, a catheterization lab and an expanded emergency department.
Express Care – Downtown
The first downtown Cleveland walk-in Express Care Clinic opened in October 2016 at 313 Euclid Ave., off Public Square. The facility includes six exam rooms and is staffed by a team of providers, including physician assistants and nurse practitioners. This location expands access for the growing population living and working downtown.
COMPLETED GROWTH
48 | 2016 State of the Clinic48 | 2016 State of the Clinic
COMPLETED GROWTH
Holiday Inn
Opened in May 2016, this nine-story hotel at Euclid Avenue and East 86th Street includes 276 rooms, a fast casual restaurant and bar. The Holiday Inn offers additional accommodation options for patients and families who travel to main campus for care.
“You will either step forward into growth, or you will step backward into safety.”
~ Abraham H. Maslow
2016 State of the Clinic | 49
FUTURE GROWTH
Cleveland Clinic Akron General Emergency Department
The new facility will triple the size of the current emergency department to 59,000 square feet. This Level 1 trauma center includes 53 treatment bays, eight triage rooms and four high-acuity trauma rooms. The ED opens in November 2018.
Coral Springs Family Health Center
Design is underway for a 73,100-square-foot, three-story outpatient facility in Coral Springs, Florida, which will include four ambulatory surgery operating rooms and 42 exam rooms. The building is scheduled to open in summer 2018.
50 | 2016 State of the Clinic
FUTURE GROWTH
Health Education Campus
The new home of the Cleveland Clinic Lerner College of Medicine, Case Western Reserve University (CWRU) School of Medicine, CWRU School of Dental Medicine and Frances Payne Bolton School of Nursing. The building is being designed by Foster+Partners in London and opens for first students in July 2019.
IBM Watson Health Building
The two-story, 43,000-square-foot building at 10500 Cedar Ave. will house the IBM healthcare data analytics enterprise. In 2016, Cleveland Clinic and IBM entered a five-year agreement to expand Cleveland Clinic’s health information technology capabilities. The facility is scheduled to open in summer 2018.
2016 State of the Clinic | 51
FUTURE GROWTH
Lakewood Family Health Center
Designed as part of the Lakewood medical neighborhood, the three-story, 64,700-square-foot facility includes 60 exam rooms and 16 emergency department treatment bays. The building is scheduled to open in 2018.
Cleveland Clinic Rehabilitation Hospital – Bath
Developed in partnership with Select Medical, the two-story, 72,500-square-foot facility includes 60 beds and is scheduled to open in late 2017. Cleveland Clinic and Select Medical have a joint venture to bring rehabilitation care closer to home.
52 | 2016 State of the Clinic
FUTURE GROWTH
Cleveland ClinicRehabilitation Hospital – Beachwood
This 60-bed, 60,000-square-foot facility, developed in partnership with Select Medical, is scheduled to open in late 2017.
Taussig Cancer Center
The multidisciplinary outpatient cancer center will revolutionize treatment with advanced therapies, evidence-based protocols and patient-centered care. The seven-story, 377,000-square-foot building has 126 exam rooms, 98 infusion rooms and abundant natural light. The facility opens in March 2017.
2016 State of the Clinic | 53
FUTURE GROWTH
Weston Bed Tower – Expansion Phase II
To meet increasing patient volumes, Cleveland Clinic Florida is building a five-story tower with 74 beds, three operating rooms, and an emergency department with 40 treatment rooms and 24 observation bays. Opens July 2018.
Cleveland Clinic London
Cleveland Clinic is expanding globally with a location at 33 Grosvenor Place, London. This eight-story, 323,100-square-foot facility includes 205 beds and eight operating rooms. Scheduled to open in fall 2020, it will offer major medical specialties, CT, endoscopy suites, lab and pharmacy.
SONES INNOVATION AWARD RECIPIENT
Michael Kattan, PhD, Chair of Quantitative Health Services in Cleveland Clinic’s Lerner Research Institute, pioneered mathematical models (nomograms) that predict risk of disease recurrence or progression in prostate cancer and other conditions. He holds two patents for risk calculators, and he developed online calculators that address 34 different diseases. Dr. Kattan is a financial risk mod-eler and former stage IV cancer patient. His widely validated methodology has powerful clinical potential.
The award was established to recognize achievements that reflect the spirit of Dr. Sones and honor the Cleveland Clinic tradition of innovation for better patient care. It comes with a $25,000 prize.
Michael Kattan, PhD
201654 | 2016 State of the Clinic
2016 State of the Clinic | 55
CLEVELAND CLINIC ABU DHABI
9500 Euclid Ave. | Cleveland, OH 44195
Please visit our website at clevelandclinic.org.
16-CCC-2411