Cleveland Clinic strengthens grip in Sunshine State

As Florida experiences a wave of independent hospitals looking for partners, Cleveland Clinic is seizing the opportunity to establish a network of hospitals in the southeastern region of the Sunshine State.

While the Clinic has long had satellite campuses — in Toronto, Las Vegas, Abu Dhabi and Florida — this represents a new effort to build a regional system around one of the Clinic outposts.

The system is looking at acquisitions as far as 130 miles north of its main Florida location in Weston, where the Clinic is also building a new bed tower to keep up with local demand.

"You can start kind of thinking about how we could build a system in Southeast Florida that really values high quality care and at the same time works hard to decrease costs, and that's a huge benefit to the community there," said Dr. Wael K. Barsoum, CEO and president of Cleveland Clinic Florida.

The system is in talks to bring four hospitals into the system — Indian River Medical Center and Martin Health System's three hospitals. The Clinic has signed a letter of intent with both Indian River and Martin Health and is in negotiations with each to reach definitive agreements. The Clinic also is a finalist in Boca Raton Regional Hospital's search for a partner, Barsoum said.

"In all three of these hospital systems, all have very good clinical reputations," Barsoum said. "I mean, they're outstanding hospital systems. So again, they fit in with the kind of phenotype of the types of hospitals that would like to join the Cleveland Clinic."

Meanwhile, Cleveland Clinic Florida is investing $328.5 million in a new five-story bed tower on the Weston campus, slated to open in August, and a 73,000-square-foot outpatient facility in Coral Springs, scheduled to open in July. The new bed tower adds 75 beds to the Weston facility's often-full 155 beds.

"In terms of being able to serve our patients with the best possible care, we recognized that we had to grow," Barsoum said.

The timing of multiple deals at once has been largely driven by the independent hospitals looking for partners, he said.

Allan Baumgarten, a Minnesota-based consultant who studies health care markets, including in Florida and Ohio, said there are several hospitals in Florida currently going through the process of finding a bigger partner. Remaining independent is increasingly challenging for such hospitals, which don't have the leverage in negotiations with insurers, suppliers and more, and may have trouble raising capital to make major investments.

"So you see a lot of these independent hospitals basically saying we can't remain independent; we have to join one of the larger systems," Baumgarten said.

Steven G. Ullmann, professor and chair in the Department of Health Sector Management and Policy in the University of Miami's School of Business Administration, wrote in an email that South Florida's health care market is "highly competitive" with a range of types of hospitals and ownership models.

Cleveland Clinic is currently a single hospital system, which he wrote is "a true rarity down here."

"And competition for the paying patient is significant, especially in a time of declining revenues in the health care arena," Ullmann added.

Florida has seen a lot of competition, especially for specialty care, Baumgarten said. Expanding through acquisitions of independent hospitals will help solidify the pipeline of patients from those geographic areas who will go to the Clinic when they need high-end specialty care, rather than Mayo Clinic in Jacksonville, Florida Hospital in Orlando or the Baptist Health System in South Florida, he said.

"They want to benefit from having a greater system of feeders into their facilities and their specialty practices," Baumgarten said. "It's an expensive way to do it, but I think they see that given the fact that all these hospitals are in play and getting snapped up, that if they don't make the investments and don't make some of these acquisitions, then it will be the other hospital systems that get the flow of patients coming out of those communities and not the Cleveland Clinic."

The Clinic was chosen in January to take over Indian River Medical Center, a county-owned hospital in Vero Beach, located roughly 130 miles north of Weston. The system reportedly offered up to $352 million in financial consideration for the hospital.

Martin Health System — in Stuart, Fla., about 95 miles north of Weston — announced in March that it had entered into an agreement to explore opportunities to become a full member of Cleveland Clinic. The announcement came just two months after the Clinic and Martin Health System announced that they had entered into a cardiovascular affiliation with plans to explore other opportunities to work more closely together.

Boca Raton Regional Hospital, which the Clinic is a finalist for in its RFP process, is located about 25 miles northeast of Cleveland Clinic Florida.

"If you look at Northeast Ohio, we've built an incredible care delivery system where Cleveland Clinic quality care is available to just about everybody in their backyard," Barsoum said. "Our goal for Southeast Florida is to be able to provide that same high-quality care locally and not just in Weston, and not just in our present Cleveland Clinic facilities."

The strategy in Southeast Florida has the potential to benefit Cleveland Clinic facilities throughout the system, including in Northeast Ohio, he said. "So I think there are key things in Florida that we can do well and that will benefit the entire health care system, just as today we'll learn something from the group in Abu Dhabi or we'll learn something from Cleveland."

"Cleveland Clinic strengthens grip in Sunshine State" originally appeared in Crain's Cleveland Business.