Dr. Toby Cosgrove’s State of the Clinic, 2013

Cleveland Clinic

“This is Our Time”Cosgrove

“We are stewards of a great tradition. We cannot and will not be deterred in our quest to build a new model of health care delivery for our patients, our country and the globe,” said Cleveland Clinic CEO Toby Cosgrove, MD, in his annual State of the Clinic address delivered Wed., Feb. 27 at Cleveland’s Intercontinental Hotel.

“I have never been more optimistic about this organization. This is our time.”

Growth, value-based care, finances and more were among Dr. Cosgrove’s panoply of topics.

But he never ranged far from patient care as central to the Clinic’s continuing mission as he addressed the organization’s nearly 45,000 employees both live and via remote broadcast.

The North Star

“We must be aggressive in our approach to reducing costs and improving quality,” said Dr. Cosgrove. “Yet, we must remember why we have been called to do this work. We are all caregivers who put the needs of our patients first.

“Patients are the North Star for all of us.

“They are the reason all of us are here, whether it’s research, education, or clinical care. They are the reason we are a hospital and they are the reason we all exist.”

Finances Strong


 Cleveland Clinic finances remained strong in 2012. Total revenue increased 7 percent over 2011, reaching $6.2 billion. Operating income decreased to $228 million, and investments were up 21 percent, reaching $5.2 billion. Community benefit reached $693 million, accounting for 12 percent of expenses.


Abu Dhabi


Current expansion into Abu Dhabi, the capital and the second largest city of the United Arab Emirates, leads the Clinic’s international growth opportunity.

500 million people live within a 6 hour flight range to Cleveland Clinic’s home base in Ohio. But 3 billion people are within a 6 hour flight range of Abu Dhabi. “We think we have an enormous opportunity for this institution to spread our method of care across the world,” said Dr. Cosgrove. He expects the Clinic to employ 1800 workers in Abu Dhabi in 18 months.


More Patients


Joseph Knapp, MD, Medical Director, Cherine El-Dabh, MD, Executive Director, and Stephen Sayles, MD, Emergency Director at the Cleveland
Clinic Richard E. Jacobs Health Center in Avon.

Cleveland Clinic saw 1.3 million unique visitors in 2012, an increase of 5 percent over 2011. 125,000 of those visits were from new patients. Locally, the Jacobs Family Health Center in Avon is among the busiest in the system, accounting for 224,000 patient visits.



An Hour of Change

Health care is seeing a transition from volume based pay to value based care.
“We meet in an hour of change, challenge and anxiety, in a time of hope and fear, in an age of exploding knowledge,” said Dr. Cosgrove. “We know that we are not going to get paid as much as we have in the past and we know that we are going to be held more accountable by having to report on quality measures.”


Value Based Care


A Value-Based Care Team – made up of physicians, nurses, and other experts – will work to translate “better, lower cost, faster” into everyday practice throughout Cleveland Clinic.

“Increasingly, we will be living in an outcome based payment model where the quality of care that we deliver, the outcomes that the patients achieve, will be the basis of the payments that we receive,” said Dr. David Longworth, Value Based Care Team Chair.


To glimpse Cleveland Clinic’s reputation, consider that its Lerner College of Medicine received 1900 applications for 13 available positions. From local news to international press, Cleveland Clinic enjoys the world class status of Johns Hopkins and UCLA. Social media, said Dr. Cosgrove, has exploded. Cleveland Clinic’s Facebook has grown to 400,000 followers, up 300 per cent. 1200 high-impact journal publications, half from the Lerner Research Institute, have also built momentum.

Staying Strong

DSC_7251-3 DSC_7252-4

Cleveland Clinic cash and investments were up 11 per cent in 2012, totaling nearly $5 billion.

“We need this sort of investment and capital capability because we have an insatiable need for capital expense,” said Dr. Cosgrove.

In the last five years, the Clinic has spent $2.6 billion on capital improvements.

“Projecting ahead, we are planning to spend another $3.3 billion to keep the facilities and equipment of this organization at top levels,” said Dr. Cosgrove. “Our financial strength is essential. In order to remain financially strong, we have to reduce our costs and we have to optimize our resources.”

Care strategies like avoiding 12,082 lab tests – for a savings of $1.2 million – and lowering the cost of lung transplant surgery by 11 percent are examples.



“No organization is going to be strong and successful unless it grows,” said Dr. Cosgrove. “We cannot grow it without great leadership and management.”

Leadership and management development will lead to more efficient local, regional and patient-centric service areas.

Nationally, a network of owned and partnered relationships will soon be announced. International growth will be center on Abu Dhabi and Canada, with referral offices in Riyadh, Turkey, China and London.


“We have not changed our mission statement,” reports Dr. Cosgrove. “We are striving to be the world’s leader in patient experience, clinical outcomes, research and education. I think the emphasis here has to be on ‘striving.’ We will never be completely satisfied with our journey. It is a constant journey.”

Caregivers & Leadership

“Caregivers are vital to our success. We must attract, engage and retain people with appropriate skills and, most importantly, people with the appropriate attitude,” said Dr. Cosgrove. In return, caregivers should access opportunities to maximize professional growth in all areas, including education, earnings and advancement.

Leaders will align around strategy, goals, operating models and “our matrix organization.”

“This organization has become so big, and so complicated and so interdependent that it is no longer possible to lead this through traditional leadership,” said Dr. Cosgrove. “A decision by one individual affects multiple other portions of the organization. Therefore we have to matrix in a way that has just not been common in the past.

“We have to engage our caregivers to deliver first class patient care, which is the essence of what the Cleveland Clinic is about,” said Dr. Cosgrove.

New Frontier

“There is a new frontier here, whether we seek it or not,” said Dr. Cosgrove of the evolving world of health care. “Those who came before us created the first wave of a group practice model, the first wave of integrated care delivery and the first wave of patient-centric care.

“Now it is up to us to lead the first wave of a new delivery system.”

Better, Faster, Lower Cost

“This organization was not built by people who waited,” said Dr. Cosgrove. “This organization was built by people who moved forward and dealt with uncertainty.

“We are privileged to have a secure model of health care delivery, financial stability, and committed caregivers.

“The question is, are we up to the task? Are we equal to the challenge?

“I fervently believe in you, our organization and our future,” he concluded. “Only a few organizations have earned the opportunity to lead. We have the opportunity, the ability and the duty to lead.”

Cleveland Clinic

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