The city’s budding love affair with the Cleveland Clinic

By Marshall Allen

Thursday, Sept. 24, 2009 | 2 a.m.

Discussions between the Cleveland Clinic and Las Vegas City Hall about developing a larger medical presence in town are moving forward — if the code spoken Wednesday is any indication.

Dr. Delos “Toby” Cosgrove, president and CEO of the Cleveland Clinic, said during a Sun interview while sitting next to Las Vegas Mayor Oscar Goodman that their two institutions are “holding hands.”

“We haven’t kissed yet,” Goodman added. “But we’re holding hands.”

The venerable 1,800-physician hospital system, which since February has run the medical and research operations at the Cleveland Clinic Lou Ruvo Center for Brain Health in the emerging Symphony Park complex in downtown Las Vegas, is now exploring what other services it can provide in Las Vegas. But beyond making reference to the fledgling romance, Cosgrove would not provide any details about Cleveland Clinic’s possible expansion.

The 85-year-old Cleveland Clinic is a $4.8 billion operation with 38,000 employees at locations in Cleveland; Weston, Fla.; Toronto; the United Arab Emirates; and Las Vegas. U.S. News & World Report consistently ranks many of its specialties in the top 10 nationally.

Cosgrove, a world-famous heart surgeon, was in Las Vegas on Wednesday as the inaugural speaker at the Symphony Park Lecture Series. Goodman joined him during a 90-minute conversation with the Sun, where Cosgrove discussed health care reform — Cleveland Clinic has been praised as a model for reform by President Barack Obama — and the proposed expansion in Las Vegas.

Cleveland Clinic explored coming to Las Vegas about six years ago, but received a chilly reception from the local medical community. Goodman said that “it’s always the same thing” with the doctors who don’t want the Cleveland Clinic in Las Vegas.

“They want to preserve their income,” Goodman said. “They don’t want competition.”

The climate is different this time because of the hepatitis C outbreak that was linked to a local endoscopy center, Goodman said. The mayor said doctors lost their credibility with their inept response in 2008 to the outbreak, which health officials said was caused by nurses who reused syringes and single-use medicine vials. Now when physicians tell him the Cleveland Clinic shouldn’t expand in Las Vegas he tells them to “drop dead.”

Cosgrove sighed — seemingly in exasperation — when discussing aspects of the health care reform debate taking place in Congress. Obama has lauded Cleveland Clinic’s high-quality care and cost-saving methods as he has tried to sell the country on health care reform. Obama has highlighted the problem of the “crushing cost” of health care, which has caused insurance premiums to grow four times as fast as wages in the past eight years.

But the debate and proposals have not taken the tack of making health care more efficient or excellent, Cosgrove said.

“It went from essentially health care reform to insurance reform and I was amazed when the president made that switch in his rhetoric,” Cosgrove said.

Cosgrove named three tenets of providing cost-effective, high-quality health care at the Cleveland Clinic that are not being stressed in the health care debate: efficiency, individual responsibility and measuring quality — which includes being open and honest with patients about the outcomes of hospital procedures.

Health care costs are rising, he said, because there are more people, more elderly people and more options for treatment. Adding tens of millions of people to insurance rolls — as Congress proposes to do — will cause “the costs of health care to continue to escalate,” Cosgrove said.

One of Cleveland Clinic’s distinctions is that it pays its doctors a flat salary no matter how many consultations or procedures they perform, as opposed to the fee-for-service model that’s the norm in America. Doctors also face accountability: They have no tenure and are evaluated annually based on their performance, Cosgrove noted.

The health care reform proposals have also failed to emphasize the need for individuals to take responsibility for their own health, Cosgrove said, citing overeating and smoking as costly health care burdens. The Centers for Disease Control and Prevention reported recently that 10 percent of health care costs nationally can be attributed to obesity, and that there are now 3.8 million Americans who weigh more than 300 pounds. It’s not genetics, he said. “How many people weighing 300 pounds did you see when you were growing up?”

Cleveland Clinic banned smoking on its campus and offered free smoking cessation classes to its employees and to any person in the county where it’s based. The organization will no longer hire smokers, he said.

The emphasis on changing individual behavior is probably missing from the conversations in Congress because it’s politically unpopular, Cosgrove said. The United States still subsidizes tobacco growing, he said, and politicians won’t address the obesity issue because it’s covered by the Americans With Disabilities Act.

To become more patient-centric, he said, Cleveland Clinic reorganized about three years ago by grouping the hospital’s doctors in institutes that focus on related diseases. Psychiatrists, neurologists and neurosurgeons, for instance, are clustered in the neurological institute to promote innovative care by facilitating discussion among the specialties, he said.

Cleveland Clinic has been a leader in measuring its quality of care and making its results public. It measures its performance in each of its specialties and publishes the results — including mortality and infection rates — in reports and on its Web site. Patients can find the specifics about a Mercedes-Benz, Cosgrove said, so they should be able to do the same with a knee replacement.

“We can no longer just say we’re good,” Cosgrove said. “We have to prove it.”

Cosgrove said he would have preferred if Congress had taken a more measured health care reform process, where experiments in various states could inform the improvements that must take place. Instead, politicians who have studied health care only since January are pressing for legislation that would be imposed nationally, he said.

He believes Congress will pass a bill that’s focused on providing insurance, and that it will become the first step toward further reform.

“This is the start of the process,” he said.