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It’s a common sight in Northeast Ohio. Travelling down the highway as you approach an exit, on one side of the road, there’s a shiny new outpost of the Cleveland Clinic, on the other side, one belonging to University Hospital. A few exits down the highway, you might see the exact same thing. In town after town, you come across facilities for both. It’s an indication of just how dynamic the overall healthcare industry is and how the marketplace is evolving. For seven weeks, WKSU News will examine various facets of the economic impact of the healthcare industry in “The Business of Health.” The series provides an overarching look at how big medicine directly and indirectly affects the lives of the residents of Northeast Ohio and whether they’re sharing in the economic benefits and getting the healthcare options they need at a cost they can afford. That’s Tuesday’s during December and January on Morning Edition.

Can the Smaller Guys Survive in the Shadow of the Big Two?

a photo of Summa's Akron campus

The Cleveland Clinic and University Hospitals are based within a few blocks of each other on Euclid Avenue on Cleveland’s east side. But they’ve been increasingly opening offices to the south, including in Akron, a city where Summa has traditionally been dominant. WKSU’s Kabir Bhatia reports on how Summa and others can stay competitive in the face of increased consolidation.

In 2014, the Cleveland Clinic had the highest net patient revenue of any health system in Northeast Ohio, at just under $4.3 billion. No. 2 was University Hospitals. A couple of spots down the list -- compiled by Crain’s Cleveland Business – is Summa, which had revenue of $717 million. Summa was formed in 1989 with the merger of Akron City and St. Thomas Hospitals. This year, the Cleveland Clinic announced it would take over Summa’s biggest competitor, Akron General.

J.B. Silvers is a professor of health finance at Case Western Reserve University and says Akron General’s financial position made it more susceptible to takeover than Summa. He says Summa should be able to stay competitive with the Cleveland Clinic.

“They’re both general hospitals; they do everything. The Clinic may see some areas they want to go into in 

Summa has shuttered Wadsworth-Rittman's inpatient care, and the Wadsworth-Rittman Joint Township Hospital District is suing to regain control of the hospital.

more depth down there. They have made some of their hospitals more specialized and others more general. The other broader question is: 'What are they going to do across the spectrum? What are they going to do about the population that's there?'”

Managing costs
Summa is the largest employer in Summit County. Silvers says it will likely remain dominant in the county due to its ability to manage its total cost of care.

"The proof of that is the Accountable Care Organizations that they have [which] I think it is the most successful in Ohio and one of the best in the country in terms of getting bonuses back from the feds for their care of the population."

Silvers says the difference in service and care between healthcare providers won't be that noticeable to most people, but systems like Summa will be concentrating on better outcomes and lower costs.

"So, electronic prescribing pharmacy arrangements, remote radiology departments, outpatient centers in drug stores. You're going to find more and more of those kind of things. And more distance care."

Case Western Reserve University Health Finance Professor J.B. Silvers says Summa will likely stay competitive because of its ability to manage the total cost of care.

Increased revenue
That’s something Summa is already doing, according to Benjamin Sutton, senior vice president for strategy. He says that’s one reason revenue has climbed 4.2 percent.

“We got very focused about three years ago on our operations and [on] improving things like productivity in the health system. Our workaround revenue cycles. Our spending on medical supplies. Improving some of our quality indicators that help with efficiency, like length-of-stay in the hospital.”

That’s part of a national trend, as is the shift away from inpatient services at many facilities. Much of Summa’s St. Thomas is closed or sparsely used. Summa has controlled Wadsworth-Rittman Hospital since 2008, and they closed inpatient services there two years ago. Sutton says it’s a matter of evaluating the best way to serve their population.

Patients don't go long distances for healthcare. So you have to be able to do it where they live.

 “It isn’t always going to be growth in inpatient capacity that we see being built in places. But it is going to be what’s the best use of the facilities that we have to really provide the care for people that they need in those communities. And a lot of times, that is growth in outpatient services. Wadsworth’s a good example.”

A community's best interests
But the Wadsworth-Rittman Joint Township Hospital District -- represented by attorney Jeff Witschey -- disagrees.

“They can argue what they want about whether they feel something is in the best interest of the community. We have, on the joint district, the elected representatives of these communities. And they are very much in touch with what the community needs.”

Witschey says that means returning local control to the citizens group and allowing them to negotiate a pact with another healthcare organization – possibly the Cleveland Clinic. This is not the only partnership whose future with Summa is up-in-the-air: the health system is embroiled in a lawsuit with the doctors who run and have a majority ownership stake in Western Reserve Hospital in Cuyahoga Falls.

Internal and external
Those are internal issues. Externally, Summa’s Benjamin Sutton says Summit County’s hospital systems can

Credit SUMMA
Summa is embroiled in a lawsuit with the doctors who run Western Reserve Hospital in Cuyahoga Falls; the doctors also own 60 percent of the hospital.


“The Cleveland Clinic -- and organizations like the Cleveland Clinic – are always going to have a role in the healthcare system. There are procedures that are performed there that are not performed anywhere else in the world in some cases. And they aren’t of high enough volume to really be done anywhere else. So we’re not going to be focusing on those things.”

With all of the consolidation that’s occurred among Northeast Ohio’s healthcare providers, Case professor Silvers says he’s not sure how much more is even possible.

“Probably 15, 20 years ago, I was quoted as saying, ‘It’s time to choose up sides.’ I think everybody’s ‘choosed up’ sides, with very few exceptions. But healthcare’s still a local business. Patients don’t go long distances for healthcare. So you have to be able to do it where they live. And we need to figure out how to make that work.”

Kabir Bhatia is a senior reporter for Ideastream Public Media's arts & culture team.