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Boca hospital will not be joining Vero in Cleveland Clinic

Photo: Boca Raton Regional Hospital

Boca Raton Regional Hospital, a hoped-for link in the future Cleveland Clinic Florida expansion that Indian River Medical Center expects to be part of, has chosen a different hospital system, Miami-based Baptist Health, as its potential merger partner.

That leaves Martin Health’s three hospitals, two in Stuart and one in Port St. Lucie’s Tradition, to join Indian River Medical Center in the Cleveland family if negotiations here go as expected. 

Cleveland Clinic and IRMC this week missed what had been a tentative July deadline for a definitive agreement. But on an encouraging note, Indian River Hospital District trustees have been asked to make their vacation schedules known through August.

That’s because any agreement must be reviewed by trustees in a meeting that requires 10 days advance public notice. The Hospital District, established by the state legislature, is a taxing district and must operate in accordance with Florida’s Government in the Sunshine laws.

Cleveland Clinic attorneys have moved on from examining the workings of the Vero hospital to reviewing issues involving the Hospital District, which owns the hospital buildings and land on behalf of county taxpayers. Because the deal proposed with Cleveland Clinic involves two nonprofits, it would be in the form of a member substitution, not an outright sale, and will require revisions to the lease the District currently has with IRMC’s management company.

In addition, the policy covering the charity care Cleveland Clinic provides to poor patients must be redrawn, District Chairman Marybeth Cunningham told the board at its Wednesday Chairman’s meeting. Originally, it was thought that Cleveland Clinic Weston’s policy would apply to all its future Florida hospitals.

“It’s probably one of the most critical issues,” said Cunningham. “Weston, which is their only experience in Florida, is not a safety net hospital, so they have other hospitals that they can refer [patients] to for indigent care and that kind of thing. It has taken them time to come to grips with the fact that we are a safety net hospital, that there is no alternative for people in our community.

“Their [Weston] policy doesn’t work for us, so [a new policy] has to be developed,” said Cunningham, who is representing the District Board at large in the dealings with Cleveland to date. “We’ve had a lot of meetings to get them to understand what they have had to develop is a brand-new policy ... which I think is all positive. I haven’t seen it, but it is to take care [of the poor] as we have or better. But I want to see it.”

The delay has left the District in limbo with its 2018-2019 budget, which is due to be finalized in September. Last week, Board treasurer Allen Jones convinced the board to OK an increase in the millage rate to .9405 as the trustees, who are elected or appointed by the governor, try to define their mission in light of Cleveland Clinic’s expected assumption of at least part of the hospital’s treatment costs for the medically indigent. The cost of that care totaled around $7.5 million this year, when the millage rate for the District was .8894.

“I would point out that the biggest amount of increase in this is for IRMC,” said Jones. If, with Cleveland’s contribution, that falls to $5 million, the millage rate would drop to .78, he said. “And if it turns out to be less than that, then it falls even further.”

“I do believe we will have enough definition on where we’re going before the September vote to be able to adjust it,” said Cunningham.

The budget and property tax rate will be discussed again in August and September.

Boca Regional, a nonprofit like Cleveland Clinic, until its decision to go in another direction last week would have been the largest in what the Ohio-based system envisions as a Cleveland Florida division. It has 400 beds and a large teaching program with Florida Atlantic University.

The committee charged last June with making the choice for Boca Regional’s future partner considered 12 hospital systems before narrowing the field to Baptist and Cleveland. The Boca Regional board of trustees made the final decision.

“While this was a most difficult choice, one that was between two of the finest healthcare providers in the country, our Trustees believe Baptist is the best fit for Boca Regional,” Boca Regional CEO Jerry Fedele said in announcing the decision.

Cleveland Clinic offered this comment through media relations manager Tora Vinci. “We appreciate Boca Raton Regional Hospital for the opportunity to participate in this process. While disappointing, we remain optimistic about our growth opportunities in Florida and continue discussions with Indian River Medical Center and Martin Health System.”

Baptist Health, already the largest health system in south Florida with 2,251 beds, will become a 10-hospital system if the deal with Boca goes through. Its flagship, Baptist Hospital, snatched the top U.S. News rating in the state away from Cleveland Clinic Weston last year for hospitals in Palm Beach, Broward and Miami-Dade counties. This year’s ratings are due later this month.

Boca would be Baptist’s third hospital in Palm Beach County. Last year, it acquired Bethesda Health’s two hospitals in Boynton Beach. Cleveland Clinic has none, and with no certificate of need to build its own hospital, it has made clear it intends to partner with an existing one.

Boca is one of two that are not already part of a larger system; Jupiter Medical Center is the other, and it has said it intends to remain independent.

Cleveland’s last-minute back-and-forth with Boca may have contributed to the delay in reaching a definitive agreement with Indian River.