Last year, the Cleveland Clinic was cited for 23 health and safety issues. Plus, it received two letters warning that reimbursements for Medicare patients would be stopped if corrective action wasn't taken within days.
Financial reports indicate the Clinic gets 43 percent of its revenue from Medicare. So, this was a big deal and more so because it wasn't the first time the Clinic had received letters threatening a cut in federal funding.
It has received at least two other similar warnings over the last four years.
In a letter to Clinic CEO Dr. Toby Cosgrove last June, the U.S. Centers for Medicare and Medicaid said the issues raised "limit your hospital's capacity to render adequate care and ensure the health and safety of your patients."
The Cleveland Clinic's Chief Quality Officer, Dr. Michael Henderson says the letters "are the standard forms."
"The first time I got one of these, I said, Oh My God what's all this about," Henderson says.
Among the problems that have been cited by federal inspectors: operating room fires that burned patients; inadequate accounting of tools used in surgery; expired blood tubes found in the operating rooms; failure to make sure surgeons had the correct credentials for the operations they were performing.
Lisa McGiffert, who directs the Safe Patient Project at Consumers Union says the reports can be shocking to read but "I think those are things that can happen in any hospital and I think that the situation about Cleveland Clinic is that there's a pattern of repeated violations."
Dr. Henderson says after a visit from inspectors in May 2013 found numerous violations, the Clinic moved to clean up inventory tracking and has reassessed its protocols.
"This was really when we kicked into a much higher gear of how we manage policies across our whole health system and led to us revamping our whole privileging and credentialing process," Henderson says.
Inspectors for CMS cannot levy fines when they spot violations. So, instead, they send letters to the hospital and when it's bad enough they use their only tool: a threat to pull the agency's funding.
That threat is generally saved for only the most severe condition violations. Henderson says about 20 percent of the Clinic's violations were at this severe level.
And many of the Clinic's violations focused on how it manages its staff and operating room procedures. The medical staff, governing body and Dr. Cosgrove were all cited during inspections.
"We usually find about two-thirds of these are what I would call more administrative and the other third are what we call clinically related," Henderson says.
Dr. William Jessee, a former executive of the national accrediting board and a professor of health systems management at the University of Colorado, says there's a good reason inspectors focus on those administrative concerns.
"Individually, a lot of them look very much like administrative issues but collectively they form the infrastructure for trying to protect patients and optimize patient safety," Jessee says.
These particular citations by the Centers for Medicare and Medicaid were all initiated because of complaints. Modern Healthcare, an industry trade publication, found that 9,500 complaints had been filed at 1,600 hospitals during the three years covered in the database. The federal agency also gives citations based on its routine surveys and inspections. We don't have details on those.
It's clear the Cleveland Clinic is not alone. But the complaint-based citations show it has had far more citations than other metro-area hospitals.
Henderson says the Clinic may get more scrutiny because of its reputation.
"As Chief Quality Officer here, these kinds of things help me enormously move things forward to another level of excellence and I think Dr. Cosgrove also is the first one to say these can be painful but they always make us better," Henderson says.
Last week, Dr. Cosgrove's name surfaced as a possible choice to become the new head of the Veterans Administration. Cosgrove took his name out of the running. He says the federal health and safety inspections had no bearing on that decision.