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The MetroHealth System
The MetroHealth System
The MetroHealth System
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The MetroHealth System is a [2] non-profit, public health care system located in Cleveland, Ohio. Founded in 1837 as City Hospital,[3] The MetroHealth System serves the residents of the city of Cleveland and Cuyahoga County. The MetroHealth System is a teaching hospital of Case Western Reserve University, with which it is affiliated.[4]

Key Information

The system provides care at three hospitals, more than 20 health centers and 40 additional sites throughout Cuyahoga County.[5] As of December 2023, it had almost 9,000 employees.[6] The system is the 10th largest employer in Northeast Ohio.[7]

MetroHealth is a Level I Adult Trauma Center and Level II Pediatric Trauma Center.[5] It is one of the three major health care systems in Cleveland, Ohio, along with Cleveland Clinic and University Hospitals.

In 1982, MetroHealth established its Metro Life Flight air ambulance service. Metro Life Flight has completed more than 90,000 medical missions, all safely. This air ambulance service is internationally known and has trained crews from Poland to Japan. It uses a fleet of three EC-145 helicopters for its air ambulance service.[8]

History

[edit]

City Hospital was founded in 1837 when Cleveland City Council designated control and management of the Township Poor House to the new City Board of Health and renamed the building City Hospital. For more than a decade, the hospital operated in the two-story building, located at the northwest corner of Clinton Street (now East 14th Street) and Sumner Avenue. The site is now part of Erie Street Cemetery.[9]

In 1855, the institution, then called City Infirmary, moved to its current location about 2+1⁄2 miles southwest of downtown on an 80-acre lot on Scranton Road in Brooklyn Township. The new five-story building was “designed to accommodate both the insane of the city and the sick and infirm poor, and furnish also facilities for clinical instruction to the physicians of the day."[10][11]

In 1889, a new building, large enough to treat 200 patients, opened on the Scranton Road campus. The building offered the latest in medical science and accommodations (steam heat, feathered pillows and hair mattresses, which replaced straw bedding).[12]

In the decades around the turn of the century, as Cleveland's population soared from 160,000 in 1880 to almost 800,000 in 1920,[13] City Hospital saw major growth and a shift from an organization primarily serving the city's destitute to an institution providing medical care to all. It also became a robust training ground for doctors and nurses.[9]

Milestones during this period included the formation of the hospital's first medical staff in 1891, the construction of a children's hospital in 1899 and the construction of a tuberculosis sanitorium in 1902.[12]

In 1914 City Hospital and the medical school at Western Reserve University (now Case Western Reserve University) forged a formal affiliation, combining research with education and creating a firm basis for modern medical science.[12]

Aerial view of Cleveland's City Hospital, circa 1920.

By City Hospital's 100th anniversary in 1937, its campus on Scranton Road boasted 16 buildings and 1,650 beds, making it the country's sixth largest hospital.[9]

In 1958, voters of Cuyahoga County approved a measure to transfer City Hospital to county control, and the Cuyahoga County Hospital System was born. It is recognized as the nation's first public hospital system. City Hospital became known as Cleveland Metropolitan General Hospital.[14]

In 1970, the system opened its nationally renowned burn center.[12]

In 1972, construction was completed on Cleveland Metropolitan General Hospital's 12-story twin bed towers, capping a decade-long $40 million expansion and renovation of the hospital's campus.[15]

The Cuyahoga County Hospital System was renamed The MetroHealth System in 1989.

In May 2014, MetroHealth announced plans for a Campus Transformation project to rebuild the hospital on its main campus.[16][17]

Structure and finances

[edit]

The MetroHealth System is governed by a board of trustees composed of 10 voluntary members approved by Cuyahoga County Council. Per Section 339 of the Ohio Revised Code, the trustees are appointed or re-appointed for a term of six years.[18]

MetroHealth receives funding from Cuyahoga County taxpayers via a Health and Human Services levy. In 2020, the system received $32.4 million in county taxpayer support, which made up 2.2% of its total operating revenue.[19]

Education and research

[edit]

MetroHealth is an academic medical center and has been affiliated with the Case Western Reserve University School of Medicine since 1914. All active staff physicians hold faculty appointments at CWRU.[20]

The system has 47 residency and fellowship programs and trains more than 2,000 students, residents and fellows each year. Medical, clinical and epidemiological research is conducted throughout the system.[20]

Main Campus Transformation and the MetroHealth Glick Center

[edit]
The MetroHealth Glick Center main campus hospital rendering

In 2014, the system announced plans for a Main Campus Transformation that included the construction a new hospital and the eventual demolition of the current hospital bed towers.[21]

Financing for the project was secured in 2017 with the sale of $946 million in hospital-issued revenue bonds.[22]

The system unveiled the design of the new hospital and reimagined main campus in 2018. The plan includes a 12-acre park and more than 25 acres of total green space on the campus.[23]

Ground was broken on the project in April 2019.[24]

In December 2020, the system announced its largest gift ever, a $42 million donation from JoAnn and Bob Glick. Although none of the gift will finance construction of the new hospital, the building will be named The MetroHealth Glick Center in honor of the Glicks.[25]

The new 11-floor hospital, located on Scranton Road just south of the hospital's Emergency Department, opened in November 2022.[26]

Turner Construction Co. servied as construction manager for the project.[27]

Hammel, Green and Abrahamson, Inc. (HGA) led design planning, architecture and engineering.[28][29]

Neighborhood revitalization

[edit]

MetroHealth's main campus is located in Cleveland's Clark-Fulton neighborhood, one of the city's poorest and most densely populated neighborhoods.[30] The health system has made revitalizing the neighborhood a priority and is using its Campus Transformation as a catalyst in that effort.[31]

Working with residents, lawmakers and local community groups, MetroHealth created the first hospital-led EcoDistrict in the world, the MetroHealth Community District.[32]

The system is undertaking multiple neighborhood revitalization efforts, including:

Public transit – In 2017, MetroHealth and the Greater Cleveland Regional Transit Authority partnered to create the MetroHealth Line bus-rapid-transit (BRT) system.[33]

Public safety – MetroHealth has announced plans to move the system's more-than-75-officer police force into new headquarters constructed in the neighborhood, on West 25th Street.[34]

Digital connectivity – The system has announced plans to join with tech partners to bring affordable internet access to up to 1,000 households near its campus.

Housing – In June 2019, MetroHealth announced plans for three new apartment buildings. One, a building offering up to 72 affordable units, is under construction on its campus. In total, the $60 million-plus project will provide at least 250 new apartments to the nearby neighborhood. Each of the apartment buildings will have a first floor dedicated to making life easier for residents of the neighborhood, including commercial space for a mix of amenities including restaurants, a grocery store and an Economic Opportunity Center offering job training and other services.[34]

Leadership

[edit]

Christine Alexander-Rager, MD, was appointed Acting President and CEO on July 26, 2024.[1]

Locations

[edit]

MetroHealth has health centers, offices and clinics throughout Greater Cleveland:[35]

  • Beachwood Health Center
  • Bedford Medical Offices
  • Brecksville Health and Surgery Center
  • Broadway Health Center
  • Brooklyn Health Center
  • Brunswick Health Center
  • Buckeye Health Center
  • Cleveland Heights Medical Center
  • Glenville Community Health Center
  • Lakewood Recovery Resources
  • LGBT Community Center of Greater Cleveland
  • Lyndhurst Health Center
  • Medina Health Center
  • MetroHealth Medical Center Main Campus
  • Middleburg Heights November Family Health Center
  • Midtown Recovery Resources
  • Ohio City Family Dentistry
  • Ohio City Health Center
  • Old Brooklyn Medical Center
  • Old Brooklyn Recovery Resources
  • Parma Medical Center
  • Rocky River Medical Offices
  • State Road Family Practice
  • West 150th Health and Surgery Center
  • West Park Health Center
  • Westlake Health Center
  • West Shore YMCA (physical therapy)

LifeFlight Helicopter Bases

  • Portage County
  • Lorain County
  • Wayne County

References

[edit]
[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

The MetroHealth System

View on Grokipedia
from Grokipedia

The MetroHealth System is a public integrated organization founded in 1837 as Cleveland City Hospital to centralize treatment for poverty-related ailments, epidemics like and , and mental distress among the indigent population of , .
It operates four hospitals, four emergency departments, more than 20 health centers, and over 40 additional sites across Cuyahoga County, functioning as the region's primary safety-net provider dedicated to addressing socioeconomic health disparities and serving underserved communities.
MetroHealth has pioneered advancements such as early ambulance services for contagious diseases and the nationally recognized MetroLife Flight air medical transport program, while maintaining affiliations for and .
In recent evaluations, it has been cited as a national leader in value-based care delivery and earned top rankings for , including an "A" grade from the Lown Institute for contributions.
However, the system has faced significant leadership controversies, including the 2022 firing of CEO Akram Boutros amid revelations of nearly $2 million in unauthorized self-awarded bonuses, confirmed by independent audit, and the 2024 termination of successor Airica Steed for performance shortfalls, both resulting in lawsuits alleging , retaliation, and .

Historical Development

Founding and 19th-Century Origins

The MetroHealth System traces its origins to Cleveland City Hospital, established in response to the that afflicted in 1832, killing approximately 50 residents or 5% of the population at the time. On May 6, 1837, shortly after 's incorporation as a city in 1836, the City Council designated the existing infirmary—originally a —as City Hospital, formalizing provisions for the care of the indigent sick, chronically ill, aged, mentally impaired, and poor. Initially housed in a two-story building near Erie Street Cemetery at East 14th Street and Sumner Avenue, the facility centralized services amid outbreaks of , , and other diseases prevalent among impoverished populations. By the mid-19th century, growing demand prompted relocation; in 1855, City Hospital moved to an 80-acre site in Brooklyn Township along Scranton Road, formerly a poor farm, where it was temporarily renamed City Infirmary to accommodate expansion. A new five-story Italianate-style red-brick structure, known as the "Middle House," was completed that year to serve as the primary facility. In 1863, Dr. J. H. Marshall introduced Cleveland's first horse-drawn ambulance—a covered vehicle powered by a single horse—primarily for transporting patients with tuberculosis and other contagious diseases, marking an early innovation in emergency response. The late 19th century saw further modernization efforts. Construction of a new building began in , culminating in the 1889 opening of a state-of-the-art facility on Scranton Road equipped with amenities such as hair mattresses, steam heating, and improved sanitation. In 1891, 28 physicians and surgeons organized the first formal medical staff, volunteering services in exchange for training opportunities, which laid the groundwork for clinical education. During the 1890s, City Hospital pioneered systematic pathological anatomy studies and autopsies in , enhancing diagnostic capabilities; by 1899, a dedicated was constructed on the grounds for $35,565, featuring a separate entrance on Valentine Avenue to address pediatric needs. These developments positioned City Hospital as a foundational public institution, evolving from a welfare-oriented into a structured medical provider by the century's end.

20th-Century Expansion and Challenges

In the early , Cleveland City Hospital expanded to address specialized care needs amid growing urban demands. In 1901, the Tuberculosis Hospital and City Infirmary relocated to Sunny Acres Farm, enhancing capacity for infectious and chronic conditions. By 1909, a new City Infirmary opened at Cooley Farms in Warrensville Township to serve the chronically ill and disabled. In 1914, a formal affiliation with Western Reserve University (now ) School of Medicine elevated clinical standards and training. These developments reflected the hospital's evolution from a to a multifaceted public institution, though it continued facing pressures from serving indigent patients in a rapidly industrializing city. By the 1930s, significant infrastructure growth marked further expansion. A 169-bed was added in 1932 at Warrensville Township, later evolving into Highland View Hospital. In 1937, City Hospital ranked as the sixth largest in the United States, comprising 16 buildings and 1,650 beds. The 1939 opening of the Colahan Memorial Pavilion introduced the facility's first dedicated , funded by an $80,000 estate donation. Post-World War II, challenges emerged from , which strained city finances as populations shifted outward, prompting a 1958 voter-approved transition to county governance as Cleveland Metropolitan General Hospital, securing levy-based funding. This shift addressed fiscal limitations while enabling sustained operations for a safety-net provider. Mid- to late-century expansions solidified MetroHealth's regional role despite episodic strains like the polio epidemics. In 1954, the hospital was designated a National Respiratory Care Center, operating 32 iron lungs to combat cases. The 1960 groundbreaking for the Bell Greve Outpatient Building expanded ambulatory services. A major $40 million campus overhaul from 1962 to 1972 included the Twin Towers (North Building), two 12-story structures adding 503 beds at a cost of $18.5 million, featuring advanced features like centralized nursing stations and specialized units for and pulmonary care. Highland View transformed into a renowned rehabilitation center by 1953. Later milestones included the 1970 , 1979 , and 1982 Metro Life Flight service, enhancing trauma response. Governance and name changes in the late reflected consolidation amid ongoing demands for uncompensated care. In 1978, Highland View merged with Cleveland Metropolitan General to form The MetroHealth Rehabilitation Institute. The 1989 renaming to The MetroHealth System unified its operations under Cuyahoga County oversight, incorporating centers and specialized programs. These efforts countered demographic shifts and resource constraints, maintaining focus on underserved populations without private payer subsidies.

Post-2000 Reforms and Modernization

In 2013, Akram assumed the role of president and CEO of The MetroHealth System, initiating a period of strategic reforms aimed at enhancing operational efficiency and clinical capabilities. Under his leadership, the system expanded its employee base from 6,200 to nearly 8,000 workers and increased annual revenue from $785 million to over $1.5 billion by 2022. raised the to $15 per hour in 2019 and oversaw the launch of initiatives like the Northern Ohio Trauma System in 2010, which had saved over 640 lives by 2013 through collaboration with . A of post-2000 modernization was the 2015 announcement of the Campus Transformation project, a multi-year overhaul valued at over $1 billion, encompassing physical infrastructure upgrades and clinical enhancements. This included the completion of an 85-bed Clinical Care Pavilion in 2016, demolition of outdated facilities like the Northcoast Behavioral Center, and the opening of new emergency departments in Heights and that year. In 2017, MetroHealth issued $946 million in bonds to fund the initiative, followed by the completion of parking garages and finalization of the new hospital design in 2018. for the 11-story, 316-bed hospital on West 25th Street occurred in April 2019, supported by a $42 million donation from JoAnn and Bob Glick in 2020—the largest in the system's history. The Glick Center opened to patients on November 5, 2022, marking the completion of the core hospital component on time and under budget at a cost of $759 million, with 723,643 square feet and 386 beds overall in the transformed campus. This facility introduced state-of-the-art features, including advanced patient rooms and integrated technology, as part of broader efforts to modernize care delivery. Complementary developments included the 2019 establishment of the Institute for H.O.P.E.™, focusing on social determinants of health, and expansions into school-based healthcare starting in 2013 with the Cleveland Metropolitan School District. In 2018, legislative amendments via Ohio's HB 111 authorized MetroHealth to extend services beyond Cuyahoga County to eight additional counties, enabling regional growth. Subsequent reforms addressed financial sustainability amid rising uncompensated care costs, which reached over $1 million daily by 2025. In July 2025, the system laid off approximately 125 employees—less than 1.5% of its workforce—to stabilize finances, followed by the closure of six walk-in offices in October 2025 to consolidate sites and redeploy resources for expanded access. These measures aligned with the MetroHealth 2030 vision to position the system as Northeast Ohio's "Home for Health," emphasizing access, equity, and while navigating post-pandemic pressures. An outpatient center, delayed but slated for April 2026 opening at $168 million, further supports ongoing modernization.

Organizational Structure and Governance

The MetroHealth System operates as a entity and a component unit of , subject to governmental accounting standards and state oversight. Its legal framework derives from Chapter 339 of the Ohio Revised Code, which authorizes county hospital systems to provide integrated health care services while maintaining fiscal accountability to county authorities. As a safety-net provider, it receives public funding and must comply with requirements for transparency, including annual audits by the Ohio Auditor of State to assess financial reporting, internal controls, and adherence to federal and state compliance mandates. Governance is vested in the MetroHealth System Board of Trustees, consisting of voluntary members appointed by the to ensure alignment with public interests. The Board establishes bylaws for operational rules, delivery, and strategic direction, with standing committees such as the and Compliance Committee responsible for reviewing , independent audits, and compliance programs to mitigate risks like or regulatory violations. The Governance Committee further maintains the Board's structure, evaluates trustee performance, and addresses succession planning to sustain effective oversight. While the core system functions as a governmental entity, it is distinct from affiliated nonprofits like the MetroHealth Foundation, Inc., a 501(c)(3) organization that supports fundraising but operates independently for charitable purposes. Oversight extends to federal programs, such as accountable care organization (ACO) reporting, where the Board ensures compliance with Medicare Shared Savings Program requirements through designated voting members and public disclosures of governing body structures. This layered accountability framework balances autonomy in clinical operations with public fiscal responsibility, as evidenced by regular state audits confirming no material weaknesses in internal controls as of fiscal year 2023.

Internal Divisions and Operations

The MetroHealth System organizes its clinical operations through specialized departments, with the Department of Medicine featuring 12 divisions: , , , , , , , , , , and . These divisions support inpatient and outpatient care, including delivery via and across more than 20 ambulatory health centers. Surgical and nursing operations are managed separately, with a Director of overseeing clinical activities in medical, surgical, and related units since at least 2000. Administratively, the system includes support units such as the MetroHealth Foundation, a 501(c)(3) entity for , and the Institute for H.O.P.E.™, which addresses like and transportation to complement medical services. Overall operations rely on nearly 9,000 staff members, including over 600 physicians and 1,700 nurses, to serve more than 300,000 patients annually, with two-thirds uninsured or enrolled in Medicare/ as Cuyahoga County's designated safety-net provider. Recent operational adjustments reflect financial pressures, including the of 125 employees—primarily in administrative roles from senior leaders to entry-level positions—in July 2025 to stabilize operations amid funding uncertainties. In October 2025, the system consolidated six offices into centralized locations to streamline services, extend hours, and redeploy resources for broader access. These measures align with the MetroHealth 2030 strategic plan, emphasizing efficiency across four hospitals, four emergency departments, and over 40 additional sites.

Facilities and Clinical Services

Core Locations and Infrastructure

The MetroHealth System's core infrastructure centers on its Main Campus Medical Center at 2500 MetroHealth Drive in , , encompassing a 52-acre site west of downtown that integrates clinical, research, and educational functions. This campus features the Glick Center, an 11-story that opened in November 2022 as part of a billion-dollar revitalization project, providing 388 beds in a design emphasizing flexibility with all rooms equipped for intensive care capabilities and surge capacity doubling. The facility includes a Level I Adult Trauma and Burn Center, alongside supporting infrastructure such as a new central utility plant and loading dock completed concurrently. The campus layout adopts a "hospital in a park" model, allocating 25 acres to green space for enhanced patient and staff well-being, while consolidating services to optimize access across Cuyahoga County. Adjacent developments include specialized units like rehabilitation services and research institutes, with over 70,000 square feet dedicated to facilities. Key secondary locations include the Parma Medical Center at 12301 Snow Road in , which delivers comprehensive adult and pediatric care, including an , in a facility divided into east and west sections with dedicated parking. The system maintains four hospitals overall, supplemented by surgery centers like Brecksville Health and Surgery Center and multiple health centers, ensuring broad coverage but with the Main Campus serving as the hub for advanced trauma and specialized infrastructure.

Specialized Medical Programs

The MetroHealth System operates Ohio's only verified adult and pediatric , accredited by the American Burn Association and the for comprehensive care of both age groups. This program handles complex injuries, integrating surgical, rehabilitative, and critical care services, with specialized units supporting recovery from , chemical, and electrical . The center's capabilities include advanced management, infection control, and multidisciplinary teams comprising surgeons, intensivists, and therapists. As Cuyahoga County's most experienced Level I Adult , verified by the since 1992, MetroHealth provides 24/7 emergency response for severe injuries from accidents, violence, and falls. The trauma program features rapid triage, surgical intervention, and post-acute support through the Trauma Recovery Center, which offers free psychosocial services to patients and families without enrollment requirements. This includes counseling for post-traumatic stress and assistance with reintegration, addressing both immediate life-saving needs and long-term outcomes. The MetroHealth Rehabilitation Institute specializes in restoring function for patients with , brain injuries, injuries, and , featuring dedicated inpatient units with 57 beds across three floors tailored to these conditions. Outpatient services encompass physical, occupational, and speech therapies, alongside targeted programs for cancer rehabilitation, amputee care, and . Specialized clinics address back and , hip and knee disorders, hand and upper extremity issues, , , management, and follow-up, often involving interdisciplinary collaboration with orthopaedics, , and specialists. Additional focused programs include the Comprehensive Care Clinic within pediatric services, which adopts a medical home model for coordinated care of children and adults with developmental disabilities, emphasizing preventive health and holistic management. These initiatives leverage MetroHealth's integration as a safety-net provider, prioritizing evidence-based interventions amid high-acuity caseloads from its urban setting.

Education and Workforce Training

Academic Affiliations

The MetroHealth System has maintained a primary academic affiliation with the (CWRU) School of Medicine since 1914, serving as a key for and . This longstanding partnership enables MetroHealth to function as an academic medical center, where all active staff physicians hold faculty appointments at CWRU, facilitating integrated clinical training for medical students, residents, and fellows across multiple specialties. In July 2021, the institutions extended their collaboration through 2031, emphasizing continued joint efforts in graduate , clinical rotations, and translation into patient care. MetroHealth supports a wide array of residency programs under this affiliation, including , , , , and , providing hands-on training with a diverse urban patient population drawn from Cleveland's safety-net demographics. These programs leverage MetroHealth's role as a major CWRU affiliate to offer from experienced faculty and exposure to complex cases, preparing trainees for varied career paths in academic, community, or specialized practice settings. Additionally, MetroHealth participates in CWRU's in Anesthesia program as a primary affiliate site, hosting clinical rotations for students in core and specialty areas. Beyond the School of Medicine, MetroHealth established an affiliation with the CWRU School of Dental Medicine in 2017, aimed at expanding research opportunities, clinical training, and interdisciplinary collaborations in oral health and related fields. This partnership builds on MetroHealth's broader commitment to workforce development, though it remains secondary to the ties, with no comparable integrations reported with other institutions as of 2025.

Residency and Continuing Education

The MetroHealth System sponsors a range of graduate medical education programs, primarily through its affiliation with School of Medicine, offering residencies and fellowships in specialties such as , , , , , and . The residency, for instance, emphasizes comprehensive training in a high-volume urban safety-net environment, with residents managing diverse patient populations including those with socioeconomic challenges. residency integrates community-based care, featuring clinics in , , behavioral health, and , serving a multi-ethnic patient base in . The residency spans four years, focusing on anatomic and clinical with hands-on experience in autopsies, , and . These programs prioritize resident wellness, with structured support for work-life balance amid rigorous clinical demands. Fellowship opportunities include advanced practice provider tracks in and obesity medicine, alongside and fellowships, designed to build expertise in subspecialties relevant to MetroHealth's demographics. Application processes for these ACGME-accredited programs typically involve the Electronic Residency Application Service (ERAS) and (), with positions filled annually; for example, categorical residencies recruit PGY-1 through PGY-5 levels. MetroHealth's Graduate department oversees , , and , ensuring compliance with standards while fostering skills in and interdisciplinary care. In (CME), MetroHealth is accredited by the Ohio State Association (OSMA) to provide physician , designating activities for AMA PRA Category 1 Credits through its Professional Department (MPED). The program delivers high-quality offerings such as conferences, online courses, and learning-from-teaching modules, aimed at advancing knowledge in clinical developments and research applicable to safety-net care. Recent activities include CME conferences addressing topics, with events like the 2023 Spring Ball integrating and networking. MPED also supports interprofessional , including programs and summer preceptorships, to sustain competencies in areas like interventions and specialized services. These initiatives emphasize practical, evidence-driven updates, with ensuring independence from commercial influence.

Research and Innovation Efforts

Key Research Centers

The MetroHealth System operates several dedicated research centers that integrate basic science, clinical trials, and population-level studies to address pressing health challenges, particularly for underserved communities in . These centers leverage affiliations with and secure substantial federal funding, including from the (NIH). The Center for Cancer Research, founded in 2021, focuses on targeting , diagnostics, , therapeutics, tumor development, , and disparities, with emphasis on breast, , colorectal, and cancers. It houses facilities within MetroHealth's 70,000 square feet of research space, supporting 28 researchers across seven laboratories equipped with state-of-the-art technologies. In 2024, the center produced 15 peer-reviewed publications and maintained 12 NIH-funded grants. The Center for Rehabilitation Research drives innovations in neuromusculoskeletal conditions, , , and assistive technologies, including leadership in for motor function restoration. Co-directed by physicians and scientists in collaboration with and the Louis Stokes Cleveland VA Medical Center, it oversees multiple divisions with ongoing projects and has amassed over $83 million in extramural funding from federal, state, and foundation sources. As of February 2023, its efforts ranked first nationally for NIH funding among U.S. departments. The Population Health Research Institute coordinates interdisciplinary efforts across three core centers— including the Center for Health Care Research and Policy—to promote equitable health outcomes through data-driven interventions, clinical care integration, and community partnerships. Supported by a and Data Sciences Division and over 50 faculty collaborators, it managed 37 active grants totaling more than $50 million and generated over 160 publications in 2024, while mentoring 90 trainees and engaging 70 community partners. Supporting these initiatives, the Clinical Research Unit provides multidisciplinary facilities, experienced staff, and equipment for trials in areas like emergency care, , and , facilitating over 177 active clinical studies system-wide as of 2021.

Notable Projects and Outcomes

The MetroHealth System's research efforts have yielded significant outcomes in funding, publications, and clinical advancements, particularly through its specialized institutes. In 2024, the and Equity Research Institute (PHERI) supported 37 active grants exceeding $50 million in value and produced over 160 peer-reviewed publications, while mentoring more than 90 trainees. These outputs reflect a focus on and community-driven studies, including projects like the Assessment of Biomarkers in Children to Help Parents Quit Tobacco (ABC Quit), aimed at reducing pediatric exposure to . The Rehabilitation Institute achieved the top national ranking for (NIH) funding in , securing $35 million in new grants in and maintaining $83 million in total active extramural funding. This funding supports investigations into brain injury, , and , contributing to improved standards of care and patient outcomes through innovative treatments. In March 2023, MetroHealth completed a state-of-the-art vector and cellular (GMP) facility, enhancing local access to advanced therapies for cancer patients by enabling on-site production of cellular and gene-based treatments previously requiring off-site manufacturing. The Emergency Care Research and Innovation (ECRI) center has advanced through programs in , care, , , , , , opioid safety, and , fostering collaborative trials that improve delivery. Additionally, a with TriNetX expanded clinical trial opportunities by 20- to 30-fold, facilitating rapid recruitment for studies such as those on COVID-19. In 2017, MetroHealth collaborated with on a $2.2 million NIH grant to refine heart disease risk calculators, enhancing predictive accuracy for cardiovascular interventions.

Financial Operations and Sustainability

Revenue Sources and Budgeting

The MetroHealth System's primary revenue source is net patient service revenue, which accounted for approximately 70% of total operating revenues in 2023, totaling $1.258 billion out of $1.812 billion in operating revenues. This includes reimbursements from Medicare, , and commercial insurers, with and Medicare together comprising about 41% of net patient revenue despite serving 86% of patient visits, reflecting lower reimbursement rates typical for safety-net providers. Disproportionate share (DSH) payments and uncompensated care pools supplement these, with Ohio's Care Assurance Program (HCAP) contributing significantly; for instance, MetroHealth anticipated $119 million in HFF charity care adjustments for state 2025. Cuyahoga County provides direct charity care funding, reclassified as part of net patient revenue at $35 million annually as of , up from a separate $32.4 million line in 2023. Other operating revenues, such as from retail pharmacy operations and ancillary services, added $522 million in 2023 and grew to $581 million in , driven by expanded clinical volumes and non-patient services. Nonoperating revenues include net investment income of about $54 million annually and noncapital grants and donations around $4.5–5 million, primarily from the MetroHealth Foundation. Total revenues reached $1.847 billion in 2023, increasing to approximately $1.955 billion in amid 9.5% growth in patient service revenue, though offset by rising expenses in salaries, benefits, and pharmaceuticals. Community benefits, including $108 million in uncompensated care and $72 million in Medicaid shortfalls, represent implicit costs absorbed within these revenues. Budgeting occurs through an annual process where MetroHealth's board of trustees proposes an operating , which is then submitted for approval by the , reflecting its status as a component unit. The 2025 , approved by trustees in November 2024, projects $2 billion in operating revenues against $1.9 billion in expenses (excluding ), emphasizing volume growth, expansions, and stable charity care funding at $35 million. Prior years show disciplined fiscal management, with revenues growing 41% from 2019 to 2023 ($1.295 billion to $1.82 billion), though net position declined to $379 million in 2024 due to obligations and one-time costs. Management anticipates continued reliance on federal and state adjustments, such as Medicare DSH increases of $652,000 for federal 2025, to sustain operations amid inflationary pressures.

Economic Contributions and Performance Metrics

The MetroHealth System serves as a major economic anchor in Cuyahoga County, employing nearly 9,000 individuals as of 2023, including 716 physicians, 463 residents and fellows, 2,404 nurses, and over 5,200 support staff, positioning it among the region's largest employers. These roles generate substantial payroll expenditures that circulate through local businesses via employee spending, while the system's of further stimulates economic activity in and surrounding areas. In recent years, MetroHealth has expanded its workforce by adding more than 600 caregivers, enhancing job stability and supporting household incomes in a region with persistent economic challenges. A key aspect of its economic contributions lies in community benefits, totaling $243 million in 2023, which included $107.8 million in uncompensated care for uninsured or underinsured patients, $71.7 million to cover payment shortfalls, $50.8 million for , $7.6 million for research, and $5.1 million for community outreach programs. These investments effectively subsidize healthcare access for low-income residents, reducing the fiscal burden on county taxpayers and enabling broader participation in the workforce by mitigating untreated health issues that could otherwise lead to lost productivity. The system's role as a safety-net provider amplifies these effects, as evidenced by prior analyses of its campus transformation projects, which projected nearly $900 million in total economic output from construction and operations between 2012 and beyond. Financial performance metrics reflect a period of revenue expansion followed by emerging pressures. Total reached $1.82 billion in 2023, marking a 41% increase from five years prior, driven by higher patient volumes and expanded services. However, operating losses mounted to $50 million in 2024 due to factors including national healthcare workforce shortages, elevated supply costs, and increased demand for charity care, prompting workforce reductions of about 125 positions—less than 1.5% of staff—in July 2025 to restore sustainability. The 2025 budget projects $2 billion in operating against $1.9 billion in expenses (excluding ), with net anticipated to rise amid efforts to optimize surgical volumes and manage service that began in 2023. Despite these challenges, the system maintains reserves sufficient to meet bond covenants without direct intervention as of September 2025.

Community Impact and Initiatives

Neighborhood Revitalization Projects

The MetroHealth System's neighborhood revitalization efforts center on the Clark-Fulton area in , , integrating its $1 billion Glick Center hospital campus transformation with community investments to enhance housing, green spaces, and economic opportunities. This approach positions the hospital as a catalyst for broader , emphasizing like and environmental improvements. In June 2019, MetroHealth announced a $60 million investment for three mixed-use buildings along the West 25th Street corridor, yielding 250 apartments alongside on-site amenities including fresh food markets, facilities, and job training programs. The initiative, developed in partnership with The NRP Group, prioritizes affordable units for families and seniors to stabilize the neighborhood. Key components include the Vía Sana building, which broke ground on February 22, 2021, and provides 72 affordable family rental units with integrated job training services. Complementing this, MetroHealth North offers 72 additional affordable housing units in one- to three-bedroom configurations aimed at families. The project incorporates extensive , converting 26 acres of the 52-acre campus into landscaped parks, including a 12-acre public park along West 25th Street to serve as a gateway. In 2024, MetroHealth collaborated with and the Western Reserve Land Conservancy on a vacant land greening initiative targeting environmental inequities in Clark-Fulton and adjacent areas like Brooklyn Centre and Stockyards. This partnership secured a $17 million U.S. Agency grant on September 11, 2024, funding efforts with seven community organizations to tackle climate justice and in disadvantaged neighborhoods. These developments aim to reduce health disparities by improving access to stable housing, nutrition, employment, and safe outdoor spaces, with MetroHealth committing ongoing resources through its Institute for H.O.P.E.

Public Health Interventions

MetroHealth System addresses public health challenges through systematic screening for (SDOH), targeting factors that influence approximately 80% of health outcomes, such as , , transportation, , and . The system screens over 200,000 patients annually for nine specific SDOH, including food insecurity, financial strain, transportation limitations, inability to pay for or utilities, , , infrequent , daily stress, and lack of . This screening is conducted in-person or via telephone by care coordinators, or online through the MyChart patient portal, with an electronic platform enabling referrals to over 250 community-based organizations for support. Data from these efforts indicate that patients reporting experience 1.9 times more hospitalizations, 2.4 times more visits, and are 2.4 times more likely to miss appointments compared to those without such needs. Supporting these screenings, the Institute for H.O.P.E. (Health. Opportunity. Partnership. Empowerment.), part of MetroHealth's Institute, coordinates interventions to reduce health disparities in , where life expectancy gaps across ZIP codes can reach 23 years. Key programs include Calls for H.O.P.E., which deploys volunteers for telephone outreach to combat ; the Opportunity Center, offering financial coaching and a food pantry; the Trauma Recovery Center, providing for survivors; and the for Arts in Health, delivering arts-based programs to build resilience. These initiatives emphasize , such as the Unite Ohio network, to align resources and scale solutions. MetroHealth allocates $331 million annually—equivalent to 21.3% of its operating expenses—to programs exceeding twice the national average for U.S. hospitals, funding access expansion and disparity reduction. In efforts, MetroHealth has leveraged (HIT) since implementing its Epic system in 2009, integrating Advisory Committee on Immunization Practices guidelines for automated reminders and alerts. A 2012 outreach campaign targeted adolescents overdue for vaccinations using text messages, phone calls, and postcards, resulting in improved uptake rates and subsequent expansion of reminders to all patients, which boosted adult compliance. Additionally, the system operates neighborhood-based maternal and child health programs delivering clinical visits, community outreach, and services to underserved populations. These interventions reflect a broader commitment to preventive care, though challenges persist, such as unresolved referrals for food insecurity, particularly among younger patients.

Leadership and Key Figures

Executive History

Dr. Akram Boutros served as President and Chief Executive Officer of The MetroHealth System from January 2013 until his termination by the Board of Trustees on November 22, 2022, after nearly a decade in the role during which he oversaw transformations including responses to the county jail healthcare crisis and the COVID-19 pandemic. His departure followed an announcement of planned retirement at the end of 2022, but the board cited issues including unauthorized bonuses exceeding $4 million. Boutros later contested the firing, refiling a civil damages case in November 2024 alleging wrongful termination, with an Ohio state auditor determining in the same month that his bonuses did not violate law. Boutros succeeded Mark Moran, who had been CEO until announcing his resignation in early 2012 amid a search for new leadership. Dr. Airica Steed, Ed.D., RN, MBA, FACHE, was appointed as Boutros's successor, assuming the President and CEO position effective January 1, 2023, marking her as the first woman, first Black individual, and first nurse to lead the system. Steed's tenure, spanning less than two years, ended with her firing on August 9, 2024, following a special board meeting, amid reported internal challenges and potential legal disputes. Following Steed's removal, Dr. Christine Alexander-Rager, a longtime executive and physician within the system, was named and CEO on July 26, 2024, during Steed's . The Board of Trustees promoted Alexander-Rager to the permanent role effective immediately on October 8, 2024, through at least 2025, citing her internal experience and stability needs after two CEO firings in quick succession. This period of rapid executive turnover reflects ongoing board efforts to address operational and issues at the safety-net health system.

Board Composition

The MetroHealth System is governed by a Board of Trustees composed of voluntary members appointed by the , as established under Chapter 339 of the Revised . The board oversees the system's strategic direction, , and operational policies, with members serving without compensation and typically numbering around 10 individuals vetted through county processes. As of 2025, E. Harry Walker, MD, serves as Chair, a position to which he was reappointed in May 2025 following leadership of the system through recent operational challenges. John M. Moss holds the role of Vice Chair, while John Corlett acts as Secretary. Additional members include Artis A. Arnold III, Sharon Dumas, Ronald Dziedzicki, and Dolores Garcia, the latter two among recent appointees introduced in early 2025. The board operates through committees such as , which focuses on effectiveness assessments and training, and others addressing finance, quality, and . Appointments emphasize diverse expertise in healthcare, , and to ensure oversight of the county-affiliated entity, though specific member backgrounds are not uniformly detailed in . The board meets monthly, with agendas and minutes available publicly to promote transparency in decision-making.

Controversies and Criticisms

Management and Leadership Disputes

In November 2022, the MetroHealth System Board of Trustees fired President and CEO , alleging he unilaterally awarded himself $1.98 million in bonuses without proper board approval, violating bylaws and constituting misappropriation. , who had served since June 2013 and planned to retire at the end of 2022, denied wrongdoing, claiming the payments aligned with his contract's provisions for performance incentives available to other executives, and filed a accusing the board of , , and retaliation for his criticisms of board hiring practices. In November 2024, following a 22-month investigation, the Auditor of State cleared of criminal violations, determining the bonuses did not break law but criticizing the board for ineffective oversight of processes. refiled an expanded civil suit in November 2024 against MetroHealth and the board, seeking damages for reputational harm and contract violations. Boutros' dismissal prompted the board's appointment of Airica Steed as interim then permanent CEO in early 2023, marking her as the first Black woman to lead the 188-year-old public system. On August 9, 2024, the board terminated Steed, citing failure to meet performance expectations, , and loss of confidence, shortly after she took a . Steed, through her attorney, rejected the claims as "denigrating" and unfounded, alleging board misconduct including corruption and , and indicated intent to pursue legal action for unlawful termination. In May 2025 court filings, MetroHealth attorneys defended the firing by detailing instances of poor judgment and defiance of board directives, amid ongoing litigation threats. These consecutive CEO ousters—within less than two years—highlighted tensions between the board and executive leadership over , compensation, and performance accountability, with critics attributing instability to board governance lapses rather than individual failings. One board member resigned in December 2022, defending and decrying the board's handling of his exit as retaliatory. No criminal charges resulted from either dispute, but both spurred lawsuits underscoring disputes over contractual rights and board oversight.

Operational and Policy Challenges

The MetroHealth System has encountered significant operational challenges stemming from escalating financial pressures, including $50 million in operating losses for 2024 and projections for even greater deficits in 2025. These losses are exacerbated by a doubling of charity care costs since 2022, driven by increased uncompensated care for uninsured and underinsured patients in its safety-net role. In response, the system implemented layoffs affecting approximately 125 employees—primarily in administrative roles—on July 24, 2025, marking the largest workforce reduction since 2011, alongside a partial hiring freeze to curb expenses. Operational inefficiencies have arisen from the system's decade-long expansion of service sites, leading to service duplications and fragmented resource allocation across . To address this, MetroHealth announced the closure of six outpatient offices in locations including Rocky River, , Westlake, , and Broadview Heights on August 25, 2025, as part of a budget stabilization plan aimed at consolidating services and redeploying staff to higher-volume sites for improved efficiency. Additionally, the system plans to shutter its psychiatric by December 31, 2025, citing unsustainable operations while preserving capacity at its standalone Behavioral Health Hospital opened in 2022. Policy challenges compound these issues, particularly uncertainties in federal and state policies for and Medicare, which form the bulk of MetroHealth's payer mix. Recent congressional actions, including the July 2025 passage of budget legislation perceived by some stakeholders as risking reductions, have heightened funding volatility for safety-net providers like MetroHealth. At the local level, Cuyahoga Ronayne's proposed 2026-2027 budget includes a $24 million cut to health and human services, directly impacting MetroHealth's allocations amid broader fiscal strains. These policy dynamics underscore the system's vulnerability to external shortfalls, prompting internal restructuring to maintain core services without additional county subsidies, as reserves remain sufficient for debt obligations per bond covenants.

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