eye-opener-logo6The White House has reportedly contacted the chief executive of the renowned Cleveland Clinic, Delos “Toby” Cosgrove, about heading the Department of Veterans Affairs in the wake of a scandal involving treatment delays and falsification of scheduling records.

Former VA Secretary Erik Shinseki resigned last week after an inspector general’s report detailed the problems, and President Obama named Sloan Gibson, the VA’s former No. 2, to serve as interim head of the agency.

Most of the past VA secretaries have been veterans but not physicians. Cosgrove is both. He also has experience running a massive and successful health-care organization that has been praised for its efficiency, outcomes and patient satisfaction.

Here are some additional facts about Cosgrove to help shed light on why Obama would consider tapping him to lead the federal government’s second-largest agency, as well as why he might shy away from choosing him:


Cosgrove, 75, is a decorated Vietnam veteran who served as a surgeon and head of the U.S. Air Force’s Casualty Staging Flight during the conflict.

He has worked at the Cleveland Clinic since 1975, becoming chairman of the network’s thoracic and cardiovascular surgery department in 1989 and serving since 2004 as the clinic’s CEO.

Cosgrove earned his medical degree at the University of Virginia School of Medicine and completed his clinical training at Massachusetts General Hospital, Boston Children’s Hospital, and Brook General Hospital in London.

A Namesake Medical Device

Cosgrove helped develop a medical device and procedure used for repairing leaking heart valves. The Cosgrove-Edwards Annuloplasty System is widely used at U.S. hospitals, including at the Cleveland Clinic.

Cleveland Clinic Details

The Cleveland Clinic is relatively huge, just like the VA. It works with an annual budget of $6 billion, with more than 75 facilities, including a main campus in Cleveland and outpatient clinics throughout Northern Ohio and a handful of medical centers outside the state.

The Cleveland Clinic handled about 5.5 million patient visits last year, according to the network’s year-end fact sheet. For comparison, the VA health system handled about 84 million outpatient visits in 2012.

The clinic employs about 40,000 workers, making it Ohio’s second-largest employer behind Wal-Mart. The VA employed about 338,000 workers as of 2013, according to data from the Office of Personnel Management.

The Cleveland Clinic announced in September that it would shed about 3,000 workers through early retirement as part of a plan to trim spending by 5.5 percent as healthcare providers begin receiving lower Medicare reimbursements under the Affordable Care Act.

For what it’s worth, the Cleveland Clinic is a not-for-profit health network, so the staff reductions are not an attempt to shield shareholders from the health-care law’s financial impacts.

As part of a somewhat unique setup, the clinic groups its physicians into institutes rather than traditional departments, bringing together doctors across multiple disciplines for each of its divisions. The VA recently began using a similarly holistic-minded approach to patient care.

The Cleveland Clinic began publishing its clinical outcomes annually during Cosgrove’s time as CEO, showing, for instance, how many patients die during each type of medical procedure. Relatively few hospitals follow that practice.

Veterans groups have called on the VA to focus more on quality of care as a primary metric for holding staff accountable, so Cosgrove’s focus on transparency and accountability bode well for him.

Cleveland Clinic Successes

U.S. News & World Report regularly names the Cleveland Clinic as one of the nation’s best hospitals. Its heart program, in particular, has been ranked No. 1 since 1995.

Obama praised the Cleveland Clinic for its efficiency and cost controls in 2009, when he and Democrats in Congress were working out the details of the Affordable Care Act.

In 2013, the Cleveland Clinic fulfilled 98 percent of its requests for same-day appointments, accommodating 1 million such visits, according to Cosgrove’s annual report on the state of the clinic. The network has also reduced its emergency-department wait times by 76 percent compared to 2010, lowering the average to 11 minutes last year.

Those numbers will sound attractive to veterans who have dealt with treatment delays lasting more than 90 days in some cases at the VA.

Cosgrove also oversaw a $1.25 billion fundraising campaign to support new construction and improvements for the clinic, including a major expansion of its urology and cardiac practices. The VA has struggled in recent years with delays and cost overruns for construction projects, so his experience and success in this area could prove useful.

Conflict-of-Interest Concerns

Amid the national debate over conflicts of interest in medical research, Cosgrove has run into some trouble due to his ties to the Foundation Medical Partners hedge fund. He served as a general partner for the organization, which invested in companies that published studies on some of the Cleveland Clinic’s experimental products.

Other doctors at the clinic, as well as board members, were known to have similar links. As the details emerged publicly, Cosgrove asked the board to examine potential conflicts of interest within the organization. The review criticized Cosgrove for inadequate disclosure but did not cite him for ethical problems.

The clinic ultimately recommended that its physicians and researchers continue working with medical companies, but it warned that their connections would be regularly reviewed.

Stance on Obamacare

Granted, this issue has little to do with leading the VA, but the president is unlikely to nominate someone who openly criticizes his signature legislation.

Cosgrove has publicly discussed drawbacks of the Affordable Care Act, but he has not opposed the health-care law. He said in a March Fox News interview that premiums have risen for about three-quarters of consumers who signed up for new plans under the law. He also noted that providers would be paid less for working  with Medicare patients.

Cosgrove has visited the White House at least twice to discuss the Affordable Care Act, once with a group leading officials from the health-care industry and again as part of a meeting coordinated by Business Roundtable, a group of CEOs from major U.S. corporations.

Political Donations

Cosgrove has contributed money to candidates from both sides of the political spectrum. Among the Democrats he backed are Sen. Sherrod Brown (D-Ohio) and former Sen. Bill Bradley (N.J.), when he ran for president in 2000.

As for Republicans, Cosgrove gave money to the Romney campaign in 2012, as well as to former Sen. Bill Frist (R-Tenn.) in 2000, among other candidates.


Cosgrove is dyslexic, but he credits the disorder with helping him develop a knack for creative problem-solving.

“We’re not very good at the scholastic stuff, but we see other things that are different — and that’s a big advantage,” he said of dyslexics in a University of Michigan profile for a series on dyslexia success stories.

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