CLEVELAND, Ohio -- Northeast Ohio health systems are doing away with the age-old doctor's office visit -- the cornerstone of care for a generation of Americans -- in what's part of a profound shift in the nation's health care delivery system that has left some patients saying they're unable to afford routine care.

There are still plenty of doctors in the area -- nearly 6,000 of them in the five-county Greater Cleveland alone.

But these days, more and more doctor's visits are at one of a growing number of "off-campus" health centers, which bill patients for "outpatient hospital visits," a designation that brings higher payments from Medicare and private insurers for the same services performed in a "doctors' office" visit.