In a move that could create a new medical superpower, Columbia University is eyeing an affiliation with a wealthy hospital in the Midwest.

The Cleveland Clinic, a top-tier hospital with more than $4 billion in annual revenue, is reportedly seeking to sever ties with its current academic partner, Case Western Reserve University, following recent disagreements between the two institutions.

Under the terms of the new relationship, Columbia would partner with the Cleveland Clinic’s Lerner College of Medicine. Officials from the Cleveland Clinic and Columbia University declined to comment, but sources said the two institutions have been exploring a possible affiliation for several months.

“We’ve talked about it,” a trustee of the Cleveland Clinic who asked not to be identified said. “This is very much a discussion, and I think the issue is a very open issue.”

Columbia already has a medical school, the College of Physicians and Surgeons, which is affiliated with NewYork-Presbyterian Hospital. The affiliation with the Cleveland Clinic that is now under review would only cover medical education, and would not include NewYork-Presbyterian, although a broader relationship could develop later on, some suggested.

While sources at the Cleveland Clinic said it was premature to speculate about the nature of a relationship with Columbia, it is not seen as likely that researchers from the clinic would move to Columbia, or that medical interns from Columbia’s College of Physicians and Surgeons would rotate through the clinic.

Among the reasons the Cleveland Clinic is looking to Columbia, a source close to the discussions said, is that the benefactor of the Cleveland medical college, Alfred Lerner, graduated Columbia College, was chairman of its Board of Visitors, and served on the university’s board of trustees. In 1995, Mr. Lerner pledged $25 million toward a student center at Columbia.

An affiliation could also further boost the reputation of both institutions, which already enjoy top status in their fields.

In 2007, U.S. News and Word Report ranked the Cleveland Clinic fourth on its list of the top 18 hospitals in the country. NewYork-Presbyterian Hospital ranked sixth.

While such an affiliation would be unusual because of the geographical distance between the Columbia and the Cleveland Clinic, it would not be unprecedented.

In 2004, NewYork-Presbyterian Hospital and one of its affiliated medical schools, Weill Cornell Medical College, entered into a 30-year affiliation agreement with the Methodist Hospital in Houston. Under the agreement, physicians at the 1,269-bed Texas hospital can choose to have faculty appointments at Weill Cornell Medical College.

Cleveland Clinic’s discussions with Columbia stem from fissures in its relationship with Case Western that have emerged in recent years. In 2002, the clinic and Case Western partnered to establish the Lerner College of Medicine.

Two years ago, Case Western agreed to a “primary affiliation” with another Cleveland hospital system, the University Hospitals of Cleveland. Shortly thereafter, the University Hospitals system added “Case” to its name, upsetting the leadership of the Cleveland Clinic, which sees the system as its competitor.

“Were it not for that, this would be working fine,” the Cleveland Clinic trustee said of the relationship with Case Western. “When this thing happened, we had the rug pulled out from under us.”

Sources said the hospital has been looking at a number of universities, but focused on Columbia.

According to officials at Case Western, a decision by the Cleveland Clinic to disaffiliate would not be received favorably. “On our end, the collaborative efforts with the clinic are very important and valuable to us,” a spokesman for Case Western, Jason Tirotta, said. “We have several agreements with members of the Cleveland community. The clinic is one of them.”