HCA Healthcare TriStar President Mitch Edgeworth on Middle Tennessee's freestanding ER growth
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Source: Nashville Business Journal
Author: Nikki Ross
Date: November 17, 2024
As Nashville’s population continues to grow, so do the number of freestanding emergency rooms.
And that growth, primarily driven by the work opportunities and family friendly environment of Nashville, isn’t just contained to Davidson County: It’s bleeding into surrounding counties like Rutherford and Sumner, to name a few.
As those surrounding counties grow, local hospital systems in the region, like HCA Healthcare and Ascension Saint Thomas, are targeting them for freestanding emergency rooms.
“Seconds and minutes can make the difference between quality of life and poor quality of life,” said Mitch Edgeworth, president of HCA Healthcare’s TriStar Division. “As the community, and I’m specifically thinking Middle Tennessee, has grown, it’s more time consuming to find your way to those precious, limited number of acute care hospitals.”
Nashville is one of the fastest-growing areas in the nation; in 2023, the Nashville Area Chamber of Commerce said the region’s population grew by 86 people per day.
As the population grows, Edgeworth said the hospital system is conducting traffic pattern studies to figure out where the greatest needs are. Adding more services to high-traffic areas doesn’t just benefit the patient, but it also helps emergency response teams get to the next call quicker.
“The less drive time they have to the ER, the quicker they can be back at their station serving the next phone call that comes in,” Edgeworth said. “If they’re responding … and they have to be in their truck transporting for an additional 30-45 minutes to get to a hospital in town, that’s precious minutes that the next call, that might be another neighbor, is going to have to wait on.”
Where are the freestanding emergency rooms?
TriStar is a division of Nashville’s largest public company, HCA Healthcare Inc., which had $64.9 billion in revenue in 2023. It currently has five freestanding emergency rooms within 100 miles of Nashville. There are facilities in Dickson, Spring Hill, Antioch, Mt. Juliet and Portland. The hospital system is planning to build another on East Nashville’s Dickerson Pike and in White House.
Ascension Saint Thomas, one of Nashville’s largest employers with 10,700 employees locally in 2023, currently has one freestanding ER with Highpoint Health, which is a joint venture the hospital system operated with Lifepoint Health.
Ascension Saint Thomas, in collaboration with Highpoint Health, and TriStar both recently obtained certificates of need to build freestanding ERs in White House. Established nationwide in 1972 by the federal government, certificate of need is a permit for the establishment or modification of a health care institution, facility or service at a designated location, according to the Tennessee Department of Health.
While a massive overhaul of the certificate of need process was passed earlier this year, the changes for freestanding emergency departments won’t go into effect until July 2025. This means until next summer, hospitals will still need to file for a certificate of need.
“Even before it was passed, we were already working on this,” Edgeworth said of the White House plans. “I’m still encumbered by the bureaucracy and the red tape that is the certificate of need process.”
Starting next year, hospital systems will be able to build a freestanding ER within 10 miles of their hospital without a certificate of need. Competitors will be able to build a freestanding ER outside of that 10-mile radius without a certificate.
Edgeworth said the changes will benefit communities that need additional emergency services, like White House.
“It would help more if we continue down the pathway of further reform,” Edgeworth said.
Looking to the future
TriStar isn’t stopping with White House.
“We desire to continue to expand, we’re going to continue to expand, we’re going to continue to grow,” Edgeworth said. “We do believe that continuing to find ways to serve our community by expanding access is really, really important. We think it makes a difference.”
It doesn’t matter if the hospital system needs a certificate of need or not.
“We’re not opposed to continue to file certificates of needs for projects,” Edgeworth said.
And he already has his next city picked for freestanding ER expansion. But he’s not quite ready to share it with the public … yet.