Nashville, Tenn.-based HCA Healthcare — one of the largest ASC operators through its HCA Surgery Ventures arm — is facing pushback over its outpatient growth efforts in both Virginia and Tennessee.
Here’s what ASCs need to know:
Virginia: freestanding ERs, ASCs and market tensions
HCA Healthcare and Cincinnati-based Bon Secours Mercy Health are increasingly at odds as both systems continue expanding their outpatient footprint across Central Virginia.
On Dec. 11, Bon Secours opened a new freestanding emergency department in Ashland, Va., marking its fifth such facility in the Richmond market. The $37.5 million, 17,000-square-foot facility includes 10 patient beds and offers 24/7 emergency care and outpatient imaging services, including CT, MRI, X-ray and ultrasound. About 35 staff members, including emergency physicians and nurses, work at the facility each day.
Bon Secours also operates freestanding ERs in Chester, Short Pump, Colonial Heights and Westchester, Va. The Ashland facility received state approval in 2023 — around the same time the Virginia Department of Health denied a similar proposal from HCA in the same area.
Still, HCA has not backed away from the region.
In October, HCA announced plans to invest nearly $60 million to build three freestanding emergency rooms in Central and Northern Virginia. The expansion will increase HCA’s freestanding ER footprint in the state from eight to 11, with all three sites expected to open in 2026.
HCA also plans to open three new urgent care centers in the Richmond area over the next two years, bringing its statewide total to 15. The new sites are located in areas of rapid population growth, according to the system.
“This is about meeting families where they are,” William Lunn, MD, president of HCA’s capital division, said in a news release. “These new emergency rooms and urgent care clinics are vital community assets that build on the exceptional care we already provide. When every second counts, we want to ensure patients get the help they need — without delay.”
HCA’s broader vision in the region includes a 60-bed hospital, a freestanding emergency department, medical office buildings and a potential 90-bed expansion, pending state approval. Although two of HCA’s certificate-of-need applications were previously denied, the state approved a separate application last year for a $21 million ASC in Hanover — a project viewed as the first phase of a larger hospital plan.
Bon Secours has accused HCA of attempting to encroach on its market share, while HCA maintains its expansion is aimed at improving access.
“The surgical center would significantly benefit our patients by improving access to high-quality surgical services from their preferred health system at a location much closer to home,” a HCA spokesperson told Becker’s.
Tennessee: freestanding ER proposal draws community opposition
In Tennessee, an HCA affiliate, Parkridge Medical Center, is facing criticism over its plan to build a freestanding emergency department in Cleveland, Tenn.
Vitruvian Health’s Bradley Medical Center has launched an online petition urging residents to oppose the project, arguing the new facility would increase costs and fragment care in the region.
Bradley Medical Center said the proposed for-profit emergency department would duplicate existing services while drawing patients away from the local nonprofit hospital. The facility would steer patients toward Parkridge hospitals in Hamilton County, even when Bradley Medical Center is closer and more affordable, the hospital said.
HCA leaders, however, argue population growth in the area requires more emergency care options.
“The proposed Parkridge Cleveland ER will strengthen emergency care access at a time when this community is growing faster than the system can keep up,” Mr. Cosby said in a statement to Becker’s. “With more than 110,000 residents and thousands of new homes, businesses, and commuters coming into the area, relying on a single hospital creates longer waits and fewer options when minutes matter. Adding a second, full-service ER helps relieve that pressure, lowers wait times, and adds competition that raises the standard of emergency care for everyone.”
