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Matt Taylor said one of every five patients in metro Orlando who seeks out emergency care goes to a freestanding facility versus a hospital.
That equals roughly 269,000 patients going to freestanding emergency departments, according to Florida Agency For Health Care Administration statistics for 2023. The senior vice president for asset strategy at Orlando Health said that demand guides his organization's expansion strategy.
“If 20% of your market need is seeking out care in a freestanding emergency room, we certainly want to provide that solution and answer to the patient’s needs,” Taylor said.
Competitors Orlando Health, AdventHealth and HCA Healthcare Inc. (NYSE: HCA) all have ramped up the work on facilities in metro Orlando. Freestanding ERs often are affiliated with a nearby hospital and provide primarily emergency medical care, including imaging like CT scans or X-rays.
In April 2018, there were five freestanding ERs in Central Florida. As of April 2024, more than 26 are open, including several more on the way, and that growth also can be seen across the state.
Florida has more than 119 off-site emergency departments as of March 2024, up from 26 freestanding ERs in 2016, according to the state Agency for Health Care Administration. Much of that has come since the state got rid of its certificate of need program for hospitals in 2019, which experts say has streamlined the process and created less development hurdles.
With that growth in mind, Orlando Business Journal took a dive into the strategy of these facilities and how investment has expanded locally over time.
What is pushing freestanding ERs' growth?
Allan Baumgarten, an independent health care analyst, said the ERs are a cost-effective way for systems to get into areas of high population growth. The facilities provide high revenue because of the cost of emergency room care, and also can be a way for health systems to market themselves in an area.
“As the population in Central Florida and other parts of the state continues to grow and new areas are developed, each of the health systems would like to be the first to establish their presence in these newly developing areas," he said. "Because of the low population and the expense, those areas are not good candidates for a full-service hospital, but they are good candidates for limited facilities like a freestanding emergency room.”
Metro Orlando — which includes Lake, Orange, Osceola and Seminole counties — has grown from 2.13 million residents in 2010 to 2.67 million in 2020, an addition of more than 500,000 people during that time.
Residential development is something that drives those conversations about property purchases for new ERs. Brian Adams, president and CEO for the Central Florida Division with AdventHealth, said the 14-acre Millenia site it bought that previously was home to Christian theme park The Holy Land Experience became a strategic site over time.
“The density of population that sits downtown and down through [Millenia] that has grown — there’s no new land, but there are new condos and townhomes driving that density.”
A 19,000-square-foot ER replaces the coliseum and other buildings that once stood on the former Holy Land Experience site and were demolished last year. That new building is poised to open in June with signage that will be visible from Interstate 4.
Setting the stage for a hospital
Baumgarten added that some freestanding ERs can grow into hospitals if there is continued population growth that can support one. Local examples in metro Orlando include the Orlando Health Horizon West Hospital, its soon-to-open hospital in Lake Mary, AdventHealth Winter Garden and HCA Florida Oviedo Medical Center.
Taylor said when Orlando Health sources real estate, it often already knows whether it will grow into a full hospital or remain a freestanding ER. With Horizon West, the large site allowed it to start with the ER and medical office building in 2018 and eventually expand to a hospital in 2021.
The system’s Randal Park and Reunion Village ER campuses also each have the space to become a full hospital eventually. Each campus is approved for 240 hospital beds.
Meanwhile, AdventHealth’s Millenia site has space to add services in the future. Prior conceptual plans include a potential hospital tower, but the final mix of services could be determined by the level of growth nearby.
Both AdventHealth and Orlando Health systems use metrics to determine what the long-term growth in an area will look like, including the age of residents.
Where does the growth go from here?
Taylor said the development of roadway infrastructure also has created areas of interest. For example, the completion of the beltway around the region made up of State Roads 417 and 429 formed a loop around the metro area and has drawn large levels of commercial development.
“This certainly is a new frontier in some cases where we are planting a flag, but it’s not in isolation," Taylor said. "It’s part of a greater system strategy to link that care in an emergency department to the follow-up care someone may need."
The northwest and southeast are two areas of focus for AdventHealth's local freestanding ER expansion.
In the northwest, that includes areas such as Minneola, where an upcoming hospital is planned.
In the southeast, AdventHealth already has a freestanding ER in Lake Nona that will become a full hospital campus. In addition, the proposed development in Tavistock’s nearby Sunbridge development over 27,000 acres between Osceola and Orange counties will create demand for Centra Care, Primary Care+, traditional physician offices or a freestanding ER.
"You never want a community to develop without roads, school or health care. We wake up and our mission is with one of those, but that is how we think about it."
Where health systems are adding ERs
HCA has proposed emergency rooms in Winter Garden, in downtown Orlando at 719 Peachtree Road and 1434 N. Alafaya Trail. It plans to open the HCA Florida Maitland Emergency facility this spring.
Besides Millenia, AdventHealth already has an ER planned in Fruitland Park near The Villages. The system also has filed plans to build in the Southchase area of Orlando and another one in Poinciana, though those are in the early stages.
Orlando Health has two ERs under construction, including two in Orlando at 11898 Lake Underhill Road to open in spring 2025 and in Longwood at the site of South Seminole Hospital targeted for early 2025.
Orlando Health also has several more ERs in the pipeline. Those include one in Winter Park at 750 S. Orlando Ave. where it would demolish an existing Bank of America building; a 10-bed ER in Eustis for which it is working to buy land in May, and one in Wildwood that would start as an ER and eventually become a larger medical campus.
UF Health plans to open an emergency room in Clermont in 2025.
How big are these properties?
- AdventHealth: The ERs usually fit a 12- or 24-bed format.
- Orlando Health: The system’s prototype includes 10,849 square feet with 10 exam rooms.
- HCA: Recent ERs in the area are roughly 11,000 square feet with 11 exam rooms.
How many people does each location hire?
- AdventHealth: Up to 100 total staff, depending on size
- Orlando Health: Usually includes 15-23 staff on-site depending on patient volumes
- HCA: Usually around 20 people.
How much do they cost?
Size often determines the construction price, but HCA's sites usually cost about $15 million. Some bigger facilities can cost more. AdventHealth's Millenia facility is $26 million. AdventHealth and Orlando Health do not always release costs for ER facilities.
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