Two Freestanding ERs Will Compete With Lakeland Regional

3 ER locationsIt won’t be long before Lakeland residents facing a medical emergency will have choices:

  • In south Lakeland, a small freestanding emergency room on Florida Avenue planned by HCA.
  • In northeast Lakeland, a slightly larger freestanding emergency room just west of Florida Polytechnic University planned by Adventist.
  • North of downtown, Lakeland Regional Health’s massive emergency department with its pediatric ER and a trauma center.

Last month, news broke that an unidentified entity, using the name of the limited liability company Zack 1030, had filed site plans to build a 10,920-square-foot freestanding emergency room on seven parcels on South Florida Avenue across from Merchant’s Walk shopping plaza.

A check into Zack 1030’s corporate officers reveals that the national chain Hospital Corporation of America was behind the land purchases.

On Friday, HCA West Florida spokesperson Debra McKell confirmed that HCA purchased the land but said the company is not releasing any more information at this time.

Based in Nashville, the for-profit HCA owns approximately 179 hospitals. HCA’s West Florida Division, which includes Brandon Regional Hospital, has eight freestanding ERs, including one in Plant City, according to the comany website. And its North Florida Division, which includes Poinciana Medical Center and Osceola Regional Medical Center in Kissimmee, has five freestanding ERs.

Also on Friday, Adventist Health System updated LkldNow about its plans for a freestanding emergency room on a portion of the 104.1-acre tract it bought in 2017 off Interstate 4 near University Drive and Research Way.

The company expects to break ground on the Lakeland project in the first or second quarter of 2019, Richelle Hoenes-Ahearn, spokesperson for Adventist/Florida Hospital West, said.

Based in Altamonte Springs, Adventist Health System is a nonprofit, religion-operated chain with 48 hospitals in 10 states, including at least 25 hospitals in Florida, although none in Polk County. It currently has three freestanding ERs in the Orlando area and two in the Tampa area and has broken ground or has plans for more in Oviedo, Deltona, Palm Coast, Brandon and Westchase, in addition to Lakeland.

Freestanding ERs

Freestanding ER centers can evaluate and stabilize any patient and can arrange for transfer if a hospital admission is needed, according to the American College of Emergency Physicians. Freestanding ERs must have the same basic equipment as a hospital ER, including CT scans, MRIs and ultrasounds and an advanced laboratory. They are staffed by emergency medicine physicians, nurses and technicians and typically are open 24/7.

Because a free-standing emergency department may be closer to a patient than an emergency department at a hospital, “going there first would allow lifesaving medical treatment to begin sooner than going to a more distant hospital,” an ACEP fact sheet said.

Lakeland Regional Health declined to comment about the impact having two small freestanding ERs open in its traditional market.

However, the health system frequently points with pride to figures showing it is the busiest single-site emergency department in the country with 210,020 visits in 2017.

By comparison, the free-standing emergency rooms being planned by HCA and Adventist each would likely have 10,000 to 20,000 visits a year, based on the projected sizes of their facilities.

Because freestanding ERs charge hospital emergency department prices, they can operate at a profit seeing far fewer patients than a hospital emergency department, which must maintain staffs with a wide range of specialties, high-end operating suites and other amenities.

A freestanding emergency room can be profitable seeing as few as eight to 10 patients a day, according to data from ACEP. The slower pace is appealing to many harried emergency medicine specialists –- and to patients.

Freestanding ER patients who need hospitalization typically are transferred to the affiliated hospital even if another hospital is closer, according to ACEP. And usually if the affiliated hospital is in a patient’s insurance network, so is the freestanding ER.

Freestanding ERs are becoming common in the Tampa Bay area, where Bayfront Health today opened one on Gandy Boulevard, not far from its downtown St. Petersburg hospital and ER, the Tampa Bay Times reports.

“These health care companies are going to encourage people to go to these other sites, like free-standing EDs and preventative care services, as a way to introduce patients to their brand,” Jay Wolfson, a University of South Florida medical professor, told The Times. Once you’re in the system, and you had a good experience, you’ll be more likely to return to that brand.”

The planned free-standing ERs in Lakeland, like their affiliated hospitals’ emergency departments, will have to accept patients regardless of ability to pay.

In some areas of the country there are independent, free-standing emergency departments that do not have to accept uninsured patients because they are not hospital owned, but those are not the type coming to Polk County.

The planned Lakeland freestanding ERs operated by HCA and Adventist must accept patients regardless of ability to pay. That is also the case for another Polk County hospital’s facility: Haines City-based Heart of Florida Regional Medical Center’s free-standing ER at Four Corners. Heart of Florida is is operated by another for-profit national national chain, Community Health Systems.

HCA project

During August, September and October, HCA bought seven parcels totaling 1.7 acres through a limited liability company it named Zack 1030.

Public records show that the property includes five commercial parcels – 3500, 3504, 3510, 3522 and 3526 S. Florida Ave. – and two houses at 114 and 120 Eastway Drive. HCA, through Zack 1030, paid approximated $5.35 million for the seven parcels.

clinic site
Several properties on South Florida Avenue have been purchased for an HCA freestanding emergency room.

In mid-November, Zack 1030, along with the engineering firm S&ME Inc., filed site plans with the City of Lakeland and with the Southwest Florida Water Management District for a 10,920-square-foot, free-standing emergency room

The site plans show that the existing buildings, which most recently housed a medical office, real estate office, two insurance offices and two homes, will be demolished. There will be one driveway on Eastway Drive and another on South Florida Avenue, at the northern end of the site.

The building will be nestled in the far southeastern part of the tract, near the intersection of Eastway Drive and Florida Avenue. Plans include parking for 44 vehicles and a 13 ½-foot-tall canopy capable of handling ambulance traffic on the northern side of the building.

Chuck Barmby, the city’s transportation and development review manager, said that although the area, located just north of the Polk Parkway interchange, has heavy traffic “it is not failing from a service standpoint” and could handle the traffic generated by the ER facility.

A traffic study was done this summer for an unrelated project that the developer Palmetto Capital Group had been planning, Barmby said. At that time, the developer had asked for and received planned unit development zoning on four parcels to facilitate building a fast-casual restaurant there. But before those plans were put into place, Palmetto Capital sold its four parcels to HCA’s Zack 1030.

A fast-casual restaurant would have generated considerably more traffic than the ER’s estimated 15 to 20 trips during its peak hour, Barmby said.

From a traffic standpoint, “this would be a benefit, generating less traffic at that intersection” than a restaurant, Barmby said.

From the city’s viewpoint, the biggest concerns are access and landscaping, Barmby said.

The current traffic light at Florida Avenue and Eastway Drive allows only right and left turns and does not permit vehicles to go directly across Florida Avenue into Merchant’s Walk. That would not change, he said.

Drivers entering or leaving through the Florida Avenue driveway at the northern end of the property could turn either right or left, Barmby said.

A dry retention pond would replace the two houses now on Eastway Drive, and that area would serve as a buffer to the residential area off Eastway Drive, Barmby said.

Adventist project

Last May, Mike Schultz, chief executive officer of Adventist Health System’s Florida West Division, told The Ledger that Adventist was looking at a 10-year trajectory for its large tract in northeast Lakeland with the free-standing ER serving as an entry into the Polk County market for what may eventually include a full hospital on the property.

Polk County property records show that Adventist/Florida Hospital paid a total of $14.75 million for three vacant parcels that make up its 104.1-acre tract.

The free-standing ER would be on a tiny portion of the tract. Most of the health system’s free-standing ERs are in the 10,000- to 20,000-square-foot range.

While the property is located within the far northeastern city limits of Lakeland, it is close to Polk City and Auburndale, and the free-standing ER would be expected to draw patients for those cities, as well as from Winter Haven, which is served by BayCare Health System’s Winter Haven Hospital.

Lakeland Regional

The nonprofit Lakeland Regional Health Medical Center has won national accolades for how it manages its extraordinarily busy emergency department. In 2014, after a year-long process of evaluating and revamping its emergency department, it was recognized with the Innovation of the Year in Patient Care Award from the Florida Hospital Association and with the 2014 EmCare Genesis Cup Award.

Lakeland Regional’s emergency department is classified as one of 12 state-certified Level II trauma centers, the only one in Polk, Highlands and Hardee counties. As such, it not only has trauma surgeons on duty around the clock but also a stable of multi-disciplinary specialists available and a dedicated chest pain management team.

And, according to its website, it also has a direct-to-catheterization lab program that works in conjunction with Polk County Fire Rescue and Emergency Management Services to get heart attack patients to the operating room within an average of 50 minutes after contact with an EMT.

HCA’s Osceola Regional Medical Center in Kissimmee is also certified as a Level II trauma center, although not its hospital in Brandon. Osceola Regional Medical Center is 51 to 54 miles, depending on the route, from HCA’s planned Lakeland free-stand ER, a little more than an hour’s drive. The travel time from the free-standing ER to HCA’s Brandon Hospital is estimated at 38 to 40 minutes.

For most patients going to a free-standing ER, the issue is moot because the vast majority are not admitted as hospital patients.

But, according to ACEP, for patients who need to be transferred to a hospital for observation or because of a heart attack, stroke or catheterization procedure, those transfers happen quickly.

“For patients who are discharged from the emergency department, studies have shown no functional difference between a freestanding emergency department and a traditional one,” ACEP said.