For generations, Lakeland residents facing serious medical emergencies had one place to go: Lakeland Regional Health Medical Center. Within a few years, they might have nine.
Local dignitaries cut the ribbon Wednesday on HCA Florida’s second standalone emergency room in Lakeland, at the northeast corner of Carpenter’s Way and U.S. Highway 98 North.
The 11,570-square-foot emergency room, which will begin seeing patients on Monday, and its sister HCA facility on South Florida Avenue are just the beginning of a massive expansion of acute care facilities in Lakeland. Two full hospitals and six more freestanding emergency rooms are in the pipeline.
By 2027, local emergency care options could include:
- Lakeland Regional’s main hospital on Lakeland Hills Boulevard.
- The freestanding emergency room owned by HCA Florida at 3526 S. Florida Ave. — which opened in May 2020.
- The new freestanding ER owned by HCA Florida at 1075 Carpenter’s Way.
- A freestanding ER that Lakeland Regional has nearly finished building at 6150 S. Florida Ave. — opening in early 2025.
- The emergency department at a seven-story hospital that Orlando Health is midway through constructing at the southeast corner of the Polk Parkway at Lakeland Highlands Road — expected to open in the summer of 2026.
- A freestanding ER that Orlando Health plans to build at Lakeland Park Center, just north of Interstate 4 — expected to open in 2026.
- A freestanding ER that BayCare plans to build at 5501 S. Florida Ave. — expected to open in 2026.
- A freestanding emergency room that Lakeland Regional has received land-use approval to build at its Kathleen Road campus, though no specific plans have been announced.
- The emergency department at a 10-story hospital that AdventHealth plans to build at the southeast corner of Harden Boulevard and Frontage Road/Polk Parkway — expected to open in 2027. Tampa Bay Business Journal reported that AdventHealth paid $14 million for 218 acres at the site in a deal that closed Nov. 25.
It is poised to be a dizzying array of options, with five large hospital systems competing to funnel patients into their own networks of care. The new facilities will bring potentially lifesaving services closer to home for tens of thousands of Lakeland residents — but there are some potential pitfalls.
Pros and cons: Freestanding ERs are a fairly new concept in Lakeland, but other parts of the U.S. have had them for a decade or longer. Proponents say they expand access to high-quality care and take pressure off overburdened hospital emergency rooms.
Stormy Durham, 70, of Lakeland, experienced the benefits firsthand four years ago when she was driving on the Polk Parkway, returning home from Orlando, and started having chest pains.
She recalled seeing HCA’s south Lakeland emergency room, which had opened a few weeks earlier, and drove herself there.
“I walked in and they took me to the back. Then, the next thing I know, I’m lying there. She comes back in and she’s yelling, ‘Can you hear me? Can you hear me?' ” Durham recalled. “I could see everything she was saying and doing, but I could not respond.”
Former health care executive Carole Philipson, who worked for both Lakeland Regional Health and AdventHealth, said she welcomes the new facilities and thinks they will benefit Lakeland residents. However, it’s important for people to understand how they work.
Freestanding ERs provide the same level of care as traditional emergency departments, but they don’t have operating rooms or specialists. Emergency physicians can stabilize many life-threatening conditions, but for patients who need critical care, having to wait for an ambulance transfer to a hospital can delay getting treatment.
Also, while freestanding ERs sometimes look similar to urgent care centers, there is a significant cost difference. Emergency room care is expensive, whether it’s attached to a hospital or not. Urgent care centers are a much less expensive option for conditions like upper respiratory infections, fevers, stitches and sprains.
The closest ER might not send you to the closest hospital: Freestanding ERs typically transfer patients to the hospital they are affiliated with unless time is critical and another facility is closer.
Nationally, about one in five Americans went to an emergency room in 2021. Of those, 87% were treated and released. The other 13% were admitted to a hospital.
The admission rate tends to be lower at freestanding ERs. Tripp Owings, CEO of HCA Florida’s Brandon Hospital, said HCA’s south Lakeland emergency room treats about 65 patients a day and 5% to 7% are admitted (about four people).
Owings said HCA has three fully equipped ambulances it uses to transport those patients to Brandon Hospital at no charge. And if they need a ride back to Lakeland upon discharge, the hospital pays for a Lyft or Uber ride.
However, patients do not have to go to the affiliated hospital. Under a federal law known as EMTALA (Emergency Medical Treatment and Active Labor Act), patients or their legal representatives can ask to be sent elsewhere — for instance, if someone has an established relationship with a local hospital or wants loved ones to be able to visit easily.
As long as the facility is willing to accept them, Owens said HCA would arrange with Polk County Fire Rescue or a private ambulance service to transport the patient, and normal ambulance costs would apply. HCA would forward all of the patient’s test results and information to clear the way for admission.
Convenience, but at a cost: Freestanding ERs are typically more convenient for patients than hospital emergency departments, where it might take hours to be seen, or doctors’ offices, where it might take days or weeks to get an appointment.
They can perform CT scans and X-rays, do many laboratory tests and administer potentially life-saving medications for heart attacks, strokes and sepsis. They are staffed by an ER physician and a combination of nurses and paramedics, and they are open 24 hours a day, 365 days a year. Wait times are usually much shorter than at hospital-based emergency rooms.
But that convenience can come at a steep cost.
In a 2016 analysis of insurance claims in Texas, the first state to have a proliferation of freestanding ERs, UnitedHealth Group found the average cost of treating strep throat was $2,732 at a freestanding ER compared with $159 at an urgent care center.
An analysis of Blue Cross Blue Shield insurance claims found similar disparities. About 80% of the emergency room bills were facility fees, which urgent care centers do not charge.
Urgent care centers are also expanding: Lakeland has at least 14 urgent care centers — four of which opened this year. Several are owned by regional hospital systems or insurance companies.
- AdventHealth Centra Care North Lakeland at 3637 U.S. Highway 98 N. opened in February 2020.
- AdventHealth Centra Care South Lakeland at 6419 S. Florida Ave. opened on April 8.
- BayCare Urgent Care at 2645 S. Florida Ave. in the Southgate Shopping Center opened in June 2020.
- Concentra Urgent Care, owned by Humana, at 5040 U.S. Highway 98 N. opened in 2019.
- Lakeland Regional Health Lake Gibson Urgent Care at 930 Marcum Road opened on Dec. 9.
- Lakeland Regional Health Kathleen Urgent Care at 2400 Kathleen Road opened in February.
- Lakeland Regional Health Lake Miriam Urgent Care at 4710 S. Florida Ave. changed from a walk-in clinic to an urgent care center in 2019.
- Lakeland Regional Health Pablo Campus Urgent Care at 130 Pablo St. opened in October 2020.
- MD Now, owned by HCA Heathcare Inc., at 3700 U.S. Highway 98 N. opened in January. It was formerly a MedExpress, owned by UnitedHealth Group’s Optum.
- Owl Now Urgent Care at 3240 S. Florida Ave. opened in 2005.
- Sunshine Urgent Care at 3305 U.S. Highway 98 (Bartow Road) opened in November 2015.
- Watson Clinic Urgent Care Main at 1600 Lakeland Hills Blvd. opened in October 2013.
- Watson Clinic Urgent Care South at 1033 N. Parkway Frontage Road opened in January 2020.
- Watson Clinic XpressCare Highlands at 2300 E. County Road 540A opened in September 2015.
Why is health care construction booming? For many decades, new hospitals could not be built unless the state issued a “certificate of need.” Applicants had to show evidence that existing hospitals couldn’t keep up with local demand and population growth.
However, Gov. Ron DeSantis signed a law in 2019 eliminating that requirement for most types of health care facilities. The move opened the floodgates for construction of facilities like freestanding emergency rooms and hospital-affiliated urgent care centers.
But that’s not the only reason. The building boom has gone hand-in-hand with industrywide consolidation, as large hospital systems have merged and bought out smaller rivals, according to Keith Benson, program director of the Master of Health Administration program at the University of Florida.
Benson said population growth, economies of scale, spreading out risk, boosting negotiation power and improving access for patients are also factors.
Profit motive? Emergency room care is tremendously expensive, but it is not necessarily highly profitable. Benson explained that hospital margins are typically 1% to 6%, and charges are closely reviewed by health insurance companies and the Agency for Health Care Administration.
In addition, although HCA Healthcare Inc. is a publicly traded for-profit corporation, the other hospital systems in the area — Lakeland Regional Health, AdventHealth, BayCare and Orlando Health — are nonprofits.
Will there be enough patients to fill all of these facilities? Although any major investment carries risk, Benson said he thinks the odds of a local health care bubble are slim.
“These are usually well-researched by the organizations, and there are sound business reasons for doing this,” Benson said. “My gut feeling is that the population growth is one of the key factors driving it.”
Philipson also said she thinks the new facilities are appropriate. For many years, Lakeland Regional expanded its emergency room to accommodate growth. In 2022, it was ranked the nation’s second busiest emergency department with nearly 200,000 visits, according to Becker’s Hospital Review.
“This is what a community our size would normally have,” Philipson said. “We were an anomaly. We would normally have three hospitals.”
LkldNow’s Insight Polk independent reporting initiative is made possible by the Community Indicators Project with funding by GiveWell Community Foundation & United Way of Central Florida. All editorial decisions are made by LkldNow.
