As HCA Healthcare seeks to build a freestanding emergency department in Bradley County, Vitruvian Health is seeking to block the move.
Two health systems are bracing for a fight over one’s plans to build a freestanding emergency department in Tennessee.
Vitruvian Health, a Dalton, Georgia-based health systems serving parts of Georgia and Tennessee, has launched an online petition and other efforts to oppose HCA Healthcare’s proposed freestanding emergency center near Cleveland, Tennessee. Vitruvian acquired Cleveland-based Bradley Medical Center for $160 million in 2024.
Vitruvian executives say the proposed facility would duplicate existing services, pull patients — potentially at higher cost — away from its nonprofit hospital, and fragment care in a region where its existing emergency department already serves the local community’s needs.
Executives at HCA’s Parkridge Health System, conversely, argue their project is necessary for a county experiencing rapid growth. They cite long travel times and strain on existing resources and are positioning the facility as a practical solution to improve healthcare access.
The debate has moved to the Tennessee Health Facilities Commission, which will soon rule on HCA’s certificate of need application.
The Bigger Picture
The debate highlights several themes, including capital competition, payer dynamics and the major regulatory impact on growth strategy. Vitruvian’s acquisition and reinvestment plan (which includes new physicians, expanded service lines and a 10-year facility plan) reflects a significant capital commitment. Meanwhile, HCA’s push to add another urgent care asset shows how for-profit systems are leveraging freestanding facilities to capture market share and diversify service delivery in high-growth regions.
This dispute also raises questions about return on investment and revenue mix. A freestanding ER with payer support could attract higher acuity patients who generate lucrative facility fees — especially if Vitruvian remains out of network with major payers like UnitedHealthcare
, "It's gotten worse, there is no alignment,” Julie Soekoro, CFO of Vitruvian Health Care System, and HealthLeaders Exchange member, said in a previous HealthLeaders story on Vitruvian’s struggles to find common ground with payers. “We are not growing in the same direction when they have margins as a goal.”
A competing healthcare facility in the area would likely split patient volumes and reimbursement dollars between the two health systems, affecting operating margins.
Should the THFC approve the certificate of need, it might prompt other health systems to grow their networks in that area. If the agency denies the certificate, it might dampen HCA’s expansion strategy while reinforcing Vitruvian’s positioning.
CFOs evaluating expansion, acquisition or service line growth in comparable markets should weigh how regulatory timelines, competitive responses and payer leverage shape both growth and cost structures.
As the state commission’s decision looms, CFOs should monitor not just the immediate impact on local care delivery, but also how this dispute reflects broader industry trends: nonprofit vs. for-profit competition, the role of freestanding ERs in care networks, and the influence of payer negotiations on strategic facility planning.
Marie DeFreitas is the CFO editor for HealthLeaders.
KEY TAKEAWAYS
Vitruvian Health’s Bradley Medical Center is campaigning against an HCA-backed freestanding ER proposal, arguing it would drive up costs and fragment care.
HCA Healthcare defends the project as needed for a growing population, underscoring competitive tensions between nonprofit and for-profit systems.
The Tennessee Health Facilities Commission’s decision, expected this month, could affect access, payer mix and regional revenue streams for both health systems.