Freestanding ERs are becoming more common. Middle Tennessee could soon have four more.

TriStar is working to open another freestanding emergency room — this one in White House, a small town about a half hour’s drive north of Nashville.

The company already runs several freestanding ERs in Middle Tennessee, including sites in Antioch, Spring Hill and Mt. Juliet.

TriStar’s hospital has to prove to state regulators that White House needs the facility. The company made its argument in a press release this month.

Why White House?

A big part of TriStar’s case was the town’s recent population boom. Estimates vary, but there’s a consensus that it has more than doubled in size over the past couple decades — and a sizable portion of that growth has been in the last few years. The number of residents has grown by nearly 25% since 2020. It’s surpassing 15,000 now, and many of those residents are already using TriStar hospitals. They’re driving to the NorthCrest facility in Springfield, or to Hendersonville.  

Dr. Kevin Hamilton is the chief medical officer of TriStar Hendersonville. He said the new ER would operate under that hospital.

“So, the one that we’re proposing for White House would be a department of the TriStar Hendersonville Medical Center, just attached to our main campus by a 10-mile virtual hallway,” he said. “And so they’re staffed by our emergency room physicians and supported by our medical staff, just like our main ER. It just happens to be 10 miles away.”

He noted that these sites operate differently from urgent care clinics because they can treat higher acuity patients, like those coming in with heart attacks or strokes. And the patients can be transferred if they need to be admitted for full-service hospitalization.

Modern ERs, by the numbers

Freestanding emergency rooms are physically separate from full hospitals, but they are often owned and operated by one, according to state regulators.  

Back in 2001, freestanding facilities made up about 1% of all emergency departments across the U.S. As of last year, that number was closer to 11%. 

The model has become popular for several reasons. Hospital companies can expand their service area with lower construction costs. And later, if it makes financial sense, they can expand the ER into a full hospital.

Starting small

TriStar has taken that approach to expansion. It was operating an ER in Spring Hill — another community undergoing a population boom. It got the state’s sign off in June to build it out to a full-service facility. 

Tennessee is one of many states with certificate of need laws, which require health providers to prove their proposal is necessary for the surrounding community. TriStar is pursuing that certificate for the White House emergency room, and it’s already secured certificates for sites in East Nashville, Nolensville and Bellevue.

TriStar isn’t the only hospital operator looking to build an ER in the area. Highpoint Health and Ascension St. Thomas are also applying for a certificate of need, according to a press release issued last month. In it, that company also cited the population boom.

“White House is experiencing significant growth, and the healthcare needs of its residents are evolving,” said Rod Harkleroad, market president of Highpoint Health. “The addition of a free-standing emergency department would provide immediate, high-quality emergency care that the community deserves. This facility is not only essential for White House but will also support surrounding communities and rural areas experiencing similar growth.”