Nashville, Tenn.-based HCA Healthcare is facing resistance to its expansion efforts across multiple states, as competing health systems challenge the for-profit giant’s push to add new emergency rooms, surgery centers and hospitals in regions where it already has a presence.
Tennessee
Vitruvian Health, which operates hospitals in Dalton, Ga., and Cleveland, Tenn., is pushing back against HCA’s Parkridge Health System plans to open a freestanding emergency department in Bradley County. Vitruvian’s Bradley Medical Center in Cleveland, Tenn., launched a petition urging state regulators to reject the proposal, citing concerns over cost, duplication of services and patient redirection to HCA facilities in other counties.
Bradley Medical Center, a nonprofit hospital acquired by Vitruvian in 2024, said it already offers the same emergency services HCA plans to provide. It argues that the new ER would raise patient costs and strain care continuity.
“Freestanding emergency rooms are not community care providers,” the petition reads. “They charge hospital-level ER fees without hospital-level services.”
HCA argues that Bradley County’s growth justifies additional emergency care access.
“The proposed Parkridge Cleveland ER will strengthen emergency care access at a time when this community is growing faster than the system can keep up,” Parkridge Health System CEO Chris Cosby said in a statement to Becker’s. “With more than 110,000 residents and thousands of new homes, businesses, and commuters coming into the area, relying on a single hospital creates longer waits and fewer options when minutes matter. Adding a second, full-service ER helps relieve that pressure, lowers wait times, and adds competition that raises the standard of emergency care for everyone.”
Virginia
HCA is competing with Cincinnati-based Bon Secours Mercy Health to expand emergency and outpatient care in Central and Northern Virginia. Bon Secours recently opened a fifth freestanding emergency department in the Richmond region — a $37.5 million site in Ashland, Va. — after the state approved its certificate-of-need application. HCA’s similar proposal for the same area was denied.
Still, HCA has pressed forward, planning three new freestanding emergency rooms and three urgent care centers in the region by 2026. The additions will increase HCA Virginia’s freestanding ER footprint to 11 and its urgent care footprint to 15. The system also received approval for a $21 million ambulatory surgery center in Hanover County and has broader ambitions to build a full-service hospital.
“Bon Secours Mercy Health continues to expand access to care closer to where patients live,” John Emery, president of Bon Secours Memorial Regional Medical Center and Rappahannock General Hospital, said in a statement. He noted the new facilities aim to relieve pressure on overburdened hospitals.
HCA spokespersons said its growth strategy is designed to expand choice for patients and increase convenience in high-growth areas.
“This is about meeting families where they are,” William Lunn, MD, president of HCA’s capital division, said in a news release. “These new emergency rooms and urgent care clinics are vital community assets that build on the exceptional care we already provide. When every second counts, we want to ensure patients get the help they need — without delay.”
North Carolina
HCA’s Mission Health in Asheville recently lost a legal challenge against a competing hospital proposal. The North Carolina Supreme Court declined to hear Mission’s appeal opposing AdventHealth’s 67-bed hospital in Weaverville. Mission had argued that regulators deviated from established policy and that new beds would be better placed at Mission Hospital, where it treats patients needing higher-acuity care.
Despite the court ruling, Mission is continuing to pursue its own expansion plans and is one of four systems applying for 129 acute care beds in western North Carolina. It will face competition from Altamonte Springs, Fla.-based AdventHealth, Chapel Hill, N.C.-based UNC Health and Winston-Salem, N.C.-based Novant Health.
The intensifying HCA-AdventHealth turf war underscores a broader industry tension: as systems expand across state lines, battles over certificate-of-need approvals are becoming flashpoints for debates around market control, competition and patient access.
HCA’s continued growth push — in North Carolina and beyond — is increasingly met with resistance from nonprofit competitors seeking to shape the future of care delivery in the markets in which they operate.
