Seven Rivers hospital exterior

Bayfront Health Seven Rivers Regional Medical Center in Crystal River.

The owners of Bayfront Health Seven Rivers hospital are planning to build a freestanding emergency department in Citrus Hills.

Community Health Systems, which owns the Seven Rivers hospital along with 17 other health care facilities throughout Florida, submitted its plans for the emergency department with the Southwest Florida Water Management District. CHS has 106 hospitals in 18 states.  

CHS submitted plans for the 11,086 square foot, one-story facility to the regulatory agency along with its stormwater and topography studies. A search of state filings revealed that it has yet to submit plans to Florida hospital regulators.

Jennifer Siem, spokeswoman for Bayfront hospitals in Crystal River, Brooksville, and Spring Hill, told the Chronicle in an email that she had nothing to share about the application but would be discussing it with the Chronicle later.

The proposed site of the facility is north of County Road 486 and just west of the county road’s intersection with North Forest Ridge Boulevard, according to the Swiftmud records.

The documents did not discuss the number of examination rooms that would make up the freestanding ER, but documents said the plan includes 63 parking spaces.

The proposed site would put it less then 5 miles northwest of Citrus Memorial Hospital and about 6 miles southeast of Bayfront Health Seven Rivers. It would also serve to provide Seven Rivers with patients needing hospital care.

The ER facility would sit on nearly 2 acres. The property is currently undeveloped. The project is called the Bayfront Health Seven Rivers Freestanding Emergency Department.

This would not be CHS’ first foray into freestanding ERs.

Most recently, CHS in late 2018 opened a freestanding emergency department in Pinellas Park. That facility is 11,400 square feet and has eight examination rooms, along with a full lab and imaging center. That freestanding emergency department is affiliated with Bayfront Health St. Petersburg.

Citrus County Administrator Randy Oliver said county staff and CHS representatives have had some discussions on the issue, “but nothing formal.”

Freestanding ERs are required by Florida health care regulators to provide the same level of care as emergency rooms in a hospital. If the patient needs additional or admittance care, the ER staff transports them to a hospital.

Standalone ERs serve not only to provide emergency services, but also funnel patients to nearby hospitals affiliated with the facility.

Emergency rooms account for about half of the nation’s hospital admissions, according to a study by the RAND Corporation, a nonprofit think tank.

At Citrus Memorial Hospital, the ER accounts for about 80 percent of the hospital’s inpatient population, hospital CEO Ralph Aleman told the Chronicle last year.

The ER business is a growing one.

In 2014, Citrus Memorial’s ER saw 26,268 patients, according to the Florida Agency for Health Care Administration. That did not include ER patients who were admitted or sent to other facilities for specialized care. By 2017, that rose to 34,762, according to the hospital.

In 2014, Seven Rivers’ ER saw 18,037 patients, according to the Florida Agency for Health Care Administration. That did not include ER patients who were admitted or sent to other facilities for specialized care. By 2017, that rose to more than 24,000, according to the hospital.

Unlike hospitals, freestanding emergency facilities do not require certificates of need from the Florida Agency for Health Care Administration (AHCA) to be built. The affiliated hospital must still file with AHCA, though.

The Swiftmud documents list Bayfront Health Seven Rivers Regional Medical Center as the affiliated hospital.

“The off-site emergency department must be under the same direction, offer the same services and comply with the same regulatory requirements as the emergency department located on the hospital's main premises,” according to the AHCA’s website. “There are no additional rules or standards specific for emergency departments located off the premises of the licensed hospital.”

Freestanding emergency departments must be open 24 hours per day, have ER physicians onsite at all times, and have round-the-clock lab and imaging services.

There are some additional AHCA regulations governing them. 

“The agency must review the facility's plans and specifications before any construction can begin,” according to AHCA. “Reviews are also conducted during the construction phase and final physical plant approval is granted when the facility is determined to meet all applicable hospital building codes.”

The study reported there were 222 freestanding emergency departments in 2008. That swelled to 566 in 2016. A 2015 study published by the Annals of Emergency Medicine saw similar numbers. 

Hospital Corporation of America, the company that leases Citrus Memorial Hospital, also owns freestanding ERs in Tampa, Lutz and Palm Harbor.

But the United Health Group report said that only a small fraction of freestanding ER visits tend to be real emergencies. And they are not cheap.

Contact Chronicle reporter Fred Hiers at or 352-397-5914.