Becker's Hospital Review

31 CLINICAL LEADERSHIP Why health systems are flocking to Florida — and what it means for patients By Paige Twenter H ealth systems are rapidly expanding into Florida through partnerships, affiliations and new builds, raising questions about whether the Sunshine State's healthcare landscape is becoming increasingly fragmented and more difficult for patients to navigate. Florida is home to 38 unique health systems, according to the Florida Hospital Association. "ere's definitely been growth in the number of hospitals and in the number of hospital beds — which isn't necessarily from new hospitals," said Mary Mayhew, president and CEO of the Florida Hospital Association. Since 2020, Florida has added 49 hospitals and more than 3,000 hospital beds, with most of that growth coming from rehabilitation hospitals and expansions by systems already operating in the state, Ms. Mayhew said. In the last five years, two health systems established their first presence in Florida, both through rehabilitation hospitals. Many more systems are entering through joint ventures and affiliations rather than building standalone hospitals. Somerville, Mass.-based Mass General Brigham has expanded through a joint venture with Tampa (Fla.) General Hospital, while Chicago-based Northwestern Medicine has partnered with Clearwater, Fla.-based BayCare Health System and Naples, Fla.-based NCH Healthcare System. At the same time, large incumbents such as Nashville, Tenn.-based HCA Healthcare and Altamonte Springs, Fla.-based AdventHealth continue to expand their footprint, including building more freestanding emergency departments across the state. Demographics and policy fuel growth Florida's rapid population growth — particularly among older adults — is a primary driver of healthcare investment. Approximately 4.5 million Floridians are age 65 or older, a number projected to reach 6 million by 2030, Ms. Mayhew said. From 2019 to 2024, hospital visits among this population increased 7.5%. "We already see issues where individuals are getting stuck in hospital beds when they no longer require hospital level of care," Ms. Mayhew said. "We had nearly a half a million patient days where patients were stuck in a hospital bed. We couldn't safely, timely or appropriately discharge them." At the same time, Florida's regulatory environment can make expansion easier. e state does not require certificate-of-need approval for new hospitals or outpatient services, lowering barriers to entry for health systems and investors. "e demand for healthcare services in Florida just continues to skyrocket," Ms. Mayhew said. at demand, alongside investment in medical schools and research, has created what Ms. Mayhew described as a "world class healthcare" environment that is attractive to health systems nationwide. Partnerships over greenfield expansion Rather than building hospitals from the ground up, many systems are choosing partnership models to enter the market. Mass General Brigham, a 16-hospital system based in Somerville, Mass., has spent roughly five years expanding its presence through a joint venture with Tampa General Hospital, a 982-bed hospital. "If we planted our own flag, we would just be further creating more fragmentation, and it wasn't clear to us how that would actually be valuable to patients," Susan Fahmy, vice president of clinical mergers and acquisitions and strategic alliances at Mass General Brigham, told Becker's. e partnership has launched several programs since 2021, including a program for veterans that has expanded to include services for traumatic brain injury and behavioral health. e two organizations have also built a bone marrow transplant program, a cellular therapy program and an upcoming radiation oncology center in Palm Beach Gardens, Fla., with additional outpatient sites planned along Florida's East Coast. Ms. Fahmy said Mass General Brigham aims to "create a more coordinated, less fragmented [market]." Similarly, Northwestern Medicine has entered an academic collaboration with BayCare, which operates 16 hospitals across West Central Florida. "Florida's rapid growth and increasing demand for advanced care made this the right moment to connect with BayCare," Northwestern Medicine said in a statement. e collaboration focuses on expanding graduate medical education, specialty services and research capabilities. BayCare said the partnership allows patients to access advanced care locally rather than traveling out of state. "For patients, BayCare's work with Northwestern Medicine translates into expanded specialty services, more highly trained physicians and access to advanced treatments," BayCare said in a statement. A fragmented system and a potential solution Despite these partnerships, fragmentation remains a longstanding challenge in Florida's healthcare industry. "It's not an ecosystem of care; the providers aren't in [a] similar network, they're not on the same EHR," Ms. Fahmy said. "It's already complicated enough." Ms. Mayhew echoed that concern, noting that Florida's health information exchange is not comprehensive, making care coordination more difficult across systems. Still, some healthcare leaders said new entrants can improve quality and access. Conor Delaney, MD, PhD, president and CEO of Cleveland Clinic's Florida market, said the state needs more health systems. He added that large systems can bring "scale, standard, quality, supervision" to care delivery.

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