US Freestanding Emergency Department (FSED) Market Key Takeaways, Overview, Findings, Sizing, Regional Insights,Trends and Analysis

U.S. Freestanding Emergency Department (FSED) Market Trends for 2026

According to Payal Rabde, who specializes in research related to FSED services, faculty models, and healthcare services, with 5+ years of experience in market research and industry analysis, extensive research indicates strong growth opportunities in the U.S. freestanding emergency department (FSED) market. U.S. freestanding emergency department (FSED) market size was estimated at USD 17.51 billion in 2025 and is predicted to increase from USD 18.54 billion in 2026 to approximately USD 31.06 billion by 2035, expanding at a CAGR of 5.9% from 2026 to 2035. Her analysis highlights that the U.S. freestanding emergency department (FSED) market is rapidly expanding due to increasing emergency care demand, rising infant visits, growing mergers, and expanding independent facilities, along with key industry players like HCA Healthcare, Inc., Envision Healthcare, Adeptus Health, American Physician Partners, and TeamHealth.

Key Takeaways

• U.S. freestanding emergency department (FSED) sector push the market to USD 18.54 billion by 2026.
• Long-term projections show USD 31.06 billion valuation by 2035.
• Growth is expected at a steady CAGR of 5.9% in between 2026 to 2035.
• By ownership type, the off-campus emergency department (OCED) segment held a dominant revenue share of 90.33% of the market in 2025.
• By ownership type, the independent freestanding emergency department (IFSED) segment held 9.67% of market share in 2025 and is expected to grow at the fastest CAGR of 7.1% during the forecast period.
• By service type, the emergency department services segment held a dominant revenue share of 68% of the market in 2025.
• By service type, the laboratory services segment held 17% of market share in 2025 and is expected to grow at the fastest CAGR of 6.6% during the forecast period.
• By facility model type, the standalone FSED segment held a dominant revenue share of 47% of the market in 2025.
• By facility model type, the hybrid emergency/urgent care facility segment held 11% of market share in 2025 and is expected to grow at the fastest CAGR of 7% during the forecast period.
• By patient acuity type, the high-acuity emergencies segment held a dominant revenue share of 39% of the market in 2025.
• By patient acuity type, the low-acuity emergencies segment held 19% of market share in 2025 and is expected to grow at the fastest CAGR of 6.5% during the forecast period.
• By payer type, the private insurance segment held a dominant position in the market with a share of 58% in 2025.
• By payer type, the Medicaid segment held 12% of the market in 2025 and is expected to grow at the fastest CAGR of 6.4% during the forecast period.
• By patient age type, the adult segment held a dominant position in the market with a share of 61% in 2025. 
• By patient age type, the geriatric segment held 25% of the market in 2025 and is expected to grow at the fastest CAGR of 6.4% during the forecast period.

Market Overview 

A freestanding emergency department (FSED) refers to the licensed facility structurally separate from an inpatient hospital campus that offers 24/7 physician-led emergency medical evaluation and treatment. Based on the American College of Emergency Physicians (ACEP) regulations, both hospital-affiliated “off-campus emergency departments” (OCEDs) and “independent freestanding emergency departments” (IFSEDs) operating outside any hospital license under state-specific regulatory frameworks are included in the same category. These departments help in providing emergency diagnostic care, trauma management, hospital transfer services, along with other emergency medical care.

Furthermore, this report helps in covering the full scope of the market, highlighting U.S. healthcare infrastructure, emergency care demand, pricing and reimbursement support, procedure and patient volume, site development, cost structure and capital economics, value chain analysis, technological advancements, competitive landscape, and M&A/investments. Additionally, cost-of-care briefs and the private equity stakeholder projects deal-tracking database are also included in the report, which are published by CDC/NCHS, the American Hospital Association, the UNC Sheps Center for Health Services Research, ACEP, and UnitedHealth Group.

Market Findings

Total U.S. Emergency Department Hits 155 Million in 2022

Graph 1: As the market research analyst, I interpret that the given bar chart compares total U.S. emergency department visits in 2021 and 2022. In 2021, the total number of U.S. ED visits was recorded to be 140 million, which increased to 155 million in 2022 due to growing emergency care demand, shorter waiting periods, and insurance coverage.

Key Insight:

The significant growth in just one year reflects the rapid growth in emergency care demand that traditional hospital ED capacity can absorb and is one of the major factors in FSED expansion nationwide.

Source: CDC/NCHS, “Emergency Department Visit Rates by Selected Characteristics: United States, 2022,” NCHS Data Brief No. 503, Aug. 2024

Freestanding EDs Reaches 770 Since 2001

Graph 2: The above-mentioned line chart illustrates the total U.S. freestanding ED count from 2001 to 2024, which shows gradual growth. In 2021, the total U.S. freestanding ED count was reported to be 50 with 1% of all EDs, which increased to 566, making it 11% of all EDs in 2016. It recorded a further rise to approximately 770, which is 13.4% of all EDs in 2024, confirming a shift of freestanding emergency departments from a regional niche to a structural feature of U.S. emergency care delivery.

Key Insight:

Remarkably consistent growth in FSED count was recorded over 23 years, which confirmed the expansion of these facilities as a durable structural shift and not a short-term trend.

Source: Western Journal of Emergency Medicine (citing NEDI-USA and MedPAC 2016 data); Ivy Clinicians, “State of the U.S. Emergency Medicine Employer Market,” March 2024

FSEDs Hold 13.4% of All U.S. Emergency Departments

Graph 3: Based on the information gathered, the donut chart compares freestanding and hospital-based ED share in 2024. Hospital-based EDs held the major share of 86.6%, contributing approximately 4,980 facilities of all U.S. EDs in 2024, while freestanding EDs held a significant share of 13.4% of all U.S. EDs, accounting for 770 facilities, indicating their rapid expansion.

Key Insight:

The significant growth of freestanding EDs represents their conversion from a niche delivery model into a mainstream component of the national emergency care infrastructure.

Source: Ivy Clinicians, “State of the U.S. Emergency Medicine Employer Market,” March 2024

Texas Dominates the Market with 338 Freestanding EDs

Graph 4: As per my analysis, the given infographic stat panel represents Texas FSED concentration metrics. Freestanding EDs in Texas as of May 2023 were reported to be 338, while the states with at least one freestanding ED were noted to be 32. The share of all U.S. FSEDs located in Texas was recorded to be approximately 44, while the share of ED visits handled by FSEDs accounted for roughly 25%. This indicates that favorable licensing rules and rapid suburban growth in Texas are responsible for its dominance in the market.

Key Insight:

Roughly 44% of the entire national FSED footprint contributes to Texas due to its state-specific licensing environments and the growing underlying demand economics.

Source: Texas A&M University School of Public Health, “Freestanding Emergency Departments Are Popular, But Do They Function As Intended?” April 2024

Infants ED Visit Rates on the Rise

Graph 5: The bar chart highlights ED visit rates by age group in 2022, which reflect significant growth due to expanding facilities and services. The overall population ED visits per 100 population in 2022 were reported to be 47, out of which adults above 75 years of age contributed to 76 visits per 100 population, while infants under 1 year accounted for 99 visits per 100 population.

Key Insight:

The growth in the infants visit was noted to be more than double the overall population rate, while adults demonstrated 1.6x the overall growth rate.

Source: CDC/NCHS, “Emergency Department Visit Rates by Selected Characteristics: United States, 2022,” NCHS Data Brief No. 503, Aug. 2024

Black Americans Contribute to the Highest Emergency Department Visit Rate

Graph 6: Based on our research, the bar chart indicates ED visit rates by comparing the overall population with the Black non-Hispanic population in 2022. The overall population contributed to 47 ED visits per 100 population in 2022, which increased to 91 in the Black or African-American, non-Hispanic population, highlighting growing demand for emergency care services.

Key Insight:

The rising ED utilization among Black Americans at double the overall population rate drives the FSED expansion to offer persistent access and address the preventive-care gap.

Source: CDC/NCHS, “Emergency Department Visit Rates by Selected Characteristics: United States, 2022,” NCHS Data Brief No. 503, Aug. 2024

Higher Freestanding ER Care Cost Leads to Pricing Gap

Graph 7: As the market research analyst, I interpret that the given infographic stat panel represents FSED cost and operating-model metrics. Maximum cost multiple vs. urgent care for similar diagnoses demonstrated a growth of 10x, while the reported bill for a 5-stitch laceration repair contributed to more than $5,000. The share of FSEDs operating 24/7 held an approximate 70% share, while states with FSED operations were reported to be 32. This is driving the use of hybrid emergency/urgent-care facility models to overcome the pricing gap.

Key Insight:

ER patients paying up to 10x more than urgent-care patients, as per the Annals of Emergency Medicine study, makes them the major driver for the use of hybrid emergency/urgent-care facility models, along with the growing regulatory scrutiny and surprise-billing complaints.

Source: Healthcare Dive, “Adeptus Health acquired by NYC hedge fund,” Oct. 2017 (citing Annals of Emergency Medicine study)

Mapping the Journey of Adeptus Healths Rise to Collapse

Graph 8: The timeline infographic illustrates Adeptus Health corporate milestones from 2012 to 2020. In 2012, Adeptus Health recorded 15 freestanding ERs operating in Texas, and in 2015 it announced an IPO at $22/share and expansion to approximately 120 facilities across 4 states plus 5 hospitals, marking its major expansion. 2017, it filed for Chapter 11 bankruptcy with approximately $400 million in liabilities, and in 2020 it filed Chapter 7 liquidation after a brief post-bankruptcy restructuring.

Key Insight:

The court filing of Adeptus Health shows it went from rapid private-equity-backed expansion to Chapter 11 in just two years, during which it also extracted $641 million from a $57 million initial investment before its liquidity crisis forced bankruptcy

Source: Wikipedia (Adeptus Health, corporate record); Bloomberg Law, 2019; Texas Lawbook, 2021

Envision Healthcares Financial Reckoning

Graph 9: The above-mentioned infographic stat panel covers Envision Healthcare buyout and restructuring metrics. In 2017, the KKR buyout price was noted to be $9.9 billion, where the debt load placed on Envision was valued at $7-7.7 billion. 2023 was reported as the year of the Chapter 11 bankruptcy filing, while EDs managed by restructured Envision accounted for 382, which helped reshape emergency physician staffing control nationwide.

Key Insight:

Envisions post-bankruptcy lender group is now controlling one of the countrys largest emergency medicine staffing platforms, reflecting how financial engineering is becoming consequential to the FSED market as facility-level M&A.

Source: Ivy Clinicians, March 2024; PMC, “Private Equity and the Ravaging of United States Health Care,” 2025

Hospital-Based EDs Growth Rapidly Declines

Graph 10: Based on our research, the bar chart compares hospital-based ED count in 2005 and 2015. 2005, registered a total of 4,500 hospital-based EDs, which declined to 4,460 hospital-based EDs with 200 closures, 138 mergers, and 160 new openings in 2015. Therefore, the rising hospital-based ED depiste their closures due to growing emergency care demand, act as the core structural driver of freestanding ED expansion.

Key Insight:

Even though hospital-based EDs experienced a modest net decline, the number of visits per surviving hospital-based ED rose by 28.6% over the same decade, enhancing their expansion.

Source: Annals of Emergency Medicine, cited in ScienceDirect (AHA Annual Survey analysis, 2005–2015)

HCA Healthcare: The Operator of One of the Largest Combined Emergency Care Networks

Graph 11: The above-mentioned horizontal bar chart illustrates HCA healthcare hospital-based and freestanding ED counts. It indicates that the hospital-based EDs accounted for 182 HCA healthcare count, while the freestanding EDs contributed to more than 110 HCA healthcare count, highlighting the growing use of FSEDs to extend emergency care networks.

Key Insight:

The growing HCA healthcare hospital-based and freestanding ED count nationwide reflects that large health systems are using FSEDs as a deliberate network-extension strategy.

Source: Ivy Clinicians / Emergency Medicine Workforce Newsletter, March 2024

Rising Hospital Admissions Each Year Drive the Demand for Emergency Care

Graph 12: According to the survey conducted, the donut chart illustrates ED visit outcomes in 2022, which accounted for 155M. The share of total 2022 ED visits that resulted in hospital admission was reported to be 17.8 million visits, accounting for 11.5%, whereas the visits resulting in critical care unit admission were noted to be 3.1 million visits, contributing to 2.0%. Furthermore, the share of total 2022 ED visits that were treated and released held an 88.5% share.

Key Insight:

With nearly 9 in 10 ED visits resolved without hospital admission, help in highlighting what freestanding EDs can resolve on-site before requiring transfer to a full-service hospital.

Source: CDC/NCHS, FastStats: Emergency Department Visits, citing 2022 NHAMCS data

Fast Response: The Emerging ED Priority

Graph 13: The bar chart reflects the share of ED visits by door-to-provider wait time in 2022, indicating a rise in the seen after 15 minutes wait time category. The share of all U.S. ED visits with a waiting time of 15 minutes held 40.6%, while 59.4% of providers were seen after 15 minutes, which encouraged the freestanding EDs to focus on minimizing their waiting time.

Key Insight:

With fewer than half of all ED visits seeing a provider within 15 minutes, freestanding EDs should focus on improving their ability to meet the providers within the set period of time.

Source: CDC/NCHS, FastStats: Emergency Department Visits, citing 2022 NHAMCS data

Flourishing Independent FSEDs

Graph 14: As the market research analyst, I interpret that the given infographic stat panel covers independent FSED segment scale metrics. The independent FSEDs operating nationwide in 2023 were valued at more than 200, while the year the Medicare policy change enabled satellite FSED payment was recorded as 2004. Total U.S. freestanding EDs in 2024 were reported to be 770, where the growth in FSED count since 2001 was noted to show more than a 15x growth rate.

Key Insight:

The introduction of the 2004 Medicare policy change stopped the extension of independent facilities, indicating that the independent FSEDs are relying on commercial insurance and self-pay revenue, making them an investment-attractive part of the industry.

Market Sizing

The market is sized using verifiable structural indicators, rather than a dollar-denominated FSED market-size or CAGR figure, as they are syndicated model outputs without a disclosed, reproducible methodology.

Table 1: The above-mentioned table represents the market indicators along with their value responsible for the rapid expansion of U.S. FSED. It states that total U.S. emergency department visits in 2022 were recorded to be 155 million, while in 2023 independent (non-hospital-affiliated) FSEDs were noted to have expanded beyond 200 facilities. Total U.S. freestanding EDs in 2024 accounted for approximately 770 facilities, where the FSED share of all U.S. EDs in the same year was reported to be 13.4%. Thus, the FSED count growth since 2001 reflected 15x rapid growth, expanding from 15 to 770 facilities. Additionally, in FY2024, total U.S. hospitals and total U.S. community hospitals were noted to be 6,100 and 5,121, respectively.

Regions Insights

At least 32 states of the U.S. host some FSED presence, where Texas registered dominance by hosting approximately 338 facilities, which is driven by licensing rules that permit independent FSEDs to operate under a straightforward regulatory pathway.

Table 2: Based on our research, the table covers various states and regions in the U.S. with FSED facilities, where Texas held the major share with approximately 338 facilities and around 44% of total U.S. facilities, and it also handles approximately 25% of all in-state ED visits. Florida, on the other hand, is experiencing major expansion with multiple health-system FSED openings in 2024-2025, while Arizona is also contributing to significant growth due to the presence of established secondary hubs for independent operators. Southeast (broader) is rapidly expanding due to rising regional emergency-care market per industry tracking, while States relaxing FSED siting restrictions to counter rural hospital closures, such as California SB 588 March 2025 are driving West region growth. Moreover, Alaska and other constrained states showed minimal or no FSED presence due to regulatory and low-population-density constraints.

Market Trends

Unlocking the Emergency Care Infrastructure & Capacity

Table 3: The table represents total hospitals, FSEDs, and their expanding facilities across the U.S. The total U.S. hospitals in FY2024 were reported to be 6100 and community hospitals were noted to be 5,121, accounting for 84% of all hospitals. 2024 also recorded 4,980 total hospital-based EDs, which is 86.6% of all EDs, where total freestanding EDs were noted to be 770, contributing to 13.4% of all EDs. The hospital-based EDs, 2005 vs. 2015, showed a rise from 4,500 to 4,460, including 200 closures, 138 mergers, and 160 new facility openings. Rural hospitals closed since 2005 are reported to be 197, which contributed to 109 complete with 88 conversions. Net rural hospital reduction from 2017 to 2024 showed a decrease of 52 hospitals. Rural hospitals currently at risk of closure cover approximately 734 facilities, while rural facilities converted to rural emergency hospital (REH) status accounted for 37 facilities, with 19 from 2023 and 18 from 2024.

Deep Dive into Emergency Department Utilization

Table 4: The total U.S. ED visits in 2021were reported to be 140 million, which increased to 155 million in 2022. The ED visit rate in 2022 was noted to be 47 visits per 100 population, where visits resulting in hospital admission, critical care unit admission, and transfer to another hospital contributed to 11.5%, 2.0%, and 2.4%, respectively. Furthermore, the overall ED length of stay was recorded to be 199 minutes. Median ED boarding hours/day in academic EDs experienced a rise between 2019 and 2022 from 206 to 332 hours/day, that is, a rise of 61.1%. Additionally, EDs crowded conditions in routine reports were recorded to be more than 90%.

Addressing Persistent Emergency Care Access Gaps

The UNC Sheps Center and KFF data highlighted the clearest quantified access gap in the rural-urban areas, which recorded 197 rural hospital closures/conversions since 2005, with a net reduction of 52 facilities from 2017 to 2024, where around 734 rural hospitals contributing to one in three nationally are at high financial risk of closure. 69%, accounting for approximately two-thirds, were closed between 2014 and 2024 because they lacked Medicaid expansion, which linked coverage policy to emergency-care access gaps.

Source: KFF, “10 Things to Know About Rural Hospitals,” 2025 (analysis of UNC Sheps Center data)

Growth Drivers and Utilization Patterns

Table 5: The table highlights the number of ED visits in 2022, where 99 per 100 infants under the age of 1 year were recorded as the highest age group for ED visits in 2022. Adults over the age of 75 years were noted to be 76 per 100 adults visiting the ED, where 91 per 100 of the population contributed to Black/African-American non-Hispanic population, making them the highest racial/ethnic group to visit the ED. Adults with above or equal to 1 year of age held approximately 20%, while children aged above or equal to 2 years were reported to contribute roughly 5%, while ED visits with a confirmed COVID-19 diagnosis accounted for 4.8% of all visits. 43% of U.S. adults delayed or avoided ER care due to boarding concerns, whereas 44% of adults reported prolonged wait after being seen and before admission/transfer.

Market Analysis

Procedure Trends and Patient Volume Analysis

Table 6: As the market research analyst, I interpret that the total U.S. ED visits in 2022 were reported to be 155 million, where the overall length of stay was noted to be 199 minutes, while the visits seen by a provider within 15 minutes were 40.6%. In 2023, median ED boarding hours/day in academic EDs were reported to be 332 hours/day, where the boarding-to-attending physician hour ratio from 2019 to 2023 showed a rise from 2.97 to 4.62, surpassing 55.6%. Moreover, just 2.3% of FSED visits were reported to be emergent or required services unique to an ED.

FSED Financial Performance

Table 7: The above-mentioned table covers FSED charges, reimbursement support, out-of-pocket cost, and potential savings, where the average FSED charge for a common condition in Texas was $3,217, while the same condition in a physician office and urgent care center required $146 and $167, respectively. FSEDs in Texas charged a separate facility fee of more than $1,000 per visit, which accounted for 93%. Moreover, its Average patient out-of-pocket cost was reported to be more than $800, whereas physician office/urgent care required less than $100. Potential savings from shifting non-emergent FSED visits to lower-cost settings contributed to a 95% cost reduction, which saved more than $3,000 per visit. Average patient out-of-pocket cost for Colorado FSED was noted to be $735 compared to $65 for physician office and $101 for urgent care. The median allowed amount for an ER visit for network providers in 2023 was approximately $1,700, while the CMS Medicare Physician Fee Schedule 2024 conversion-factor change reported a roughly 3.4% cut to marginal reimbursement, pressuring FSED payer-mix optimization.

Cost Structure, Capital Economics & Site Development

Table 8: As per the information gathered by Aman, the table focuses on the debt load carried by major FSED-adjacent staffing and operating companies during their private-equity ownership periods. Adeptus Health in 2017 held approximately $400 million in liabilities at its Chapter 11 filing, which was converted into a final Chapter 7 liquidation in 2020. Envision Healthcare experienced $7-7.7 billion in debt after the 2017 KKR buyout, which had a $9.9B purchase price; Chapter 11 was filed in 2023, where it now contributes to lender control. American Physician Partners, with ED staffing and150 hospitals, was $472 million in debt, which led to ceased operations in August 2023, where 2,500 physicians left without getting paid.

Source: PMC, “Private Equity and the Ravaging of United States Health Care,” 2025; Wikipedia (Adeptus Health record); Ivy Clinicians, March 2024 

Technology and Digital Transformation

The FSED-specific technology-adoption-rate data consisting of EHR penetration, telehealth integration, and point-of-care diagnostics adoption does not exist, as FSEDs are typically embedded within EHR/IT infrastructure of their parent health systems or run as standalone commercial platforms. This, in turn, reflects the significant gap in technology or digital transformation in U.S FSED facilities

Evolving Value Chain and Operating Models

The physician-staffing layer is one of the major documented value-chain structures in the FSED industry. Envision Healthcare and TeamHealth are the two leading companies in the market, where they contribute to approximately 40% of all employed U.S. physicians in emergency medicine and adjacent specialties, focusing on employment or contract with staffing arrangements, bargaining power, and operational control at the company level. The direct documented example of this integration is represented by HCA Healthcare Valesco joint venture, which combines HCA owned facilities with Envision restructured staffing operation. 

Source: PMC, “Private Equity and the Ravaging of United States Health Care,” 2025; Ivy Clinicians, March 2024

Table 9: The above-mentioned table compares various organizations and their facilities present in the U.S. HCA Healthcare combined ED network, which consists of 182 hospital-based and 110+ freestanding EDs, while Envision Healthcare held 382 facilities. U.S. hospitals currently owned by private equity firms contributed to approximately 460 facilities with 8% of all private hospitals and 22% of for-profit hospitals. The share of PE-owned hospitals serving rural populations was 26%, while the share of employed U.S. physicians covered by the two largest EM staffing groups was reported to be approximately 40%.

M&A, Investment, and Funding Landscape

Table 10: Based on the survey conducted, the table highlights investments, M&A, and other transactions contributing to market growth. In 2024, global healthcare private equity investment was noted to be $115 billion, which increased from $83 billion in 2021, whereas the cumulative PE investment in U.S. healthcare was recorded to be more than $1 trillion. Envision Healthcare KKR buyout value in 2017 was reported to be $9.9 billion, where Adeptus Health private-equity extraction noted $641 million returned on a $57 million initial investment, per court filings. American Physician Partners collapsed in 2023 with $472M in debt, which affected 150 hospitals, resulting in the resignation of 2,500 physicians without getting paid.

Recent Developments

April 11, 2024, Texas hosts 338 freestanding EDs handling nearly a quarter of all in-state ED visits was confirmed by the study comparing FSED and hospital-based ED visit characteristics, which was published by Texas A&M University School of Public Health

Source: Texas A&M University, Vital Record

In May 2023, with a burden of $7-7.7 billion in debt after the 2017 KKR buyout, Envision Healthcare filed for Chapter 11 bankruptcy, where the restructured company is now being controlled by Centerbridge Partners and Blackstone.

Source: Ivy Clinicians, March 2024; PMC, 2025

In August 2023, the $472 million in debt of American Physician Partners, which is an emergency-medicine staffing group serving 150 hospitals, was announced to have ceased its operations, resulting in leaving 2,500 physicians and support staff without months of back pay.

Source: PMC, “Private Equity and the Ravaging of United States Health Care,” 2025

In October 2023, due to boarding concerns, 43% of U.S. adults would delay or avoid emergency care, while 44% of the population have already experienced prolonged post-treatment waits before admission or transfer, as published by ACEP and Morning Consult.

Source: ACEP Newsroom, Oct. 2023

In March 2024, a confirmation was provided by industry workforce tracking that the U.S. now houses 770 freestanding EDs, which is 13.4% of all EDs, along with HCA Healthcare operating 182 hospital-based and more than 110 freestanding EDs.

Source: Ivy Clinicians / Emergency Medicine Workforce Newsletter

In October 2024, a national summit on emergency department boarding after years of ACEP advocacy and an HHS-announced national boarding task force was organized by the Agency for Healthcare Research and Quality (AHRQ).

Source: ACEP, “Emergency Department Boarding and Crowding”

In 2025, a total of 197 rural hospital closures/conversions since 2005 were announced by the UNC Sheps Center, which also highlighted that 2017-2024 experienced a net reduction of 52 facilities, while roughly 734 rural hospitals are now classified as at financial risk of closure.

Source: UNC Sheps Center; KFF, 2025; The World Data, 2026

In March 2025, a statewide study to deploy freestanding emergency departments, mitigating healthcare deserts across rural and inland counties, was proposed by California Senate Bill 588.

Source: Mordor Intelligence industry analysis, 2025–2026

Key Companies

HCA Healthcare, Inc. (Nashville, TN)

It is the largest U.S. hospital operator with 182 hospital-based EDs and more than 110 freestanding EDs, which extensively focuses on combining its networks.

Envision Healthcare (post-restructuring) (Nashville, TN)

It is an emergency medicine physician-staffing group that was taken private by KKR for $9.9B in 2017 and is now responsible for managing 382 EDs under new lender ownership.

Adeptus Health/First Choice Emergency Room (defunct) (Formerly Lewisville, TX)

It is the well-known former largest independent freestanding ER chain in the U.S., which grew from 15 to approximately120 facilities in just three years (2012-2015), where 2020 marked its Chapter 7 liquidation.

American Physician Partners (defunct) (Brentwood, TN)

It is the former ED physician-staffing group that covered 150 hospitals until its operations ceased in 2023 under $472M in debt.

TeamHealth (Knoxville, TN)

It is the major physician-staffing group for hospital-based and freestanding EDs, and it includes around 40% of employed U.S. physicians in EM and adjacent specialties.

Texas Health Resources (Arlington, TX)

It is a regional nonprofit hospital system and active FSED network operator in North Texas, which is continuously expanding its freestanding ED network across the region.

Emerus Holdings (The Woodlands, TX)

It is the operator of “neighborhood emergency hospitals” partnering with regional health systems to expand across multiple states.

UnitedHealth Group (Minnetonka, MN)

It is the major commercial payer and publisher of the primary public research on FSED cost/pricing, where it published briefs quantifying FSED cost premiums in 2017.

UNC Sheps Center for Health Services Research (Chapel Hill, NC)

It is the academic health services research center and an authoritative source for rural hospital closure tracking, which tracks all U.S. rural hospital closures/conversions since 2005.

CDC National Center for Health Statistics (NCHS) (Hyattsville, MD)

It is a federal statistical agency operating NHAMCS, which is the primary source of national ED utilization data, and is responsible for publishing annual ED visit-rate data.

American College of Emergency Physicians (ACEP) (Washington, DC)

It is the primary professional association for U.S. emergency physicians, where it also controls national boarding-crisis advocacy and has published the 2023 Morning Consult poll on boarding and access.

Segmental Insights

Table: As the market research analyst, I interpret that the table specifies a granular segmentation hierarchy, where the off-campus emergency department (OCED) segment held the major share due to the presence of 770 total FSEDs, as mentioned in the Western Journal of Emergency Medicine 2020, where this hospital-licensed satellite ED also offered Medicare facility-fee reimbursement since the CMS policy change in 2004. The independent freestanding ED (IFSED) segment is responsible for operating outside a hospital license, covering more than 200 facilities nationally as of 2023, where it also offers reimbursement for state licensure and commercial payer contracts. Based on patient age, the infant subsegment contributed to the highest utilization age group, with 99 ED visits per 100 infants in 2022, while adults aged more than 75 years were the second-highest-utilization age group, with 76 ED visits per 100 adults. In patient acuity, admission-driving visits held the major share, with 11.5% of visits resulting in hospital admission due to growing visits requiring hospital-level resources, while non-emergent, FSED-treatable visits held 2.3% of FSED visits nationally, which were genuinely emergent and required services unique to an ED.

Strategic Market Key Takeaways

Aditi is a healthcare services research expert with strong experience in healthcare facilities, emergency services, and reimbursement policy markets. She conducted detailed market research, analyzed company data, clinical trends, and industry developments. Based on her comprehensive analysis, the following strategic key takeaways highlight the most important market insights and opportunities.

For Companies/Organizations

• Focus on expanding services across underserved and rural areas.
• Focus on hospital-based FSED facilities to expand the network.
• Invest in advanced technologies to enhance operational efficiency.

For Investors & Corporate Strategy Teams 

• Collaborate with facilities with a rapid expansion rate.
• Invest in pediatric and gerontologic emergency care services.
• Support new technology adoption to reduce waiting time.

Expert Insights

Based on my assessment, the market is expanding rapidly due to growing chronic diseases, which are leading to an increase in emergency conditions. The growth in the infant patient population will drive the demand for faster and more efficient emergency services, increasing the dependence on FSEDs. I also anticipate that the new collaboration and M&A among the facilities and organizations will enhance access to their services. I also see strong growth in reimbursement support and infrastructure improvement, which will create new market opportunities.

Our Experts

Payal Rabde led the primary market research, developed the methodology, analyzed trends, segmentation, competition, forecasts, and strategic opportunities, forming the report analytical foundation.

Aman was responsible for collecting and validating clinical trial data, research publications, company information, partnerships, and other quantitative datasets, strengthening evidence-based analysis and market estimations.

Aditi reviewed the complete research document, performed quality checks, validated findings, refined content, corrected inconsistencies, and finalized the report, ensuring accuracy, clarity, credibility, and publication-ready quality.

Complete Market Segmentation Listing

By Ownership

• Off-Campus Emergency Department (OCED)
  • Hospital-system owned
  • Health-system satellite
  • Hospital-affiliated community facility
• Independent Freestanding Emergency Department (IFSED)
  • Physician-owned
  • Private operator-owned
  • Investor-backed/private-equity affiliated

By Service

• Emergency Department Services
  • Emergency evaluation and management
  • Trauma and injury care
  • Cardiovascular emergency care
  • Neurological emergency care
  • Respiratory emergency care
  • Gastrointestinal emergency care
  • Infectious disease and acute illness management
  • Minor emergency procedures
• Laboratory Services
  • Point-of-care testing
  • Hematology testing
  • Clinical chemistry
  • Microbiology
  • Molecular and infectious-disease testing
• Imaging Services
  • X-ray
  • Computed tomography (CT)
  • Ultrasound
  • Magnetic resonance imaging (MRI)
• Other Ancillary Services
  • Pharmacy services
  • Observation services
  • Specialist consultation
  • Patient transfer and referral services

By Facility Model

• Standalone FSED
  • Dedicated emergency facility
  • Community-based emergency center
• Hospital-Satellite FSED
  • Off-campus hospital emergency department
  • Health-system satellite emergency department
• Hybrid Emergency/Urgent Care Facility
  • Integrated emergency and urgent care
  • Dual-track emergency/urgent-care model
• Microhospital-Integrated Emergency Facility
  • Emergency department with short-stay capacity
  • Emergency department with limited inpatient capability

By Patient Acuity

• High-Acuity Emergencies
  • Cardiovascular emergencies
  • Stroke and neurological emergencies
  • Severe trauma
  • Respiratory emergencies
  • Sepsis and life-threatening infections
• Moderate-Acuity Emergencies
  • Acute abdominal conditions
  • Moderate injuries
  • Dehydration
  • Acute infections
  • Asthma and moderate respiratory conditions
• Low-Acuity Emergencies
  • Minor injuries
  • Lacerations
  • Mild infections
  • Fever
  • Minor fractures and sprains

By Payer

• Private Insurance
  • Commercial health insurance
  • Employer-sponsored insurance
  • Managed care plans
• Medicare
  • Traditional Medicare
  • Medicare Advantage
• Medicaid
  • Traditional Medicaid
  • Managed Medicaid
• Self-Pay / Uninsured
  • Cash-paying patients
  • Uninsured emergency visits
• Other Payers
  • Workers compensation
  • Automobile insurance
  • Other government programs

By Patient Age

• Pediatric
  • Infants
  • Children
  • Adolescents
• Adult
  • Young adults
  • Middle-aged adults
  • Older adults
• Geriatric
  • Adults aged 65–74
  • Adults aged 75–84
  • Adults aged 85+

References

• CDC/NCHS. “Emergency Department Visit Rates by Selected Characteristics: United States, 2022.” NCHS Data Brief No. 503, Aug. 2024.
• CDC/NCHS. “Estimates of Emergency Department Visits in the United States, 2016–2022.” data.cdc.gov.
• CDC/NCHS. “Emergency Department Visit Rates by Selected Characteristics: United States, 2021.” NCHS Data Brief No. 478, Aug. 2023.
• CDC/NCHS. “FastStats: Emergency Department Visits.” cdc.gov/nchs/fastats.
• American Hospital Association. “Fast Facts on U.S. Hospitals, 2026.” aha.org (FY2024 AHA Annual Survey data).
• Texas A&M University School of Public Health. “Freestanding Emergency Departments Are Popular, But Do They Function As Intended?” Vital Record, April 11, 2024.
• Western Journal of Emergency Medicine. “What is a Freestanding Emergency Department? Definitions Differ Across Major United States Data Sources.” 2020.
• Ivy Clinicians / Emergency Medicine Workforce Newsletter. “State of the U.S. Emergency Medicine Employer Market.” March 13, 2024.
• ScienceDirect. “Where Do Freestanding Emergency Departments Choose to Locate?” Annals of Emergency Medicine, 2019. 
• Wikipedia. “Adeptus Health.” Corporate and bankruptcy record.
• Bloomberg Law. “Adeptus Ex-Directors Say Suit Ignores True Cause of Bankruptcy.” 2019.
• Mordor Intelligence. “United States Freestanding Emergency Department Market Analysis.” 2025–2026.
• UNC Sheps Center for Health Services Research. “Rural Hospital Closures.” shepscenter.unc.edu, 2025.
• KFF. “10 Things to Know About Rural Hospitals.” Sept. 2025.
• The World Data. “Hospital Closure Statistics in U.S. 2026.” 2026.
• ACEP. “Emergency Department Boarding and Crowding.” acep.org.
• ACEP. “New Poll: Alarming Number of Patients Would Avoid Emergency Care Because of Boarding Concerns.” Oct. 2023.
• ACEP Now. “A First Look at Emergency Department Data for 2022.” 2023.
• Academic Emergency Medicine. “Staffing Trends Amid Boarding Challenges: A Five-Year Analysis (2019-2023).” 2026.
• UnitedHealth Group. “Freestanding Emergency Departments.” Cost-of-care brief, 2017.
• UnitedHealth Group. “Freestanding Emergency Departments in Colorado.” 2017.
• Becker Hospital Review. “Freestanding EDs charge up to 22 times more than physician offices, UnitedHealth study finds.” 2019.
• PMC. “The Implications of Private Equity Investment in Emergency Medicine.” 2025.
• PMC. “Private Equity and the Ravaging of United States Health Care.” 2025.
• Private Equity Stakeholder Project. “PESP Private Equity Hospital Tracker.” April 2025.
• Private Equity Stakeholder Project. “Private Equity Healthcare Deals: 2024 in Review.” 2025.