North Carolina’s Department of Health and Human Services (DHHS) approved a long‑awaited expansion of acute‑care capacity in Western North Carolina in 2022, designating 67 additional beds for Buncombe County and neighboring areas. The state’s formula, which matches projected population growth to medical‑service needs, triggered a competitive review for a certificate of need – the permit required before a hospital can be built or major equipment purchased.
AdventHealth’s Weaverville project hits legal roadblocks
DHHS ultimately awarded the certificate to AdventHealth, a Florida‑based system, for a new hospital in the small town of Weaverville. Residents of nearby Madison County welcomed the decision, hoping to shorten hour‑long drives for critical care. However, Mission Health – the dominant provider in Asheville and a subsidiary of HCA – filed appeals to block the project, arguing that a second hospital would erode its regional market share.
The appeals have effectively paused construction, leaving Mission Health as the sole operating hospital in Buncombe County, the most populous county in the state’s mountain region. While the Weaverville site remains under development, the legal fight illustrates a broader pattern of “certificate‑of‑need” disputes that hinder timely health‑care expansion.
Statewide impact of certificate‑of‑need appeals
CPP’s analysis shows that since 2020, DHHS has approved more than 1,100 acute‑care beds that remain undeveloped because competitors have lodged appeals. Hospital occupancy rates have risen from 56 % to 67 % over the same period, and flagship facilities such as Mission Health in Asheville regularly operate above that benchmark.
At least six planned hospitals and 13 expansion projects are currently barred from breaking ground despite having secured DHHS approval. Economists generally agree that competition benefits patients by expanding choice and lowering costs, yet North Carolina’s certificate‑of‑need system incentivizes health‑care operators to use legal challenges as a strategic tool to protect market dominance.
Hot spots of hospital‑bed battles
Three regions dominate the litigation landscape:
- Research Triangle: WakeMed, Duke Health, and UNC Health vie for beds in Raleigh, Durham, and Chapel Hill.
- Charlotte area: Atrium Health and Novant clash over acute‑care capacity in Mecklenburg and surrounding suburban counties.
- Asheville corridor: Mission Health, AdventHealth, Novant, and UNC Health compete for new facilities.
In the Research Triangle alone, 337 approved beds in Wake County and 82 in Durham County sit idle pending appeals. A notable case involved Duke Health’s delayed hospital in southern Durham County, which only moved forward after a settlement with UNC Health.
What the delays mean for North Carolinians
When approved projects stall, hospitals risk becoming overcrowded, compromising patient safety. “If DHHS defines a need and legal delays prevent meeting that need, you’re leaving people without the capacity they require,” said Mark Hall, a health‑policy professor at Wake Forest Law School.
DHHS is currently reviewing applications for 225 new acute‑care beds in New Hanover County (Wilmington) and 276 beds in Forsyth County (Piedmont Triad). Competing systems such as Novant, Atrium, and Cone Health have already filed appeals that could postpone construction for years.
Looking ahead
The first installment of Carolina Public Press’s “Battling for Beds” series highlights how certificate‑of‑need disputes have become a de‑facto weapon for market control, rather than a tool for cost containment. Upcoming articles will examine whether reforms to the certificate‑of‑need process could restore competition, accelerate hospital development, and better align bed capacity with the state’s growing population.
Original reporting: Carolina Public Press — read the source article.
