Our annual list of North Carolina’s best hospitals examines data compiled from several sources to determine which medical centers provide the best care for their patients. We start by developing a comprehensive list of the state’s top-performing general acute care, adult hospitals with 50 or more beds.
The rankings are calculated using more than 25 metrics, including information provided by the U.S. Centers for Medicare & Medicaid Services. We look at patient-satisfaction surveys, as well as infection, readmission and death rates for common procedures. Other factors include safety report cards by the Washington, D.C.-based nonprofit The Leapfrog Group, distinction awards from insurer Blue Cross and Blue Shield, and national performance ratings from U.S. News & World Report.
The prime challenge of 2020 for North Carolina hospitals was battling the COVID-19 pandemic, the worst public health crisis in a century. Many centers were at risk of being overwhelmed with COVID patients needing intensive care, forcing restrictions on elective surgeries that provide key revenue for physicians and hospitals. While several hundred million dollars of federal relief funds has helped stabilize the N.C. hospitals, the crisis called for unprecedented flexibility.
Our methodology tends to skew in favor of larger institutions, which earn more points based on national awards and performance rankings. Smaller hospitals tend to come up short, largely because some procedures aren’t performed often enough to be considered. Other factors, such as health care system consolidation, had an impact on this year’s rankings.
Still, independent hospitals in smaller cities including Gastonia, Pinehurst and New Bern ranked highly this year. Smaller operators can compete effectively.
The federal data and Blue Cross and Blue Shield of North Carolina insurance distinctions were compiled in December 2020. Leapfrog safety scores and U.S. News & World Report rankings were updated in January.
UNC REX HEALTHCARE
UNC Rex Healthcare, which returns to the top ranking, keeps expanding in its fast-growing market. Its 50-bed community hospital in Holly Springs is expected to open this fall, followed next year by a $65 million, four-story cancer center at its west Raleigh campus. The 145,000- square-foot expansion doubles the hospital’s cancer-care space, improving efficiency and adding oncology urgent care and quality of life clinics.
Like every hospital, its past year has been consumed with battling COVID-19. The hospital opened an isolation unit in March, offering ICU-level respiratory care for its sickest COVID patients. In April and May, visitations were restricted and elective surgeries scaled back. And at the end of the year, it began vaccinations, first for its employees then for the most vulnerable residents.
UNC Rex is led by Ernie Bovio, who joined the hospital as chief operating officer in 2018 and became CEO in late 2019.
DUKE UNIVERSITY HOSPITAL
COVID response also took center stage at the Durham hospital, which had its 90th year of operation last year. It opened portions of its Duke Central Tower to accommodate more patients, and it started vaccinating its workers in mid-December and the state’s most vulnerable residents in January.
The hospital completed its 1,500th heart transplant in October, 35 years since its first such procedure. The latest was a donation after a circulatory death transplant, which Duke pioneered in 2019. It reanimates a still donor heart; the organ never stops during a traditional transplant. The hospital received a three-star rating for its adult cardiac-surgery program from the Society of Thoracic Surgeons for quality patient care and outcomes.
Duke Health partnered with San-Francisco-based 1Life Healthcare in August to use the technology administrator’s One Medical to expand primary-care access through clinical and digital integrations.
President Thomas Owens came to Duke in 1999 and took his current post in January 2018. He also serves as an associate professor of medicine and pediatrics at Duke University School of Medicine.
CAROMONT REGIONAL MEDICAL CENTER
CaroMont Regional Medical Center’s jump — 11 spots — was the largest made by any hospital in this year’s top 10. Construction on a $90 million four-floor critical-care tower is underway. Each floor of the 146,000-square-foot project will have 26 patient rooms offering ICU-level care, all within view of nursing stations. It’s expected to open in 2023, when CaroMont Health also plans to open the 66-bed CaroMont Regional Medical Center-Belmont. It will have an emergency department, operating rooms, a labor-and-delivery unit and imaging services. Both projects are part of a countywide investment of more than $350 million.
On Dec. 1, the hospital and Minneapolis-based UnitedHealthcare Services parted ways. The insurer claimed hospital-based services were too expensive, while the provider claimed reimbursements were too low. That put CaroMont out of network for about 11,000 local customers. Both indicated a willingness to negotiate, but a compromise had yet to be reached as of mid-February.
FIRSTHEALTH MOORE REGIONAL HOSPITAL
FirstHealth of the Carolinas has 5,000 employees and treats patients from 15 surrounding counties. Moore Regional enrolled its first patient in a clinical trial that’s testing a combination of antiviral drug Remdesivir and a highly concentrated solution of antibodies, harvested from donated plasma, against COVID-19. It also approved interior plans for its $68 million Comprehensive Cancer Center, which will be built in Pinehurst, across from Reid Heart Center. The 120,000-square-foot building will consolidate the system’s multidisciplinary cancer care, bringing treatments closer to home for more patients, says system CEO Mickey Foster. Construction should be complete in late 2022.
In January, Moore Regional Hospital advanced its robotic surgery capabilities with a second da Vinci Xi Surgical System. It gives surgeons more mobility within a patient’s abdominal cavity and uses an improved system for closing the tiny incisions that it makes. Offered since 2006, these surgeries reduce pain, hospital stays and recovery time.
In March, FirstHealth became the eighth N.C. health system to join Blue Cross and Blue Shield of North Carolina’s Blue Premier Program. Its shared-risk model makes both parties responsible for better outcomes and lower costs. Blue Cross estimates 15% savings over 10 years.
About a year after Nashville, Tenn.-based HCA Healthcare finalized its $1.5 billion purchase of Mission Health in early 2019, its Asheville nurses began questioning working conditions, which were exacerbated by COVID. By the end of September, a majority — 70% of those who cast ballots — voted to join Oakland, Calif.-based union National Nurses United, which represents about 185,000 members nationwide. HCA says a union will impair communications between supervisors and staff. Nurses still need a collective bargaining agreement, which will cover working conditions, pay and raises. While state law says employees don’t have to join or pay dues to a union, the deal will cover Mission’s 1,800 nurses in Asheville. The nurses’ vote attracted national attention because North Carolina has the second-lowest unionization rate, trailing South Carolina.
In May, HCA Healthcare Mission Fund was launched with $25 million to support businesses working to improve the quality or efficiency of health care in western North Carolina. An initial move was to support Venture Asheville’s 2020 Asheville Impact Micro Grant Program, including a $5,000 grant earmarked for a local startup in health and wellness. A board of local and hospital system leaders steers the fund.
ATRIUM HEALTH CABBARUS
One of Charlotte-based Atrium Health’s 42 hospitals, Atrium Health Cabarrus started 2020 with a new facility executive, Asha Rodriguez. Her attention quickly turned to COVID response, including handing out more than 82,000 masks and using Atrium Health Mobile Food Pantry to feed more than 1,100 people in Cabarrus County by the end of December.
The hospital also has been implementing the Atrium Health Healthy Together program, which stresses healthy habits including exercise and diet. It’s working with five schools and more than 3,300 students in its home county. Cabarrus County Schools and Kannapolis City Schools are committed to implementing Healthy Together’s 5-2-1-0 program. The hospital released the Healthy Together Workplace Wellness Toolkit last summer, which has been used by local businesses more than 100 times.
CAROLINAEAST MEDICAL CENTER
After starting 2020 by opening the $38 million, 80,000-square-foot State Employees’ Credit Union Comprehensive Cancer Center and adjacent $22 million diagnostic center, CarolinaEast Medical Center finished the year by unveiling a new procedure. Transcatheter aortic valve replacement — TAVR — uses a catheter such as those used to clear blocked coronary arteries. Four procedures were completed by December. While it was developed for patients who aren’t candidates for open-heart surgery, it has become more widely used. One benefit of the minimally invasive option is shorter recovery times. Patients undergoing traditional replacements spend as long as a week in the hospital and eight more days recuperating at home. Most TAVR patients go home the same day and are back to normal activity more quickly.
The medical center’s cardiovascular care center was the first in North Carolina to achieve an excellence accreditation from American Heart Association, and it was one of 60 nationwide to receive American College of Cardiology’s NCDR Chest Pain – MU Registry Gold Performance Achievement Award in 2020.
MOSES CONE HOSPITAL
In early August, Greensboro-based Cone Health’s board agreed to merge the system and its 13,000 employees with Norfolk, Va.-based Sentara Healthcare, which operates one other North Carolina hospital — Sentara Albemarle Medical Center in Elizabeth City. Sentara plans to use the merger to expand further into North Carolina. Cone Health CEO Terry Akin will depart upon the merger’s regulatory approval, which is expected this summer. Cone Chief Operating Officer Mary Jo Cagle will then take the reins as Sentara’s regional president. She has been with Cone for about a decade, originally hired as its chief quality officer. She will be the first woman and first physician to lead Cone.
In May, Cone Health exited talks to take over Randolph Health, which operates a hospital in Asheboro. That hospital had filed for bankruptcy protection and was seeking a $20 million state loan to cover expected operating losses. American Healthcare Systems, led by industry veteran Michael Sarian, acquired the Asheboro hospital.
NOVANT HEALTH FORSYTH MEDICAL CENTER
In mid-January, N.C. Attorney General Josh Stein signed off on Novant Health’s purchase of Wilmington’s New Hanover Regional Medical Center after a public sales process that involved the state’s four biggest hospital systems. Novant’s $4.5 billion bid included $1.5 billion for New Hanover County, which had owned the hospital, and pledges of more than $3 billion in capital expenditures over the next decade. The county commission approved the sale in October after considering bids from Atrium Health, Duke Health and others.
Novant also reached an agreement with UNC Health and UNC School of Medicine in November for a statewide expansion of medical education, clinical services and research. It includes access to clinical trials led by UNC School of Medicine researchers at Novant locations in Charlotte, Wilmington and Winston-Salem. The move followed the partnership between Atrium Health and Wake Forest Baptist Health that is leading to an expansion of the Wake Forest School of Medicine into Charlotte.
The sister organization of UNC Rex Healthcare ranks among the nation’s leaders in medical innovation. In October, its doctors were the first in the Carolinas and among the first nationwide to use cardiac contractility modulation therapy on a heart-failure patient. Its electrical pulses cause the patient’s heart to contract, pushing more oxygen-rich blood through the body.
In January, UNC Health and Boston-based Medically Home Group established the Acute Care at Home Program. It brings hospital-caliber care for chronic diseases, infections, surgery recovery and COVID to patients at home, aiming to lower costs and improve outcomes. Physicians and nurses remotely monitor patients, who traditionally would be hospitalized, and administer IVs, oxygen treatments, lab tests, X-rays, ultrasounds and other services. The program is expected to start this summer for UNC Medical Center and UNC Rex patients, eventually expanding to UNC Health’s 10 N.C. hospitals.
NOVANT HEALTH PRESBYTERIAN
BEDS: 597 | 2020 RANK: T-12
PRESIDENT AND CHIEF OPERATING OFFICER: SAAD EHTISHAM
ATRIUM HEALTH CAROLINAS
BEDS: 907 | 2020 RANK: T-7
PRESIDENT CENTRAL DIVISION: VICKI BLOCK
DUKE REGIONAL HOSPITAL
BEDS: 369 | 2020 RANK: T-7
PRESIDENT: KATIE GALBRAITH
WAKE FOREST BAPTIST HEALTH
HIGH POINT REGIONAL MEDICAL CENTER
BEDS: 351 | 2020 RANK: T-16
PRESIDENT AND CEO: JAMES HOEKSTRA
WAKE FOREST BAPTIST
BEDS: 885 | 2020 RANK: T-16
PRESIDENT AND CEO: JULIE ANN FREISCHLAG
ATRIUM HEALTH PINEVILLE
BEDS: 235 | 2020 RANK: T-20
SENIOR VICE PRESIDENT AND MARKET PRESIDENT – SOUTH: MICHAEL LUTES
MEDICAL CENTER, A DUKE LIFEPOINT HOSPITAL
BEDS: 355 | 2020 RANK: T-22
INTERIM CEO: JERRY DOOLEY
WAKEMED RALEIGH CAMPUS
BEDS: 726 | 2020 RANK: T-20
PRESIDENT AND CEO: DONALD GINTZIG
NOVANT HEALTH MATTHEWS
BEDS: 146 | 2020 RANK: 15
PRESIDENT AND CHIEF OPERATING OFFICER: JASON BERND
BEDS: 238 | 2020 RANK: T-26
PRESIDENT: MARK GORDON
ATRIUM HEALTH UNION
BEDS: 249 | 2020 RANK: 25
PRESIDENT AND CEO: MICHAEL LUTES
NEW HANOVER REGIONAL
BEDS: 769 | 2020 RANK: 11
PRESIDENT AND CEO: JOHN GIZDIC
CAPE FEAR VALLEY
BEDS: 666 | 2020 RANK: T-16
PRESIDENT AND CEO: MICHAEL NAGOWSKI
BEDS: 258 | 2020 RANK: T-32
CEO: EDWARD BEARD
BEDS: 156 | 2020 RANK: T-22
SENIOR VICE PRESIDENT AND ADMINISTRATOR COMMUNITY HOSPITALS: THOMAS GOUGH