By Kevin Ellis and David Mildenberg
Asheville’s Mission Hospital started 2024 in crisis. State and federal regulators found the care of patients seriously lacking, putting their well-being at risk. The Centers for Medicare and Medicaid Services put Mission on “immediate jeopardy” of either fixing problems or risk losing Medicare and Medicaid payments, its majority source of funding.
Subsequent inspections found no deficiencies in care, and by February Mission was no longer at threat of losing federal funding. Mission changed CEOs in mid-September. About two weeks later, Mission Hospital faced a new threat, this time from natural disaster as Hurricane Helene swept through western North Carolina, creating unprecedented damage from flooding.
Mission Hospital survived that peril, crediting not only its staff but also the size and responsiveness of its parent company, Nashville, Tennessee-based HCA Healthcare,
the largest hospital operator in the country by both number of facilities and net
patient revenue.
So how does Mission Hospital rank tied for first —with Duke University Hospital and WakeMed Raleigh — in Business North Carolina’s annual ranking of top hospitals?
BNC creates its list by using more than 25 healthcare metrics, with a significant weighting based on data from the U.S. Centers for Medicare & Medicaid Services. The report includes patient-satisfaction surveys, infections, readmissions and mortality rates for common procedures. Other data includes safety report cards by Washington, D.C.-based nonprofit The Leapfrog Group, distinction awards from insurer Blue Cross and Blue Shield of
North Carolina and national performance ratings from U.S. News & World Report.
The methodology to create this list tends to favor large institutions because they gain
more points based on national awards and performance rankings. Smaller hospitals perform fewer procedures, which eliminates those institutions from select categories
used for calculations.
Many of the Top 25 hospitals on the list are part of larger hospital systems — including Atrium Health, Novant Health, UNC Health, ECU Health and Duke University. There are some independent hospitals cited, including CaroMont Health in Gastonia, Catawba Valley Medical Center and Frye Regional Medical Center, both in Hickory, Iredell Memorial Hospital in Statesville and CarolinaEast Medical Center in New Bern.
Asheville’s historic natural disaster caused an unforgettable year for Mission Hospital. The hospital’s ER saw more than 500 patients in the first hours after Hurricane Helene blew through the region on Sept 27. Parent company HCA Healthcare, the nation’s largest hospital operator, directed about 400 colleagues from around the U.S. to provide relief and keep Mission Hospital and its five community hospitals open. Truck convoys supplied the hospital with water for two months while Asheville repaired its municipal service.
Mission Hospital is led by Greg Lowe, who had been North Carolina president of HCA Healthcare, but took on the role of Mission’s CEO in September. The change came months after state and federal regulators cited Mission for failures in following compliance with health and safety regulations. Follow-up state inspections found “no deficiencies.”
For the 10th consecutive year, the Healthgrades research firm named Mission Hospital one of the nation’s 50 Best Hospitals, the only North Carolina facility on the list. That rating is based solely on clinical outcomes. In November, Mission Hospital expanded emergency services by opening the South Asheville ER. The facility has 11 exam rooms and is about 10 miles from the main hospital campus.
Net patient revenue totaled $1.3 billion in 2023, ranking 11th-largest in the state, according to the Definitive Healthcare research firm. Since HCA paid $1.5 billion for Mission Health in 2019, the publicly traded company has faced intense community criticism. A state lawsuit in 2023 accusing HCA of reneging on a promise to maintain oncology and emergency services is pending. Mission is also appealing a state ruling that permits AdventHealth, a Florida-based not-for-profit, to build a new hospital in Buncombe County.
With more than 11,000 employees, Duke University Hospital is both a research hospital and a teaching hospital. While second in total number of beds, its net patient revenue of more than $4 billion in 2023 ranked tops in the state, according to the Definitive Healthcare research firm.
For 13 consecutive grading periods, Duke University Hospital has received top scores for patient safety from The Leapfrog Group, a Washington, D.C., group that rates hospitals for patient quality and safety. Its peers, also run by Duke Health, Duke Regional Hospital and Duke Raleigh Hospital, have earned similar grades.
The National Institutes of Health awarded Duke University School of Medicine more than $580 million in federal funding in 2024, tops in North Carolina and seventh nationally. A measure of Duke’s expertise came in August when a 34-year-old Graham man became the second person in the world to receive a BiVACOR Total Artificial Heart as a bridge to a transplant that occurred 10 days later.
In January, Duke Health agreed to join UNC Health’s plan to build a $2 billion freestanding children’s health system in the Triangle. Last year, N.C. lawmakers appropriated $320 million to UNC Health for such a hospital. The partners plan to break ground on the new NC Children’s campus by 2027, with construction expected to take about six years. A location has not been selected.
WakeMed Raleigh is the largest hospital in Wake County by number of beds, but it faces competition in its backyard from hospitals affiliated with UNC Health and Duke Health, two of the world’s top academic health systems. Its $1.3 billion in net patient revenue in 2023 compared with $1.5 billion at UNC Health Rex and $682 million at Duke Raleigh Hospital.
WakeMed delivers more babies than any other health system in the county. With nearly 10,000 births reported during its 2024 fiscal year, a new kindergarten class is born within the WakeMed system every day. WakeMed’s maternity care is one of just 168 hospitals to receive a five-ribbon performance ranking by Newsweek, based on data from Statista. WakeMed also has received straight A grades seven times in a row from The Leapfrog Group, a Washington, D.C.-based group that rates hospitals on patient safety.
WakeMed Cancer Care, which opened in 2022 near the main campus, marked its 10,000th patient served in 2024. A second Cancer Care facilty opened two months later in Cary in 2022 and a third will open this year in north Raleigh. The outpatient practice has grown to more than 80 staff members and providers.
WakeMed won approval from the state in 2023 to build a $214 million, 31-bed hospital in Garner. It is also seeking to add 21 beds to its main campus in an application with the N.C. Department of Health and Human Services.
Novant Health’s flagship Triad hospital got bigger this year after the January completion of its $400 million multiyear expansion that includes a five-story, 193,000-square-foot critical care tower. Since the project started in 2019, contractors renovated and expanded the site’s women’s and children’s center, cafeteria and energy operations.
The hospital’s nearly 3,900 employees are led by Alisha Hutchens, who was promoted from chief operating officer to succeed former President Chad Setliff. In October, he jumped to a new post as CEO of Raleigh’s UNC Rex hospital, which is part of UNC Health.
The second-biggest hospital in the Triad opened in 1964. It serves a 20-county region. Net patient revenue totaled $1.7 billion in 2023, ranking seventh-largest in the state, according to the Definitive Healthcare research firm. Novant Health ranks as the state’s second-largest healthcare system with annual revenue of about $10 billion.
Cone Health hasn’t changed its name, leadership or mission, but a merger last
year provides more financial firepower and a renewed focus. Kaiser Permanente’s startup Risant Health business combined with Cone after committing at least
$1.4 billion in capital over the next five years and as much as $300 million more over the next decade.
That includes at least $1 billion in capital for investments in facilities, health equity and other capital projects. The money will be from internal generated funds or Risant. The hospital expects to open a five-story, $160 million heart and vascular tower at its main campus later this year. A smaller similar facility opened in April at Cone Health’s Alamance Medical Center.
Cone Health was formed in 1953 and now employs 13,000 people and more than 700 physicians, plus 1,800 partner physicians. It has four acute-care hospitals. Read more about Cone Health on page 52.
UNC Health Rex hired a new leader last year, Chad Setliff, to help expand its strong Wake County operations. He previously had led Forsyth Medical Center, the flagship Novant Health hospital in Winston-Salem. The U.S. Military Academy graduate had worked at Novant Health for 20 years.
UNC Rex is the state’s eighth-biggest hospital based on patient revenues. It has submitted plans to add 20 acute-care beds and two operating rooms. Setliff also oversees the UNC Health Rex hospital in Holly Springs that opened in 2021 and is aiding the group’s effort to gain state approval for a $460 million, 50-bed hospital in Wake Forest.
UNC Rex is the sole hospital in North Carolina, and among only 18 nationwide, to receive 22 consecutive “A” grades every year since 2012, when the Washington, D.C.-based Leapfrog Group started rating hospitals twice per year for patient quality and safety.