Thursday, June 20, 2024

Novant wants to take on Mission/HCA

State Treasurer Dale Folwell lowered the boom against the state’s hospital industry again Tuesday, criticizing them for making too much money and not offering enough charity care.

He issued a detailed report on the finances of the seven biggest N.C.-based hospital systems, timing its release to the publication of a Washington Post story about how federal pandemic aid bolstered Charlotte-based Atrium Health and other robust hospital systems.

The treasurer’s latest critique comes just as one of those big N.C. systems seeks to compete against the largest U.S. hospital company. Winston-Salem-based Novant Health wants to build a 75-bed, $328 million hospital in Buncombe County, taking on the area’s dominant provider Mission Health, which is owned by Nashville-based HCA Healthcare.

It’s an unconventional move given the trend of hospital industry consolidation, not competition.

Novant filed for the expansion through the state’s Certificate of Need process, which limits growth to avoid duplication and excessive spending. Mission is also vying for additional hospital beds, as is Altamonte Springs, Florida-based Advent Health, which has a hospital in Hendersonville It is affiliated with the Seventh-day Adventist Church.

Novant is in an aggressive expansion mode, having acquired New Hanover Regional Medical Center to complement its big operations in the Triad and Charlotte areas. The investment in Buncombe would be minor compared with Wilmington, where Novant spent more than $1 billion upfront to buy the county-owned system. It also pledged a couple billion dollars more in expansions over the next decade.

Asked why it wants to compete with HCA, Novant sent a statement noting its commitment “to improving the health of our communities, one person at a time. In order to deliver on this commitment, we must ensure acute care resources expand to reach the growing population areas across the state.”

Novant contrasted its N.C. roots with the other two bidders and said its hospital “will make vital services more accessible and convenient for residents who may otherwise find the care they need is out-of-reach.” It is also proposing surgery and radiology operations and a 35-bay emergency room.

Novant would enter Buncombe as Mission faces lawsuits and widespread negative publicity related to its operations since HCA bought the system for $1.5 billion in 2019. Folwell and local officials have repeatedly criticized HCA for reducing the quality of care while boosting profits.

HCA contends it is improving care and offering broader services than Mission could have had it remained independent. It has also paid more than $50 million in taxes since the acquisition, unlike its tax-exempt peers.

Mission’s CON application calls for a $125 million expansion in ICU and medical-surgical beds “to serve the communities growing need for complex and specialty care.” It adds that it has “experienced capacity constraints for this type of specialized care because it is the region’s only tertiary care center, trauma center and pediatric specialty hospital,” according to an emailed statement

“By expanding our capacity, we will be better equipped to take in transfers from the region of the most critically ill patients.”

While hospital competition would benefit Buncombe residents, many would prefer a locally owned, nonprofit operation, says Mitchell Li, an emergency physician in Asheville who helped organize Take Medicine Back, which advocates for reducing corporate interests in health care.

His group and some other local organizations plan a public town hall-style meeting in mid-July in which Novant and Advent have tentatively agreed to answer questions about their plans.


David Mildenberg
David Mildenberg
David Mildenberg is editor of Business North Carolina. Reach him at

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