Sunday, April 14, 2024

Upfront: Winning Tradition

Ranking hospitals is a worthy pursuit that has its limitations.

For many years, Business North Carolina has published a list of the state’s top hospitals, with the main purpose of celebrating the highest achievers. There’s no subjectivity to the rankings, which is strongly weighted by data from the Centers for Medicare and Medicaid Services. It’s the biggest payer of medical bills and has the most incentive to understand hospital performance related to patient safety and outcomes.

Our rankings have shown a few hospitals that consistently outperform, including Duke University, Cone Health Moses Cone, UNC and UNC Rex. Those four ranked in our top five again this year.

The survey resonated more than ever for me after I spent considerable time in a Charlotte hospital and a rehab clinic following an October accident that ended with a couple broken ankles.

When it happened, my only hope was to travel to the nearest place offering pain relief, even if it was the world’s worst hospital. That’s what I mean by the limitations of rankings. I’m doing fine now.

My hospital experience, which involved Atrium Health, Novant Health and OrthoCarolina, left me supremely impressed by healthcare workers. My interactions with dozens of people, from room cleaners to veteran surgeons, were universally positive.

North Carolina is blessed by its plethora of strong hospitals that put patients’ interests first. Maintaining that tradition, given the industry’s consolidation trend, is an important subject to track.

Not everyone has similar positive hospital encounters. Among the state’s big healthcare stories is questions over the care provided at Asheville’s Mission Hospital. Some community and government leaders are pressing publicly traded HCA Healthcare to sell the hospital, which was a not-for-profit local authority before 2019. HCA says it’s doing solid work
in Asheville.

Mission faces unusual scrutiny because it has a unionized nursing workforce, along with a local publication, the Asheville Watchdog, which has made the hospital a priority coverage topic. Before its sale to HCA, Mission regularly ranked near the top in BNC surveys. It slipped in recent years but improved to sixth this year, up from 12th in 2023. Balancing statistical results and anecdotal experiences
is challenging.

Our ranking doesn’t factor cost and affordability, which are key issues with healthcare accounting for 17% of U.S. gross domestic spending. Various surveys show different results about how North Carolina’s healthcare costs rank nationally, reflecting the opacity of pricing and insurance.

What is clear is that hospitals are dominant economic forces and the source of enormous civic pride for many communities, as Ed Martin’s cover story explains. Lots of great folks show up every day to care for us, I can attest.


Business North Carolina staffers have had a blast producing monthly magazines since 1981, supported by supportive subscribers and advertising sponsors. That tradition will continue for a long time.

Simultaneously, my colleagues Chris Roush, Kevin Ellis, Ray Gronberg and Dan Barkin are producing an unprecedented amount of business news coverage at our website. One won’t understand what’s happening in North Carolina commerce without reading their work, I can say with confidence.

Most of the content is free, including our Daily Digest newsletter. But with plans to be around for many more decades, we’re also offering paid products that offer expanded coverage, including the North Carolina Tribune, which features Gronberg’s daily coverage of key political issues affecting the business community.

Last month, we debuted Daily Digest Extra, with more business news delivered on Tuesday and Thursday afternoons in a concise fashion.

We hope you will find great value in these digital, local news publications.

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

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