The battle for Buncombe County
At the center of this dispute is Altamonte Springs, Fla.-based AdventHealth’s planned hospital in Weaverville, N.C., expected to open in 2027. Initially approved for 67 beds, the system recently won a CON to add 26 more, bringing the total to 93 beds. This decision was met with resistance from Mission Health, HCA’s Asheville-based subsidiary, which, along with Winston-Salem, N.C.-based Novant Health, had also sought approval for additional beds.
Mission has since appealed the state’s decision, arguing that the North Carolina Department of Health and Human Services failed to properly evaluate key factors such as public comments, financial feasibility and projected service utilization. Mission maintains that it is better equipped to meet the region’s growing demand for complex medical and surgical care, given its existing infrastructure and ability to handle high-acuity cases.
“We strongly believe Mission Hospital can best meet western North Carolina’s growing need for complex medical and surgical care. If we had been awarded the beds, Mission Hospital could have had these beds available in the shortest period of time, beds which are desperately needed by our community,” a spokesperson for Mission said in a statement provided to Becker’s. “Mission remains committed to acting in the best interest of the broader region and providing the area’s most advanced healthcare.”
However, state officials and North Carolina Gov. Josh Stein have supported AdventHealth’s expansion. Mr. Stein, the former state attorney general, has positioned himself as a critic of Nashville, Tenn.-based HCA, arguing that increased competition will lead to lower costs and improved care quality in Western North Carolina.
“I called on NCDHHS to reject Mission’s application for more beds so that another healthcare provider could grow its presence in western North Carolina, Mr. Stein said in a Dec. 2 statement. “I’m hopeful that this will help people get higher-quality, more affordable care when they need it.”
A spokesperson for AdventHealth told the Asheville Watchdog the health system is “disappointed” by the extended delays the appeal will bring but is confident that the state’s decision will be upheld.
A history of legal battles
The battle over the Weaverville hospital is the latest in a series of recent legal challenges between the two systems:
- AdventHealth has repeatedly contested Mission’s expansion efforts, including appeals against HCA’s CON applications for freestanding emergency departments.
- HCA has also fought to limit AdventHealth’s growth, including an earlier challenge to its planned Weaverville hospital, which resulted in a trial last fall.
- Meanwhile, HCA is also facing a lawsuit, filed in December 2023 by the North Carolina attorney general’s office, which alleges the health system cut emergency and cancer care at Mission and lapsed on its 2019 asset purchase agreement in doing so. HCA denies the allegations, arguing that it continues to meet the obligations outlined in the APA after its $1.5 billion acquisition of Mission and intends to defend the lawsuit in court.
What’s at stake?
For hospital executives watching this battle unfold, the HCA-AdventHealth rivalry underscores larger strategic challenges in the industry:
- The evolving role of CON laws: While designed to regulate hospital growth, these laws often lead to protracted legal fights that delay service expansions.
- The effect of market consolidation: HCA’s dominance in Western North Carolina has fueled concerns about higher costs and reduced competition, while its critics argue that its scale allows for greater efficiency.
- Regulatory scrutiny of for-profit health systems: Mr. Stein’s lawsuit against HCA highlights growing political and legal pressures on large hospital operators to demonstrate tangible benefits for local communities.
With Mission’s appeal pending and a new administration in North Carolina poised to shape future healthcare policy, the battle between HCA and AdventHealth is far from over. The outcome will not only affect the future of care delivery in Western North Carolina but could also set precedents for hospital competition nationwide.
