AdventHealth, HCA and Novant Health to apply for hospital beds

SECOND HOSPITAL IN BUNCOMBE? AdventHealth is proposing to build a new hospital in the Asheville area, although the location hasn't been revealed yet, says AdventHealth spokesperson Victoria Dunkle. Photo courtesy of AdventHealth

Three hospitals plan to file applications to build a new 67-bed hospital in Western North Carolina.

The N.C. 2022 State Medical Facilities Plan, published by the N.C. Department of Health and Human Services Division of Health Service Regulation, stated Buncombe, Graham, Madison and Yancey counties will have a projected need of 67 additional acute care beds by 2024.

AdventHealth announced plans to file an application for a hospital in a Facebook post April 20. Victoria Dunkle, spokesperson for the nonprofit AdventHealth, says the application will be filed June 15.

HCA Healthcare/Mission Health, owner of Mission Hospital (the only hospital in Buncombe County), will also apply.

“Mission Health will be sending in an application for the 67 acute care beds that were identified in the 2022 NC State Medical Facility Plan,” Nancy Lindell, spokesperson for HCA Healthcare North Carolina Division, tells Xpress in an email statement. The plan “revealed a need for these acute care beds in [Health Service Area 1] … based on the high utilization of hospital beds currently in the service area combined with a population growth factor.”

Novant Health, which operates hospitals in central North Carolina and in South Carolina, will apply as well. “Novant Health is committed to improving the health of communities and has been interested in serving Western North Carolina for years,” spokesperson Ashton Miller says in an email statement to Xpress. “We look forward to submitting a proposal and will have more details to share once the application process is complete.”

Health care planning

North Carolina is one of 35 states, plus Washington, D.C., that require a certificate of need to build certain health care facilities, according to data from the National Conference of State Legislatures. The N.C. State Health Coordinating Council develops the State Medical Facilities Plan, per state law.

The plan identifies counties with a need for additional facilities, and licensed medical organizations may then propose plans for the certificate of need. According to the NCDHHS website, the Division of Health Service Regulation seeks “to make certain that health care facilities and medical equipment are developed only when needed.”

A need for additional acute care beds is partially calculated by a county’s growth rate, which is also indicated in the report. The 2021 State Medical Facilities Plan stated that Buncombe County had a surplus of three acute care beds.

The State Medical Facilities Plan also spells out the need for health services like operating rooms. AdventHealth’s facilities — AdventHealth Hendersonville and Western Carolina Surgery Center — are projected to need four surgical operating rooms by 2024. All four facilities are in Henderson County.

The plan indicates Asheville Speciality Hospital, a 34-bed, long-term care facility owned by Mission Health and located in Buncombe County, doesn’t need additional beds. (The need for long-term care beds is determined separately from the need for acute care beds, according to the state’s report.)

The State Medical Facilities Plan also indicates that some counties don’t need additional hospital beds at all. For example, the 2022 report finds Haywood County, served by Haywood Regional Medical Center, has 121 licensed acute care beds and a surplus of 40 beds.

AdventHealth’s plans

AdventHealth Hendersonville is in Fletcher, neighboring Hendersonville. Although not yet finalized, the proposed location of the new hospital will be in the Asheville area of Buncombe County, says spokesperson Dunkle. The location will be shared in the application filed on June 15, she says.

In addition to 67 acute care beds, the facility proposes lab services, an emergency department, surgery services and a dedicated cesarean section operating room, according to AdventHealth’s website.

“We were so excited about this opportunity to take the health care that people have come to know and trust with us,” Dunkle tells Xpress. “That whole person care — body, mind and spirit — that differentiates us from other experiences of care that people may have.” (AdventHealth is a faith-based, Christian nonprofit.)

If AdventHealth’s application is approved, Dunkle estimates that construction could take two- to 2.5 years. She says the nonprofit will keep the public up to date with its plans on a website:


N.C. Rep. Brian Turner (D-116) is enthusiastic about AdventHealth’s intention to file an application. “We have just one hospital in Buncombe County, which really restricts people’s choices and competition,” Turner says.

Nonprofit Mission Hospital became a for-profit hospital following a February 2019 sale to HCA Healthcare, a Nashville-based company. Since the purchase, HCA has faced criticism over allegations of understaffing, health care workers quitting and diminished cleanliness. On June 2, registered nurses at Mission held a rally with National Nurses Organizing Committee/National Nurses United alleging hospital management encourages them to work under dangerous conditions, including a high nurse-to-patient ratio.

“The business model has changed [at Mission],” Turner continues. “And so the marketplace needs to become more competitive in order to really function well for the people in the community.”

Asheville Mayor Esther Manheimer did not respond to requests for comment but shared in an email to Xpress, “I am glad you’re writing about this.” Manheimer, Turner, Buncombe County Commission Chair Brownie Newman and other elected officials co-signed an opinion column in the Asheville Citizen Times in February 2020. The column expresses “deep concern regarding the state of Mission Hospital Systems since the purchase by Hospital Corporation of America (HCA) last year.”

Turner tells Xpress his constituents say to him they want more health care choices in Buncombe County. “I hear from physicians, I hear it from physicians who are not hospitalists but who rely on the hospital, I hear it from nurses and hospitalists who are out there working every day,” Turner says. “And I hear it from patients and families of patients.” Turner called AdventHealth “a natural fit in some ways,” given its century-plus history in WNC. (AdventHealth Hendersonville was formerly known as Park Ridge Health.)

Dunkle from AdventHealth says the State Medical Facilities Plan’s stated need for more acute beds means “the window has been open for us to step in and take action on the requests that people make to us every single day.” She continues, “They want to feel empowered so they can take control of their health care, and getting more choices is really a huge step in that direction for them.”

Mission’s growth

Lindell, the spokesperson for HCA Healthcare North Carolina Division/Mission Health, wrote in an email statement that the underlying need for more acute beds in the region is due to demand for the hospital’s services.

“Mission Hospital is the only hospital in [Health Service Area 1], which means the demand for Mission’s services alone generated the need for more acute care beds,” she writes in a statement. “The community’s utilization of these advanced services indicates that Mission Hospital plays a critical role in the region in providing care.”

HCA Healthcare North Carolina Division/Mission Health is expanding with other services as well. The company announced May 25 a certificate of need approval for two emergency rooms. One ER will be at the corner of Hendersonville and Airport roads in South Asheville, the other in West Asheville near Candler.

According to HCA’s press release, both ERs will provide 24-hour care and include 12 patient rooms and on-site diagnostic testing, like CT scans, X-rays and ultrasounds. Both are projected to open in late 2023.

UPDATE, June 13, 2022: This article has been updated to correct the URL of AdventHealth’s certificate of need application website.


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About Jessica Wakeman
Jessica Wakeman is an Asheville-based reporter for Mountain Xpress. She has been published in Rolling Stone, Glamour, New York magazine's The Cut, Bustle and many other publications. She was raised in Connecticut and holds a Bachelor's degree in journalism from New York University. Follow me @jessicawakeman

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3 thoughts on “AdventHealth, HCA and Novant Health to apply for hospital beds

  1. Taxpayer

    HCA should not be allowed to apply. Everyone that can is already going out of town to avoid HCA/Mission’s horrendous quality of care. I feel sorry for the folks that work there but I wouldn’t go there. Not ever.

  2. Voirdire

    Allowing HCA more hospital beds in any new facilities they would be allowed to build in western NC would be nothing short of criminal basically. Any provider considered for this required certificate of need to build additional health care facilities for acute care here in western NC should be a nonprofit entity. Period. Time to get real about all of this.

  3. Daniel Kaplan, MD

    HCA says:
    “Mission Hospital is the only hospital in [Health Service Area 1], which means the demand for Mission’s services alone generated the need for more acute care beds,”

    That’s rather twisted Orwellian logic.
    Does HCA not understand that the demand is due to growth and not due to the quality of there services? They aren’t an ice cream shop with some new great flavor.

    If anything, it is the lack of their ability to get the job done that creates the demand (but still, it’s primarily growth).

    I’d be worried about perpetuating a monopoly within the county. AdventHealth is the smaller operating in this competition, but with a large network based on FL behind them. Just be ready for CREATION posters in the hallways (a not so subtle poster campaign they’ve run before).

    Novant is huge, with big resources in NC & SC.

    Strange how a commission will make the choice. I’d rather see more of a free market.

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