AdventHealth, Novant Health, Mission again vie for hospital bed expansion

Mission Health is competing again with two other major hospital systems for territory in Buncombe County, vying for 26 acute care hospital beds in a region it currently dominates.

Mission Health, Novant Health, and AdventHealth applied June 17 to bring the acute care beds to Buncombe. Each application has a different proposed timeline: Mission would add the beds by 2025, AdventHealth by 2027, and Novant by 2028, according to a public notice issued Tuesday.

While located in Buncombe, the beds would also serve Graham, Madison, and Yancey counties.

The bids are part of the Certificate of Need (CON) process, required under North Carolina law when providers want to acquire, replace, or add to facilities and equipment. Companies must get approval from the Department of Health and Human Services before taking any such action.

The proposals range in cost from $1.6 million to $294.4 million, according to application summaries and the public notice, and vary in their approach:

Mission corporate owner HCA Healthcare proposed adding 26 acute care beds at the Asheville hospital at a cost $1.6 million for a total of 759 acute care beds. AdventHealth proposed adding the 26 beds to a hospital it will build in Weaverville for a total of 93 acute care beds and a $109.2 million price tag.

Novant proposed building an entirely new hospital, called Novant Health Asheville Medical Center in the public release. It would be built in Arden at a cost of $249.4 million and would have 26 acute care beds.

The public may file written comments about the proposals, according to the public notice. Comments must be received no later than 5 p.m. July 31. Instructions on how to give feedback on the bids are in the public notice.

A public hearing will be held at 11 a.m. Aug. 19 in the Ferguson Auditorium of AB-Tech Community College, 340 Victoria Road in Asheville.

The applications come after the 2024 State Medical Facilities Plan identified the need for 26 more acute care beds in Buncombe County.

This isn’t the first time the hospital systems have competed for beds in western North Carolina. In 2022, they vied for 67 new beds. AdventHealth won that application in April, but only after a lengthy battle in which Novant, Mission, and UNC Health Pardee brought different arguments.

Mission argued that the CON process in 2022 wasn’t fair. An administrative law judge disagreed and AdventHealth was granted permission this May to move forward with its plans to build the hospital in Weaverville.

AdventHealth’s land purchase in Weaverville

AdventHealth paid $7.5 million in February this year for four adjoining parcels comprising 25.45 acres on Ollie Weaver Road along US 25-70, just west of I-26, according to property records.

During announcements surrounding this final stage of approval, AdventHealth confirmed it would pursue the additional 26 acute care beds.

Asheville Watchdog reached out to Mission, Novant, and AdventHealth for comment regarding the proposals.

“Mission remains committed to providing the region’s most advanced healthcare, and we believe Mission Hospital can best meet Western North Carolina’s growing need for complex medical and surgical care services,” Mission Health spokesperson Nancy Lindell said.

An AdventHealth spokesperson told The Watchdog, “AdventHealth’s work to expand access to whole-person care and bring more choice and competition to our region has been built around the conversations and relationships we have with the people in Buncombe, Graham, Madison and Yancey Counties.”

A Novant spokesperson pointed to its April 30 announcement about plans to build a 26-bed facility, which it said would be committed to cancer care in western North Carolina.

The competition comes during a time of turmoil at Mission, which in February was put into immediate jeopardy by the U.S. Centers for Medicare & Medicaid Services. A federal report found 14 patients were put in danger and four died between 2022 and 2023 as a result of deficiencies in care at the hospital. The hospital corrected issues causing that sanction.

HCA and Mission Health also face a lawsuit by North Carolina Attorney General Josh Stein, who is the Democratic candidate for governor. The lawsuit alleges that they violated the asset purchase agreement regarding cancer care and emergency services at Mission Hospital. Lawyers for HCA countered that it never promised to provide quality healthcare at Mission.

Union nurses at Mission are currently past the deadline for a new labor contract and may strike before summer is over.

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Andrew R. Jones is a Watchdog investigative reporter. Email The Watchdog’s reporting is made possible by donations from the community. To show your support for this vital public service go to


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