From Staff Reports

ASHEVILLE, N.C. — Four health systems — AdventHealth, Mission Health, Novant Health, and UNC Health West — are currently competing to add 92 new acute care beds in the Buncombe County area. 

This battle follows a previous, highly contentious 2025 competition in which the state awarded expansion beds to Mission and Novant, prompting appeals from AdventHealth and UNC Health.

Following is the backstory of the ongoing r:ivalry:

• The dominant player: For decades, HCA Healthcare-owned Mission Health has been the sole dominant hospital system in Buncombe County. However, since HCA took over in 2019, Mission has faced severe federal safety sanctions, staff exoduses, and heavy scrutiny from local residents and officials, fueling widespread demand for more healthcare competition.

• The previous round: In a late-2025/early-2026 Certificate of Need process to add up to 129 acute care beds, the N.C. Department of Health and Human Services ultimately approved Mission Hospital to add 95 beds and Novant Health to build a 34-bed hospital in Arden.

• The appeals: AdventHealth and UNC Health West appealed that decision, arguing that the expansion would only further entrench Mission’s dominance and that the approval process was flawed.

• The current 2026 race: Sparked by a new determination in the 2026 State Medical Facilities Plan for 92 additional beds in the area (encompassing Buncombe, Clay, Graham, Madison, and Yancey counties), all four systems submitted renewed proposals.

Following are the current proposals:

• Mission Health: Proposes a $66.8 million expansion of 92 acute care beds at its Asheville campus, targeted for completion in January 2032.

• UNC Health West: Aims to build a massive new, 92-bed hospital in Asheville, estimated to cost $747.3 million and slated for completion in July 2032.

• AdventHealth: Aims to add 92 beds at its new hospital currently under development in Weaverville.

• Novant Health: Proposes a $100.6 million project to add 20 additional beds to its upcoming facility in Arden, with an expected completion date of January 2031.