When AdventHealth broke ground on its long-awaited Weaverville hospital on March 26, the Florida-based health system envisioned a hospital with hundreds of beds — one which could eventually rival that of HCA-owned Mission Hospital, which currently dominates the Asheville market.
That plan, however, was thrown into doubt last week when the state Department of Health and Human Services chose to award 95 additional acute care beds to Mission rather than the new Weaverville hospital.
In all there were 129 acute care beds up for grabs, which HCA, AdventHealth, Novant and UNC Health jockeyed over in a competitive review process.
[Subscribe for FREE to Carolina Public Press’ Daily, Weekend and Election 2026 newsletters.]
AdventHealth made those beds a key part of its expansion plans for the new Weaverville hospital, and had good reason to think they’d get them after besting HCA in two previous certificate of need applications.
Ultimately, the state bucked that trend and gave most of the beds to HCA to expand Mission Hospital, bringing that facility to a total of 828 beds. DHHS gave the 34 remaining beds to Novant to build a new community hospital in Arden, which will serve southern Buncombe County.
Critics of the decision said that DHHS failed to consider Mission’s ongoing issues with immediate jeopardy citations, which have led the federal Center for Medicare and Medicaid Services to go as far as to threaten pulling crucial federal funds from the hospital.
In 2019, Tennessee-based HCA purchased the regional Mission Health chain, which until that point operated as a nonprofit. Since then, the group’s flagship hospital in Asheville has struggled with staffing issues and poor marks from inspectors, while the entire group faces regulatory action and litigation from the NC Department of Justice over service since the acquisition.
A survey by federal regulators at Mission Hospital last year uncovered preventable death, unsafe patient transport and harmful infection protocol.
Aaron Sarver, a spokesperson for Reclaim Healthcare WNC, a nonprofit focused on holding HCA accountable in its operation of Mission Health, told Carolina Public Press that the region remains reliant on Mission Hospital as its primary tertiary care facility and only trauma center.
However, many residents in need of medical care now seek alternative facilities when possible because of Mission’s noncompliance issues, he said.
“It’s safe to say that our community has lost trust in Mission,” Sarver said.
“By not adequately considering the enforcement history at Mission and the need for real competition in the region, DHHS has failed (Western North Carolina) with this decision.”
More certificate-of-need battles on horizon
The first phase of AdventHealth Weaverville is a 67-bed facility which company leaders said will create 1,300 jobs and fill the health-services gap that currently exists in northern Buncombe, Madison and Yancey counties.
Getting the certificate of need required to begin construction was a battle in itself because of a years-long appeals process by HCA, who wanted those beds for Mission.
In December, the North Carolina Supreme Court refused to hear HCA’s final appeal, allowing AdventHealth to finally begin work on the hospital.
During his remarks ahead of the groundbreaking ceremony, Gov. Josh Stein said the Weaverville hospital would “increase competition among hospitals in Western North Carolina, which ultimately benefits patients by lowering cost and improving quality.”
But further legal fights await AdventHealth, which has ambitious plans to continue adding beds in Weaverville.
In 2024, DHHS awarded AdventHealth 26 more acute care beds to expand its planned Weaverville hospital. HCA appealed that decision too, and AdventHealth spokesperson Victoria Dunkle told CPP that they expect a ruling from an administrative law judge in the coming weeks.
“These beds are an important addition to the 67 beds already approved for AdventHealth Weaverville,” Dunkle said.
Meanwhile, AdventHealth is considering whether to flip the script on HCA and appeal DHHS’ most recent decision to award 95 beds to Mission Hospital. Dunkle said AdventHealth is “evaluating appeal options that honor the community’s needs and voice.”
“Based on the recent health care access and quality concerns in our region, we do not believe the decision is in the best interest of our community and will have profound impacts,” she added, making a veiled reference to Mission’s multiple immediate jeopardy citations.
DHHS disregards HCA compliance issues
In its findings from the competitive review, DHHS seemed to favor Mission because of its broader scope of services.
The findings briefly touched on Mission’s troubles with federal regulators in a section which required applicants to prove that “quality care has been provided in the past.”
In its application, HCA admitted that Mission Hospital had recently received an immediate jeopardy citation that had yet to be officially resolved, although corrective actions had been taken.
Despite that, DHHS determined that HCA had done enough to show “sufficient evidence” of quality care across all six facilities it operates in North Carolina. No further mentions of quality of care concerns at Mission Hospital appeared in DHHS’ findings.
Another factor DHHS considered was geographic accessibility, in which it gave the edge to Novant for its proposed facility in Arden. In the end, the state divided the 129 beds between HCA and Novant, cutting AdventHealth out completely.
While HCA’s Mission Health group is a major presence in the region and Florida-based AdventHealth operates hospitals in nearby Hendersonville and Columbus, Winston-Salem-based Novant has not had a big presence in the state’s mountain region previously, though it is a major player in the hospital industry across North Carolina.
Why not Weaverville?
While the DHHS decision put a damper on AdventHealth’s plans in Weaverville, mayor Dee Lawrence told CPP he’s optimistic that future certificate of need applications will open up and allow the hospital to keep growing.
“We have to respect the process that the state has,” he said. “We hope that they would start believing that it’s better to give the public more options than less.”
For now, 67 beds is a good start in a region that Lawrence described as a “health care desert.”
An emergency department serving northern Buncombe County, which is more easily reachable by residents of neighboring counties like Madison and Yancey, is a welcome development, Sarver agreed.
“It’s important for people not from (Western North Carolina) to understand that the geography means that it can easily take more than an hour for an ambulance to reach Asheville where Mission is located,” he said.
“Giving those folks a closer option for care is important, as evidenced by the broad support Advent had from representatives of those local governments.”
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License. You may republish our stories for free, online or in print. Simply copy and paste the article contents from the box below. Note, some images and interactive features may not be included here.
