ASHEVILLE - While four different health systems made their cases for new hospital beds on Aug. 19, one company was top of mind for most attending: HCA Healthcare.
AdventHealth, Mission Health, Novant Health and UNC Health West presented their competing plans for the 92-bed certificate of need to the North Carolina Department of Health and Human Services at Asheville Buncombe Technical Community College's Ferguson Auditorium on Aug. 19, a hearing that included an opportunity for public comment. Over 100 people attended.
The state regulatory process stands to be highly consequential, with expansions of Advent, Mission and Novant facilities, or an entirely new UNC Health hospital at the Westgate Shopping Center, in the balance. State regulators are
expected to make a decision on the certificate of need before the end of 2026.
It is a quick turnaround from another recent certificate of need hearing for the region. In late 2025, the same four health systemscompeted for a 129-bed certificate of need, where, despite community pushback against Mission Health's proposal, the HCA-owned health system was awarded 95 beds. Novant Health won the other 34 beds.
Lobbying for the new certificate of need has already begun. Buncombe County Commissioners are backingthe proposal from UNC Health West, the state's nonprofit health system that recently purchased the Westgate Mall with plans to turn it into a hospital.
At the same time, representatives from Buncombe's northern municipalities — the towns of Woodfin and Weaverville — have largely backed AdventHealth's plan to expand their already under construction 67-bed hospital off of US 25/70, another hospital that had been opposed by Mission. In a smaller proposal, Novant has requested 20 beds to expand its south Asheville facility. Mission Health has proposed using all 92 beds to expand its primary hospital.
The hearing had an audience that was largely against any further expansions of Mission. During the public comment period, Asheville resident Denise Champagne asked the audience to clap or stand if they believed Mission — which has been at the center of resident, nurse and local leaders frustrations as it has been cited with immediate jeopardy four times since 2019 as its parent company faces a lawsuit from the state over its management — should not receive another bed. Almost the entire room stood. On Aug. 6, Asheville Watchdog reported that Mission Hospital was back in "substantial compliance" with Centers for Medicare and Medicaid Services regulations after the hospital was placed in immediate jeopardy two times in the last year alone.
"I wanted you to have this visual and see how much energy is in this room for the same sentiment," Champagne said to Greg Yakabowski, the NCDHHS analyst assigned to weighing who will receive the beds. "We urge you to think really hard about granting Mission Hospital another bed going forward."
Health systems pitch plans
Spokespeople from Mission Health were the first to present their plans for the new beds during the hearing. Chief Operating Officer Melina Arrowood described demand as already present at Mission, as seen by the company qualifying to operate temporary beds.
High demand has forced them to "create another hospital within the walls of Mission, finding every appropriate space we can to place beds, staff them, and care for the patients who continue to come through our doors," Arrowood said.
"Approval of these additional license beds would allow us to create permanent, modern patient rooms designed specifically for inpatient care," Arrowood said.
Proposing to only use 20 beds to expand its Arden facility to 54 beds total, Andrea Flynn, vice president of the Cancer Institute at Novant Health, called the company's proposal important to ensuring the new facility is "developed at a scale that can effectively meet growing demand, support a broader range of services and operate at a strong, sustainable community hospital from day one."
CEO of UNC Health Cristy Page described the nonprofits effort at the Westgate Shopping Center, describing its potential approval as "filling a significant gap for the underserved west side of the county and represents a natural first stop for patients traveling from Clay, Graham, Madison and Yancey counties." At an expected cost of $747 million, the proposal is the most expensive out of the four.
"The approval of our UNC Health Hospital in Buncombe County would significantly expand access to care for patients here in Western North Carolina and it will bring clinical expertise, academic and research infrastructure, including easier access to clinical trials and full scope services that this community needs and deserves," Page said.
AdventHealth's proposal would add 92 beds to its already approved 65-bed hospital in Weaverville in a project that would cost $272.7 million. Graham Fields, assistant to the president of AdventHealth, described the opportunity to expand the hospital's size as a way to change the status quo in Western North Carolina and provide more competition. In Fields' perspective, the "worst possible outcome is for nothing to change" in terms of bed distribution.
"Failure for the community is dividing up the beds to multiple hospitals of essentially the same size that offer exactly the same services. In this outcome, the people in the service area lose because they still only have one option for high acuity-care: The same one they had before the process started," Fields said, alluding to Mission Health.
Buncombe, Madison leaders diverge on Advent, UNC Health
On Aug. 18, Buncombe County Commissioners submitted an open letter backing UNC Health's plan, while Asheville Mayor Esther Manheimer attended the Aug. 19 hearing in support of UNC Health's proposal.
Though much of Manheimer's remarks addressed UNC Health's plan, they also focused on HCA and Mission's recent immediate jeopardy violations and North Carolina Attorney General Jeff Jackson's lawsuit against the company.
Manheimer noted that she has previously signed letters of support for Advent and Novant in recent years, but not for Mission.
"Since HCA acquired Mission Health, I have heard repeatedly from patients, physicians, nurses and families who are deeply concerned about inadequate staffing, difficulty accessing care and, despite an incredibly dedicated staff, concerns regarding quality of care," Manheimer said.
"We need additional beds, but we also need different providers and a better model. On behalf of the people of Asheville and Western North Carolina, I respectfully urge you to approve UNC Health's application," Manheimer said.
Meanwhile, Madison County Commissioner Matthew Wechtel spoke in support of AdventHealth's proposal, describing any decision to award the hospital beds elsewhere as undermining the goal of creating a tertiary hospital in the region. He also noted that it's placement would take it out of the way of future and current construction along Interstate 26.
"By approving Advent Health's expansion of the Weaverville facility, this will improve healthcare choices for our entire region," Wechtel said.
Will Hofmann is the Growth and Development Reporter for the Asheville Citizen Times, part of the USA Today Network. Got a tip? Email him at WHofmann@citizentimes.com or message will_hofmann.01 on Signal.
This article originally appeared on Asheville Citizen Times: Public during Asheville hospital hearing: 'Mission Hospital should not get one more bed'
