Legal appeals between competing North Carolina health systems have stalled more than 1,100 approved acute care beds statewide since 2020, according to a Sept. 14 Carolina Public Press analysis. The report “examines how certificate-of-need disputes between competing health systems have hampered the state’s ability to meet healthcare needs in its fastest-growing communities.
North Carolina requires health systems to obtain a certificate of need before building new facilities or acquiring major equipment, with DHHS running a competitive annual review to allocate approved beds among rival systems. Rival systems have increasingly used appeals to delay competitors’ projects even after state approval, contributing to statewide hospital occupancy climbing from 56% to 67% since 2020. At least six planned hospitals and 13 expansion projects remain barred from construction despite winning DHHS sign-off, according to the article.
The analysis said that three regions account for most of the disputes: Research Triangle, where WakeMed, Duke Health and UNC Health compete; the Charlotte metro area, where Atrium Health and Novant Health routinely clash; and the Asheville area, where HCA-owned Mission Health has fought AdventHealth and Novant.
According to the report, In Buncombe County, Mission’s three-year fight with AdventHealth’s Weaverville hospital pushed its opening to 2028, with none of the county’s 222 approved beds progressing despite Mission hitting 99.7% occupancy. In the Research Triangle, Duke Health delayed a UNC Health hospital by four-plus years and a WakeMed radiation device by two, both now resolved by settlement.
The dispute volume is expected to grow: this year’s State Medical Facilities Plan calls for approving a record 1,556 more acute care beds statewide, concentrated in already-contested counties including Mecklenburg, Wake and Durham.
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