Months before it can get official permission from the state, Florida-based nonprofit AdventHealth is seeking public support for a 129-bed expansion of its already approved 93-bed new hospital under construction in northern Buncombe County.

Coupled with an earlier, pending certificate of need (CON) request to the state for 26 additional beds, AdventHealth will be proposing a total of 222 acute care beds for the new facility in Weaverville, making it — if approved by state regulators, and if it withstands possible challenges from Nashville-based for-profit HCA Healthcare — the second-largest hospital in western North Carolina and the first major competitor to HCA Mission Health’s near-monopoly on hospital services in Buncombe County.

Mission Hospital in Asheville has 682 licensed acute-care beds. UNC Health Pardee in Henderson County has 201. The Charles George VA Medical Center in Buncombe County has 119. AdventHealth already operates a 62-bed hospital in Henderson County, according to the Proposed 2026 State Medical Facilities Plan.

For months, AdventHealth, a Seventh-day Adventist nonprofit that is the largest Christian-based nonprofit hospital system in the United States, quietly has been pitching a proposal for the additional 129 beds to local leaders across the region. But this week’s public announcement of plans marks the first significant indication of AdventHealth’s vision for a much larger facility. 

The announcement, however, comes months before any possible official action. 

Applications for the additional 129 beds cannot be submitted to the state until Oct. 15, according to the 2025 State Medical Facilities Plan. AdventHealth, which owns more than 50 hospitals across the nation, has been gathering letters of support from town councils, health departments and residents in preparation for its application.

It’s already started grading work at the 30-plus acre site and is planning a groundbreaking ceremony later this year. When AdventHealth first applied for the project, the nonprofit told the North Carolina Department of Health and Human Services’ Division of Health Service Regulation (DHSR) it would cost $254 million. Plans to expand the hospital will inflate the price, AdventHealth spokesperson Victoria Dunkle said. 

“We will be sharing the updated scope, scale and costs in the final application,” she said.

Though AdventHealth originally said the hospital would open by 2027, expansion and a complex application process make that aspiration unlikely.

Weaverville Mayor Patrick Fitzsimmons said that although the delays are frustrating, the prospect of a large new hospital is welcome in this town of about 4,500.

“This is a positive development for our town,” Fitzsimmons said. “We’re talking about the addition of maybe as many as a couple thousand jobs as these new hospital beds are allotted, the kind we’re trying to attract to Weaverville.”

Service area: Buncombe, Graham, Madison and Yancey

Meant to serve patients in Buncombe, Graham, Madison and Yancey counties, the facility originally was slated for only 67 beds, according to the certificate of need application AdventHealth filed in 2022, which was approved by the state months later, despite competition and opposition from other big health care systems, including the HCA Healthcare-owned Mission Health system. 

North Carolina’s CON law forces medical facilities to compete when they want to expand, add services, or buy expensive equipment. Organizations apply for projects and the state decides whether they are necessary.

In 2024 Advent added an application for 26 more beds to its original bid, bringing the total it was asking to 93. The extra 129 beds proposed this week would more than double the total bed count at the proposed Weaverville hospital.

“With 222 beds, the community will have more access to higher-level emergency and specialty care and more choices for how and where to receive this advanced care,” the release said, touting “not-for-profit, whole-person care” and “the growing needs of our region.”

Though a thumbs-up from the DHSR, the entity responsible for approving applications, is the first step to getting those beds, it’s hardly the last. CON law allows other hospitals to appeal the DHSR decision repeatedly, which Mission Health has done with all of AdventHealth’s previous approvals for the hospital. Last month an appellate court judge ruled against HCA-Mission’s most recent challenge to the 67-bed bid, which the DHSR approved more than three years ago. 

Mission Health spokesperson Katie Czerwinski declined comment on Mission’s appeals. She did not respond to a question about whether Mission would also apply for the 129 beds come October.

HCA also challenges 26-bed AdventHealth award

AdventHealth’s announcement Monday highlighted  the North Carolina Court of Appeals decision to finally greenlight the 67 beds, opposing Mission Health’s contention since 2022 that it didn’t get a fair shake in the CON process. Both Mission and Novant Health tried to win the beds that year.

“AdventHealth is grateful for the North Carolina Court of Appeals’ decision to uphold the State’s approval of our CON application for a 67-bed hospital in Buncombe County,” the news release said.

Because of CON laws and Mission’s legal contentions, AdventHealth is far from clear to finalize its vision of opening what would be one of the region’s largest hospitals by acute-care-bed count. Although the battle over the 67 beds is over now, another one is waiting on an Office of Administrative Hearings judge’s decision. Mission Health filed an appeal Dec. 20, 2024, stating that AdventHealth’s 26-bed application was erroneously granted to AdventHealth. 

“By denying Mission a CON for the Mission Application, the Agency’s Decision prevents Mission from expanding Mission Hospital to meet the needs of Mission’s existing and future patients and therefore directly limits Mission’s ability to engage in its lawful business,” the appeal said.

AdventHealth did not mention the 26 beds in its release.

“The 26-bed approval is currently under appeal by a competitor,” AdventHealth spokesperson Victoria Dunkle said Tuesday. “That appeal is being reviewed through the Office of Administrative Hearings. Despite this delay, we remain steadfast in our commitment to bring these 93 beds — and the whole-person care they represent — to the people of Western North Carolina. We are confident that the State’s original decision will be upheld, and we continue to prepare to deliver on that promise.” 

An effort to repeal CON laws, Senate Bill 370, made headway in the General Assembly this April. But that effort may be overshadowed by a 2020 lawsuit brought by a New Bern vision physician, Jay Singleton, in the state’s Supreme Court, arguing the multilayered application process “has nothing to do with protecting the health or safety of real patients.”

Currently, 34 other states have similar CON laws.

“Proponents of CON laws contend that if excess health care service capacity exists, price inflation may occur to compensate for new, underused health care services or empty beds,” according to a summary by the National Conference of State Legislators. “Opponents believe CON laws stifle competition by protecting incumbent providers and creating a burdensome approval process for establishing new facilities and services.” 

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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 arjones@avlwatchdog.org. The Watchdog’s local reporting is made possible by donations from the community. To show your support for this vital public service go to avlwatchdog.org/support-our-publication/.

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