ASHEVILLE, N.C. (828newsNOW) — Four health systems made their case Wednesday for a share of 92 additional acute-care hospital beds that state officials say are needed in a five-county Western North Carolina service area.

The competing proposals could reshape health care in the region, with UNC Health, AdventHealth, Novant Health and HCA Healthcare’s Mission Hospital offering significantly different approaches to how the beds should be used.

The North Carolina Department of Health and Human Services held a public hearing Wednesday at Asheville-Buncombe Technical Community College’s Ferguson Auditorium. Dozens of residents, health care workers, elected officials and community leaders also spoke about their experiences with the region’s health care system and what they want to see in the future.

The 92-bed need determination covers Buncombe, Clay, Graham, Madison and Yancey counties, although all four applicants propose placing the beds in Buncombe County.

State officials are expected to make a decision through the Certificate of Need process after reviewing the competing applications, written comments and responses, and testimony from Wednesday’s hearing.

How the state will decide

The nearly full hearing drew about 80 people who signed up to speak, according to Greg Yakaboski, a project analyst with the North Carolina Department of Health and Human Services’ Division of Health Service Regulation.

Yakaboski answered several questions from community members before the presentations began, including questions about who will make the decision.

He said he is the project analyst responsible for evaluating all four applications. Gloria Hale, a team leader, is the co-signer on the project.

Yakaboski said he has been with the agency since 2008 and has handled more than 300 reviews.

The process includes reviewing the applications, written comments and responses, as well as comments made during Wednesday’s hearing, he said.

Each application first will be evaluated on its own, without comparing it with the other proposals. After those individual reviews are completed, the applications will undergo a competitive review against one another.

Yakaboski also said the review is governed by criteria established in the state’s Certificate of Need law and administrative rules.

Several people questioned whether such a small group should be responsible for a decision that could significantly affect health care in the region and asked how the process accounts for personal bias.

Yakaboski said he takes the responsibility seriously and stressed that the review is based on the full record and established criteria.

Each applicant received up to 15 minutes to present its proposal and respond to written comments. After public comments, each applicant will have up to five minutes to respond to comments made during the hearing.

Four very different proposals

UNC Health is seeking all 92 beds for a proposed hospital in Asheville near the former Westgate Shopping Center. UNC recently purchased the shopping center for nearly $20 million and has proposed a hospital offering emergency and intensive care, labor and delivery, neonatology, cardiology, psychiatry, radiology, rehabilitation and other services.

The proposed hospital is estimated to cost about $747.3 million and would be completed in July 2032, according to the application information presented for the hearing.

UNC supporters told state officials the project would bring another nonprofit academic health system into the region while building on UNC’s existing relationships with UNC Health Pardee and UNC School of Medicine at MAHEC.

Asheville Mayor Esther Manheimer urged approval of the UNC proposal, saying Western North Carolina needs more than additional beds.

“We need additional beds, but we also need different providers and a better model,” Manheimer said.

She said competition would give patients more choices and force hospital systems to be more responsive.

AdventHealth is seeking all 92 additional beds for its new hospital under construction in Weaverville. The first phase of the hospital is expected to open in late 2028, while the additional 92 beds are planned for 2030. If approved, the project would grow to 185 beds and include higher-acuity services, including trauma care.

The project is estimated to cost about $272.7 million.

AdventHealth supporters emphasized the hospital’s location and argued that a larger facility would provide a second tertiary-care option for residents of northern Buncombe, Madison, Yancey, Mitchell and other mountain counties.

“We need real choice,” Fian Arroyo, president of the Weaverville Business Association, told the state.

Arroyo said the hospital would also bring jobs and workforce-development opportunities to the region.

Novant Health is seeking 20 additional beds for its planned hospital in Arden. Novant was previously awarded 34 beds and is seeking to increase the project to 54 beds. The project is estimated to cost about $100.6 million and is expected to be completed in January 2031.

HCA Healthcare’s Mission Hospital is seeking all 92 beds to expand its existing Asheville hospital. The proposed expansion is estimated to cost about $66.8 million and would bring Mission’s total licensed acute-care beds to 774, based on the current application figures. The project is expected to be completed in January 2032.

Mission supporters and employees pointed to the hospital’s existing capabilities, while many members of the public used the hearing to criticize HCA’s operation of Mission and argue that the region needs greater competition.

Public testimony puts focus on access

The public testimony repeatedly returned to one question: What does access to health care look like for people who live outside Asheville?

Madison and Yancey county officials described long ambulance trips to Asheville, traffic congestion and the difficulty of keeping emergency crews available while patients are transported or transferred.

Madison County commissioner Alan Wyatt said an ambulance recently had to fly a patient to Asheville because of concerns about traffic and the need to get the patient to a hospital quickly.

“It’s a family,” Wyatt said, arguing that distance affects not only patients but spouses, children and other caregivers.

Western Carolina University Chancellor Kelli Brown supported UNC Health’s proposal, saying a major obstacle to expanding the region’s health care workforce is a shortage of clinical training sites.

A new hospital, she said, could provide training opportunities for nurses, physical therapists, social workers and other health professionals and create employment pathways for graduates to remain in Western North Carolina.

AdventHealth supporters made a similar workforce argument, but emphasized the need for a larger tertiary-care hospital in the northern part of the service area.

Yancey County EMS Director Kristy Bryant said rural communities need another hospital with the capacity to handle complex cases rather than simply adding smaller facilities.

“The question before this committee is not whether Mission should improve,” Bryant said. “The question is whether the people of Western North Carolina can afford to wait for them.”

Mission faces sharp criticism

Much of the public testimony focused on Mission Hospital.

Speakers described personal experiences involving hospital care, referrals, emergency department waits and specialty services. Several cited regulatory findings involving Mission as evidence that the region needs another hospital system.

Those comments were countered by at least some testimony praising Mission employees.

Gail Webb, who said she was invited to speak by Mission, described a positive experience while undergoing a heart CT scan. She said employees helped her navigate the hospital and treated her with kindness when she was stressed and running late.

“I left … with gratitude and a smile,” Webb said.

The competing applications come as Western North Carolina’s health care system continues to adjust after HCA’s 2019 acquisition of Mission Health and amid years of debate over whether the region needs additional hospital competition.

The state previously awarded 129 additional beds in the same broader service area. AdventHealth received approval for a 67-bed hospital in Weaverville, while Novant received approval for a 34-bed hospital in Arden. Mission received the remaining beds in that earlier process.

Now, state officials must determine how the additional 92 beds identified in the 2026 State Medical Facilities Plan should be allocated.

The decision could determine whether the region gets another large tertiary-care hospital, a new academic hospital in Asheville, an expanded Novant facility or additional capacity at Mission.