Triad's Big 3 healthcare systems scrambling to fill Forsyth hospital beds need

State regulators' determination that Forsyth County needs an additional 103 acute-care hospital beds to fill a service gap has created a unique competition for the Triad's three not-for-profit healthcare systems.

The last time that the annual State Medical Facilities Plan identified any hospital bed shortage in Forsyth, George W. Bush was president, the Indianapolis Colts won Super Bowl XLI, the Boston Red Sox swept the World Series and The Departed received the Oscar for Best Picture.

That would be 2007 with 26 beds. The last hospital to open in Forsyth was Clemmons Medical Center in April 2013.

The rare expansion opportunity spurred Cone Health and Novant Health Inc. to not wait for the N.C. Division of Health Service Regulation to post their certificate-of-need applications by July 1.

Instead, Cone and Novant declared their intentions on the filing deadline day of June 15.

Cone has applied for permission to open a $320-million, 56-bed hospital near the Northern Beltway in southeast Forsyth.

Meanwhile, Novant confirmed it is requesting adding 63 beds to Forsyth Medical Center and 40 beds to Kernersville Medical Center. Novant has not disclosed a capital investment projection.

"If approved, these additional beds will strengthen our ability to meet increasing demand, support our care teams and provide more patients with high-quality care closer to home," Novant said.

Atrium Health Wake Forest Baptist has not responded when asked if it has plans to pursue any or all of the 103 beds.

Atrium Health did announce June 15 it has applied to build a community hospital in the Wilmington area where it would compete head-to-head with Novant's New Hanover Regional Medical Center.

Atrium did not disclose how many of the 225 additional beds that state regulators determined that New Hanover needs.

Atrium is not only competing with Novant for those New Hanover beds.

UNC Health declared in May it wants to open a 150-bed community hospital within an easy walk of Novant's 783-bed facility in Wilmington.

UNC Health said its proposed hospital also would serve residents in Brunswick and Pender counties.

How it works

The state's certificate-of-need process is designed to prevent duplication of healthcare infrastructure and services in a county or metro area.

The primary factor in the N.C. Division of Health Service Regulation's hospital bed evaluation is whether there has been enough population growth to warrant expansion.

The lack of the need over the past 19 years is a sign that Forsyth's population growth has been slower than its metro peers.

It's also a sign the Forsyth market has been adequately supplied by Forsyth Medical Center having 842 licensed beds and Baptist at 727.

Regulators typically take between six months to a year to review and decide on which healthcare systems are awarded the requested beds. In many instances, the system that is denied files an appeal that also can take months to resolve.

Typically, an existing hospital in the market will be approved to add beds.

But occasionally, regulators will decide that a new entrant will bring competition through a new community hospital representing a nine-figure capital investment.

For example, regulators approved in April Novant's application for a 34-bed Asheville Medical Center to compete with Mission Health and AdventHealth.

Cone's expansion plans

Cone has proposed building a 198,593-square-foot hospital on an undeveloped 59-acre site listed as 0 Cole Road. The property is west of Interstate 74 and U.S 311, where it connects with the beltway.

The property, valued at nearly $3 million, is owned by Bristle Investment Co. of Cary, according to a Forsyth Register of Deeds filing. Cone said the property is under a non-binding letter of intent contingent on the project being approved.

"We have been a part of Forsyth County since we opened MedCenter Kernersville in 2008," Chris Cornue, Cone's chief strategy officer, said in a news release. "I am excited as we build on that foundation."

The proposed hospital would have 18 emergency department bays; four procedure rooms built to operating room standards; 10 observation beds; imaging; pharmacy; and intensive care beds.

Cone said the proposed hospital represents "expanding its brand of value-based care to consumers in Forsyth where it plans to serve residents in east Winston-Salem, Kernersville, Rural Hall, King and High Point.

"We believe in community-centered care," Cone chief executive Dr. Paul Krakovitz said. "That means being there not only to help people stay well, but also to provide excellent, compassionate care where and when it's needed most.

"This community is ready for that next level of care, and Cone Health is proud to deliver it close to home."

Melissa Shearer, Cone's vice president of strategy, said the planned hospital site off the Northern Beltway "meets that accessible goal in a convenient location from multiple roadways."

"We're basing the need for our hospital on ZIP codes, even down into Davidson County, rather than a specific radius.

"The State Medical Facilities Plan's determination that 103 new beds were needed just gave us an opportunity to expand our ecosystem that's been in Forsyth since 2005 in a full-service manner, rather than just outpatient services."

Atrium eyes Raleigh, Wilmington

Although Baptist is being tight-lipped about whether it is pursuing additional beds in Forsyth, Atrium is not being shy about its ambitions to create a major presence in the Triangle and Wilmington.

Atrium's bid to acquire WakeMed - highlighted by a $2 billion capital investment pledge - has rocked the state's healthcare sector since they disclosed their agreement on May 1.

Although Atrium and WakeMed had been in talks for at least two years, the announcement of the proposed deal surprised WakeMed's workforce, Raleigh Mayor Janet Cowell, much of the state's healthcare sector, Gov. Josh Stein, state Treasurer Brad Briner and state Auditor Dave Boliek.

Wake County Board of Commissioners, which has oversight over WakeMed, voted May 5 to approve a 90-day pause on considering whether to grant approval of the transaction in order to give the Raleigh community time to received feedback from Atrium and WakeMed on the value of their combination.

When it comes to entering the Wilmington market, Atrium said "the need is both well documented and urgent."

"The Wilmington area was named the seventh fastest-growing metro region in the nation from 2024 to 2025, having added more than 75,000 new residents in recent years.

"Despite that growth, the region continues to rely on a single hospital operating at more than 92% occupancy."

Steve Smoot, president of the North Carolina and Georgia division at Advocate Health, said the Wilmington area "has only one hospital and not enough doctors."

"We're ready to deepen our commitment by bringing a hospital, primary care and specialty care this community deserves."

Atrium's Greensboro plans

Atrium and Baptist have been expanding rapidly into Cone's home market, including a projected Jan. 1, 2029, opening for a $262.8 million, 36-bed hospital on the 2909 Horse Pen Creek Road site.

For regulatory purposes, the 36 beds are part of High Point Medical Center. The proposed Baptist-affiliated hospital would be about 2.1 miles from Cone's MedCenter Greensboro facility.

Including a planned $163 million medical office building, Baptist has increased the capital investment for the planned Greensboro Medical Center to more than $426 million. Baptist will employ 152 when all operations are at capacity.

The first phase is an outpatient surgery center, a multispecialty medical office building, and a cancer center, scheduled to open later this year.

The 134,000-square-foot, five-story building will feature specialty clinics in cardiology, gastroenterology, general surgery and orthopedics. The facility will also offer imaging, pharmacy, physical therapy and other services.

In March, state regulators gave conditional approval for Baptist to open two 24/7 freestanding emergency departments in Greensboro at 3800 N. Church St., and 4007 S. Elm-Eugene St.

The planned emergency departments also would operate under the High Point Medical Center umbrella.

Construction on both is projected to begin by July 1. Both are projected to open by Jan. 1, 2028.

Each facility would feature eight exam rooms, two patient observation rooms, a CT scanner, a separate fixed and a mobile X-ray unit, two mobile ultrasound units, emergency laboratory and pharmacy services, and family waiting areas.

Novant's expansion bid

Atrium is not alone in expanding in Greensboro.

In December 2024, Novant Health Inc. spent $16.5 million for 53 acres near Interstate 840 and U.S. 220.

The undeveloped properties are a 29.38-acre tract at 4319 Four Farms Road and an adjacent 24.04-acre tract at 4315 Willow Rock Lane.

The two Novant properties are located between Cone Health's MedCenter campus at 3518 Drawbridge Parkway and the planned $426 million Atrium Health Wake Forest Baptist campus at 2909 Horse Pen Creek Road.

Novant said in a statement that it "continually analyzes and seeks opportunities to ensure we can meet the future healthcare needs of the communities we serve. This includes investing in property, such as this purchase in Guilford County.

"At this time, we do not have detailed plans to share about the use of the land, but will update the community as details develop."

Novant has several offices in Greensboro, including 3515 W. Market St., 1622 Highwoods Blvd. and 1941 New Garden Road.

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This story was originally published June 20, 2026 at 5:41 AM.