Two health care systems in the Cape Fear region submitted applications days apart, seeking the state’s permission to build new hospitals targeting an overlapping service area.
Planned 7 miles apart straddling the Columbus and Brunswick County border along U.S. 74, it’s not clear whether health officials were aware of each other’s competing plans before submitting them to regulators.
A big question will likely be whether there’s room in the market for both.
Both proposals from the health care operators, Novant Health and Columbus Regional, rely on the same basic premise: A new community hospital along the U.S. 74 corridor would be more convenient for the growing Leland area and could reduce crowding at Novant Health New Hanover Regional Medical Center in Wilmington.
The proposals are similar in scale and scope. Columbus Regional’s $215 million plans include demolishing the former Acme-Delco Middle School and building a three-story hospital campus with 30 beds. Novant Health’s $251 million proposal would build a two-story, 20-bed facility off Fawnbrook Way. Both pitches include emergency rooms and surgical services.
Securing permission to open a new hospital can be difficult, given a rigid regulatory environment. Under North Carolina’s Certificate of Need (CON) law, regulators scrutinize applicants’ plans when determining whether certain health care proposals are cost-effective and necessary, and weigh utilization data of existing resources.
State health officials say the rules are necessary to protect underserved areas and prevent duplicitous and costly services. Meanwhile, some industry experts argue the process is overly burdensome and anticompetitive. In a 2020 literature review, a Duke University researcher concluded that the costs of Certificate of Need laws tend to outweigh the benefits.
Hannah Jones, a spokesperson for the North Carolina Department of Health and Human Services, the agency tasked with reviewing Certificate of Need applications, didn’t address questions about the specific proposals, but said regulators have between 90 and 150 days to review applications.
Both systems propose relocating existing beds to the new facilities. Laurie Whalin, president of Novant Health New Hanover Regional Medical Center, said that while some Certificate of Need applicants vie for the same resources by asking to add new beds, its application for the Leland hospital would repurpose its existing resources in Bolivia to meet patient needs. “We’ve long had plans to build a hospital in Leland to bring care closer to home,” she said.
A spokesperson for Columbus Regional said the system does not comment on pending applications. In a news release, the system said the project “responds to dramatic population shifts reshaping the region.”
Novant has comparatively deep pockets and operates a sprawling health care network across the Carolinas and Virginia. In the Wilmington area, Novant owns New Hanover Regional Medical Center and New Hanover Orthopedic Hospital. It is currently building a 66-bed hospital in Scott’s Hill that will connect to an existing emergency department. Novant also operates Brunswick Medical Center in Bolivia and Pender Medical Center in Burgaw.
Columbus Regional, which is managed by the Charlotte-based health care giant Atrium Health, has a 154-bed hospital in Whiteville and entered the Leland market in 2021 with four new clinics.
Most Brunswick County residents travel to New Hanover for emergency services and critical care needs. “One of the goals of this project is to treat more Brunswick County residents, especially lower acuity patients,” Novant cited in its October 7 application.
In 2024, New Hanover Regional Medical Center’s occupancy rate was above 90 percent, and it has exceeded state occupancy averages for the past six years. Emergency department visits grew 17 percent between 2020 and 2024, averaging 241 patients a day. Novant says a new Leland hospital would allow its main Wilmington campus to operate more “efficiently and effectively.”
Columbus Regional agrees.
“A lack of facilities west of the US 17 corridor has created a critical mass of residents who must depend on hospitals that are too distant and/or too crowded to reliably meet their needs,” Columbus Regional wrote in its application submitted October 15.
Citing “relentless suburban sprawl” and traffic congestion, Columbus Regional presents itself as the “most logical and most immediate” solution to address the urgent healthcare needs in the area. “For Leland residents, the new Delco hospital campus could be reached in roughly the same time as the Wilmington hospital, without the stress of dealing with Wilmington’s unpredictable traffic,” the proposal states.
Columbus Regional’s targeted service area between Whiteville and Wilmington includes an underserved population with distinctive needs. This “orphan region,” as the hospital describes it, includes working families and less affluent retirees who are relatively better off than most Columbus County residents but worse off than most Brunswick County residents.
To bolster its case, Columbus Regional also highlighted critiques of Novant Health. The health care system cited Novant’s reputational challenges, including overcrowding and low patient satisfaction.
In addition to the Leland plans, Novant is on an apparent expansion blitz across the state: It also submitted proposals to build freestanding emergency departments in Carolina Shores and Cornelius, and community hospitals in Asheville and Union County.
Whalin of Novant said its existing Brunswick County hospital in Bolivia is also growing, including adding MRI capacity and a new cardiac catheterization lab. “Our plans for Leland and Brunswick County more broadly are holistic—we’re focused on how to best advance care throughout the county,” she said. “We continue to explore opportunities to grow and tailor care to each community’s needs.”