Durham, N.C.-based Duke Health is pushing into the competitive Charlotte, N.C., market, as Charlotte-based Atrium Health and Winston-Salem, N.C.-based Novant Health move to defend their ground.
Duke Health and Gastonia, N.C.-based CaroMont Health shared plans Oct. 14 to form a partnership to develop two hospitals in Mecklenburg County: a 120-bed hospital in University City and an 80-bed hospital in the River District. The 200 beds would address part of the 389 additional beds identified as needed in the county by the 2026 North Carolina State Medical Facilities Plan.
“The rapidly growing Charlotte region needs more access to care and more options for the highest quality care locally,” Duke University Health System CEO David Zaas, MD, said in the news release.
Duke is not alone in going after those beds. Mecklenburg County drew 10 competing certificate of need applications Oct. 14-15, according to the state’s application log for Nov. 1 reviews. Together they seek 686 acute care beds, nearly 300 more than the plan says the county needs. The proposed capital expenditures total about $2.35 billion.
Atrium filed for 270 beds across five projects:
- Atrium Health University City: 88 beds, $154.8 million
- Atrium Health Lake Norman: 76 beds, $257.3 million
- Carolinas Medical Center: 44 beds, $52.9 million
- Atrium Health Pineville: 36 beds, $56.4 million
- Atrium Health Steele Creek: 26 beds, through a change of scope, $47.4 million
Novant filed for 216 beds:
- Novant Health Presbyterian Medical Center: 150 beds, $200.6 million
- Novant Health Mountain Island Medical Center: a new 36-bed hospital, $364.1 million
- Novant Health Huntersville Medical Center: 30 beds, $25.3 million
The two Duke CaroMont hospitals carry the largest price tags, at $692.1 million for the 120-bed hospital and $500.6 million for the 80-bed hospital. Written comments on the applications are due Dec. 1.
Atrium and Novant have long competed over growth in the region. In April 2025, regulators approved Atrium’s request to increase its bed count and denied a bid from Novant. The rivalry extends into neighboring Union County, where Atrium filed for 93 more beds and Novant for 32.
The race comes as several North Carolina systems pursue new hospitals in a growing state. In June, four systems filed applications for five new hospitals across the state in three days. The North Carolina Hospital Association told Becker’s at that time that the demand is simple: The state has one of the fastest-growing populations in the country, and healthcare infrastructure has to keep up.
Charlotte leads the nation in numeric population growth, gaining 20,731 residents between July 2024 and July 2025. North Carolina was the third-fastest-growing state overall, at 1.3% growth, even as overall U.S. population growth slowed to its most sluggish pace since 2021.
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