T he Triad’s three major healthcare systems spread their wings in a monumental way in 2024. It would become the driving force during a 2024 focused on expansion initiatives. The Winston-Salem Journal’s top healthcare story for 2024 was Atrium Health Wake Forest Baptist making good on a pledge to open a community hospital in Greensboro. Cone Health, on its second try, fulfilled its quest to become part of a larger healthcare system by being acquired by Risant Health of Washington, D.C., gaining a $1.7 billion capital investment commitment. Novant Health Inc. bought 53 acres in northwest Greensboro for an undisclosed purpose, took several steps toward becoming a major healthcare provider in South Carolina, and had its second bid to establish an Asheville foothold rejected by state regulators. A precedent-setting medical debt relief program, with a major Winston-Salem origin component, is set to take flight Jan. 1 in the state.
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Rounding out the top-five is N.C. reaching more than 600,000 Medicaid expansion enrollees just more than a year after its Dec. 1, 2023, launch.
Baptist gets Greensboro hospital OK
The overlapping of healthcare services involving Baptist, Cone and Novant reached an elevated competitive level in August when Baptist secured in state regulatory approval for a $262.8 million, 36-bed hospital off Horse Pen Creek Road in an affluent section of northwest Greensboro. With the hospital having a Jan. 1, 2029, debut date, and counting a $163 million medical office building set to open in 2026, Baptist is spending $426 million in an attempt to wrest market share from Cone. “Atrium Health Wake Forest Baptist continues to serve thousands of patients in Greensboro, and we are committed to growing in Guilford County and offering more convenient and high-quality health care choices for our community, close to home,” said Dr. David Zaas, Baptist’s president. Atrium, Baptist and Cone engaged in public displays of disagreements over plans for the planned Greensboro Medical Center, including at an N.C. Division of Health Service Regulation public hearing. Cone stated its opposition in full-page ads in the News & Record and Winston-Salem Journal. It asked state health regulators to deny Baptist’s application, in part because the planned hospital is about 2.1 miles from Cone’s MedCenter Greensboro facility. “Overlapping services and facilities concentrated in certain pockets of our communities only amplify already pronounced health care disparities,” Cone said in the ad. “Let’s not confuse entering a market with ‘investing in a community.’” The concessions that paved the way for the Baptist hospital may never be revealed to the public because of a confidentiality agreement reached between Cone, Baptist and High Point Regional Health System. Cone said that “both organizations agree that this decision is in best interest of all parties involved.” Tony Plath, a retired finance professor at UNC Charlotte, said there are pros and cons with the settlement since “it promotes healthcare competition in Greensboro, and anything that promotes industry competition is good for consumers and healthcare costs.” But Plath called Atrium Health the “healthcare gorilla” in the Triad as part of the third-largest not-for-profit healthcare system in the country. “Probably sooner than later, Atrium’s going to develop a major urban medical center in that (Greensboro) market, not just a community hospital.”
Cone rising with Risant
Cone’s multiyear quest to become part of a larger healthcare system was fulfilled in December when it became the largest subsidiary of Risant Health — a startup nonprofit charitable group. Cone serves about 500,000 patients. It has more than 13,000 employees, more than 700 physicians, 1,800 partner physicians and four acute-care hospitals. Cone retains — as pledged — its brand, name and mission, and maintains its own board, chief executive and leadership team. Dr. Mary Jo Cagle, Cone’s president and chief executive,
said in a June interview with the News & Record that she feels the need to explain what value-based care means to Cone “since the term gets tossed around a lot” and is a critical component of the decision. “It means high-quality care at lower costs, going away from the fee-for-service model where you pay for every little thing you get,” Cagle said. “You pay one global fee, and we keep you healthy through preventive care and a focus on wellness than sick care. Cagle said Risant’s financial commitment will make it more feasible for Cone to expand its operational presence in Alamance, Forsyth, Randolph and Rockingham counties, as well as potentially enter Stokes County. System officials “know bigger is not always better,” Cagle said. “The reason to do any merger would be if it brings benefits to the community that they would otherwise not have.” “Our missions and strategies were aligned, and Risant is able to bring to us tools that helped us accelerate our vision on health equity and increased access for all, while working toward lowering the cost of health care.”
Novant’s expansion bids
Speaking of the Greensboro healthcare sector, Novant added to the intrigue on Dec. 17 with its $16.5 million purchase of a combined 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 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 Wednesday that it “continually analyzes and seeks opportunities to ensure we can meet the future health care needs of the communities we serve. This includes investing in property, such as this purchase in Guilford County.” Meanwhile, Novant’s goal is having a major healthcare facility presence in three of South Carolina’s five major metro areas including purchasing market share in Charleston and Myrtle Beach, and acquiring land in Greenville. In that pursuit, Novant completed in February its $2.4 billion purchase of Hilton Head Hospital, Coastal Carolina Hospital in Hardeeville, S.C., and East Cooper Medical Center in Mount Pleasant, S.C. By comparison, Novant paid $5.3 billion in January 2021 to purchase New Hanover Regional Medical Center of Wilmington. However, state health regulators denied for the second time in December Novant’s bid for a community hospital in the Asheville market. Novant is awaiting regulators’ answer in 2025 about its certificate-of-need application for a 36-bed, $286.94 million Knightdale Medical Center in the Raleigh suburb.
Precedent-setting medical debt relief
North Carolina will commence on Jan. 1 a landmark patient medical debt relief initiative in which the state’s 99 hospitals have agreed to eliminate $4 billion in medical debt owed by an estimated 2 million low- and middle-income households. The agreement, announced in August, has hospitals forgiving more than a decade of existing medical debt for eligible North Carolinians and prevent the accumulation of new debt going forward. Past medical debt that exceeds 5% of a person’s annual income will be relieved. In exchange, hospitals receive higher levels of Medicaid reimbursement under the federal Healthcare Access and Stabilization Program (HASP). Baptist, Cone and Forsyth Medical Center are projected to receive a combined $2.8 billion. By Jan. 1, patients who are enrolled in such programs as WIC, SNAP and Medicaid, or who are experiencing homelessness, will automatically qualify for charity care. By July 1, hospitals will forgive past debt of individuals on Medicaid and will also have policies in place to ensure medical debt does not impact a person’s credit rating. The N.C. Department of Health and Human Services has partnered with Undue Medical Debt to support participating hospitals and help them identify medical debt that is eligible for relief. The medical debt of eligible patients will be adjusted automatically. No application or additional information is required from patients. Eligible patients will receive a letter from Undue Medical Debt when qualifying medical debts are relieved as part of the initiative. Gov. Roy Cooper’s hands-on push for the medical debt initiative with the state’s hospitals included a July 23 roundtable at Trinity Moravian Church in Winston-Salem to discuss and praise the congregation’s remarkable efforts at relieving medical debt through the Debt Jubilee Project. “Medical debt is not a choice, and it’s monumental to have North Carolina hospitals committing to be part of eliminating medical debt for their patients,” Cooper said.
600,000 and counting
North Carolina ends 2024 with more than 600,000 new Medicaid enrollees — a heartening vindication of an 11-year public-health expansion quest that overcame stiff Republican legislative leadership resistance once led by Senate leader Phil Berger. North Carolina became the 40th expansion state on Dec. 1, 2023, with an initial goal of reaching 600,000 by late 2025. Cooper called surpassing the threshold “a monumental achievement for North Carolina. Now, more than 600,000 people have the peace of mind that they can go to the doctor, get needed medications and manage their chronic health conditions — that’s life-changing.” About 278,000 were enrolled automatically through their participation in the state Medicaid’s limited Family Planning program. Altogether, there are 3.04 million Medicaid enrollees in N.C. as of Dec. 16, or about 28% of the state’s 10.8 million residents. The turning point came in 2022 and 2023 when rural county commissioners, sheriffs and other elected and civic officials urged their Republican legislative representatives to approve expansion legislation. Berger became in 2022 a convert to the need for Medicaid expansion, particularly among the working poor, though Berger has made it clear his support was tied directly to certificate-of-need legislation in House Bill 76. As of Dec. 3, the 14 counties of the Triad and northwest N.C. have combined 108,308 enrollees, or 19% of the statewide total.
Waiting on a new home
Alexis Ratcliff, a 19-year-old ventilator-dependent quadriplegic, continues to reside in an adult ICU room at Atrium Health Wake Forest Baptist as she awaits a new home equipped to serve her health needs. Disability Rights NC, which represents Ratcliff, said Dec. 18 that her team “continues to work diligently to find her a home in the community. We hope to have an update about that in the new year.” Ratcliff’s story surfaced in March when Baptist officials told her she was being required to vacate her room or face trespassing charges. The system took the step of filing a lawsuit to expedite the removal. “So, you’re suing me? Believe me, I want to get out of Baptist, too, but it’s not my fault, and not my decision, to be here at age 18,” Ratcliff told the Journal. “It’s really stressed me out a lot.” After media reports, including by the Journal, on Ratcliff’s medical housing plight and advocacy work from Disability Rights NC led the system to voluntarily dismiss the lawsuit. Ratcliff, from Mount Airy, was severely injured in a car accident at 18 months old caused by her mother. She requires around-the-clock care. Both of her parents, who struggled with drug use, have died, including her mother in January 2024. Ratcliff has been in a Baptist ICU since January 2019 at either Brenner Children’s Hospital or in the adult ICU, other than a failed foster-care attempt between December 2021 and June 2022. Ratcliff was placed at Baptist as part of a court-ordered housing solution after family options could no longer meet her needs. She has been told that since she turned 18, she will not be re-admitted if she leaves the hospital — “there was no ‘maybe’ about it.” As a result, Ratcliff has not been outside the hospital for more than a year.
ProKidney’s pivotal 2025
ProKidney Corp. is headed into a pivotal 2025 for its research and corporate future. ProKidney, based in Winston-Salem, is a late clinical-stage cellular therapeutics company focused on chronic kidney disease. The company has 80 employees. On the research side, ProKidney officials continues to express confidence that the Food and Drug Administration will provide next year full regulatory approval for its leading treatment medicine rilparencel. If that FDA authorization comes, it would represent a major medical breakthrough for ProKidney, as well as validate its ambitious manufacturing plans. However, ProKidney appears to be hedging its expectations with its announcement in November it is spending $22.5 million in cash to purchase two industrial buildings West Point Business Park where it has been leasing space. ProKidney had not said how many jobs would be associated with the expansion. It is likely to be considerably smaller than the 330 jobs it pledged to create by the end of 2028 as part of a high-profile $458 million capital investment.in Greensboro. Meanwhile, ProKidney has put up for sale or lease
its 210,600-square-foot building at 7901 Indlea Point within 73 Business Center in Greensboro.
Maxing out minimum wage
Atrium Health Wake Forest Baptist, the largest private employer in the Triad at about 22,000, is increasing its minimum hourly wage by $1 to $18.50 on Jan. 12. The 6% pay raise is Baptist’s second minimum wage increase in a year following a $1 uptick that went into effect in January 2024. The latest Baptist increase means annual salaries for minimum-wage employees will go from $36,400 to $38,480. Baptist did not disclose how many employees will benefit from the hourly pay increase. Previous increases have affected nursing aides, medical assistants, pharmacy techs and environmental services technicians. By comparison, Cone Health has about 12,900 employees in the Triad and Novant Health Inc. about 9,000. Cone and Novant’s minimum wages are $17 an hour. By comparison, North Carolina’s minimum wage has been stuck at the federal minimum wage of $7.25 an hour since 2009. Cone’s minimum wage hike to $17 went into effect in January, benefiting more than 4,500 employees, or more than one-third of Cone’s more than 13,000 workforce. Counting unidentified pay increases for employees who make less than $22 an hour, Cone estimates its annual base salary expenses at $8 million.
Brenner under Levine umbrella
Atrium Health took in March another symbolic step in spreading its umbrella over Wake Forest Baptist Medical Center and Winston-Salem by attaching the Levine Children’s brand in front of Brenner Children’s Hospital. The official branding name is Atrium Health Levine Children’s Brenner Children’s Hospital. The branding change covered all Atrium pediatric care services within Georgia, North Carolina and South Carolina, such as outpatient facilities, primary care offices, emergency departments and specialty clinics. Atrium said the branding change represents reaching “a milestone within its children’s services.” Brenner Children’s Hospital and Health Service was established in 1986 through a gift from the Brenner family. In 2002, the children’s hospital moved into Ardmore Tower. Lynn Brenner Eisenberg said the Brenner family “is honored to be a part of Atrium Health Levine Children’s Hospital” in the system’s effort to enhance pediatric care. She said Brenner officials were the ones to inform the family of the branding change. “The Brenner family continues to support the amazing work of the team caring for children in this region. We’re excited about this growth and the future of care for generations to come. We’re all still involved and thrilled with what the children’s hospital has become.”
Gender-affirming coverage
The State Health Plan and about 550 North Carolinians are awaiting a decision from the U.S. Supreme Court on whether state health plans are required to cover gender-affirming healthcare services for members and their families. The SHP is North Carolina’s largest purchaser of medical and pharmaceutical services and is self-funded. It covers about 750,000 teachers, state employees, legislators, retirees and their dependents. The case of Kadel v. Folwell was filed in March 2019 by Lambda Legal and the Transgender Legal Defense & Education Fund on behalf of several current and former state employees and their children who were denied coverage for medically necessary care under the State Health Plan. The Fourth Circuit Court of Appeals’ order on April 29 upheld two lower court rulings
by an 8-6 margin with the voting along political lines . The 541 participants who get such care represent 0.007% of the overall membership. The plan’s 2023 expenditures for those beneficiaries through Nov. 30, 2023, was $1.5 million, compared with overall expenses of $3.7 billion. Outgoing state Treasurer Dale
Folwell’s 48-page petition was placed July 26 on the Supreme Court’s docket, likely because of the precedent-setting potential of a ruling.
According to a statement from Folwell , the SHP’s refusal to cover surgical and hormonal treatments related to the diagnosis of gender dysphoria dates back to the 1990s. Folwell has said the essence of his petition is whether a state’s decision to decline coverage for gender-affirming treatments violates the federal Equal Protection Clause. Folwell claims the State Health Plan’s attempt at coverage exclusion “does not discriminate on the basis of sex” and that the petition “is an excellent vehicle to resolve” the issue.
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