By Michelle Crouch and Rose Hoban
When WakeMed Health & Hospitals board members were first approached by Charlotte-based Atrium Health about combining forces two years ago, they weren’t sold on the idea.
But after two years of review and study — including bringing in an outside consultant to evaluate the deal — they changed their minds, WakeMed Board Chair Thad McDonald told Wake County commissioners on Monday.
“I am acutely aware of the angst this announcement has caused with staff, with community leaders and patients,” he said during the public comment period of the commissioners’ board meeting. “When first presented with the possibility, our executive committee felt the same. But after two years of due diligence, we came to see the pure beauty of it.”
When the news broke Friday that the Wake County hospital system was planning to combine with Atrium, the largest hospital system in the state, it produced a flurry of strong reactions from local and state leaders. They expressed concerns about higher health care costs, transparency and the speed of the deal.
In response, the Wake County Board of Commissioners — who have the power to approve or nix the proposed changes to WakeMed’s articles of incorporation — voted Monday to delay a planned vote for 90 days. Reading from a prepared statement, Wake Commissioner Chairman Don Mial said the board wanted to give WakeMed more time to share details and engage with the community.
WakeMed leaders wasted little time in mounting an offense, holding a news conference Tuesday morning in a room full of reporters ready to grill them on the details.
They said the hospital system has enough capital to function, but to meet the needs of the fast-growing Wake County community and to compete with nearby UNC Health and Duke Health, they need more resources. Atrium has pledged to invest $2 billion in Wake County as part of the deal.
WakeMed CEO Donald Gintzig said the hospital needs Atrium’s resources to rebuild the hospital’s aging flagship campus on New Bern Avenue and to build a mental health hospital in Garner, a fast-growing Wake County bedroom community.
“There are people that are making comments without knowing all the facts,” Gintzig told reporters. “I hope to clarify that for you all, because at the end of the day, when we tell our story, I hope and pray that you will see the wisdom of what we’re trying to do, not for today, but for five, 10 and 15 years.”
A marriage, not a merger?
Atrium is not buying WakeMed; no money will change hands. Nor is it a merger, per se, and Gintzig was adamant that it was not a takeover.The shape of the deal has prompted confusion and generated multiple questions.
Gintzig compared it to a marriage.
“We’re creating a family,” he said. “And that part of that family is committing to help invest into the community, but they’re not buying us. They’re committing. We are willfully under our choice going into this. And so, you know, it’s a little nuanced in that.
“If we were for sale, somebody would buy us, and then they’d own us. This is us choosing to be part of this family.”
As a county-chartered hospital authority, Atrium is prohibited by state law from expanding more than 10 miles beyond Mecklenburg County unless it partners with an existing local hospital. So it has pursued growth by “combining” with other systems, including Wake Forest Baptist in Winston-Salem.
Atrium faces no such legal restrictions out of state, and in recent years it has acquired Navicent Health in northern Georgia and combined with Midwest-based Advocate Aurora Health. Those moves have made Atrium part of the third largest nonprofit hospital chain in the U.S., Advocate Health, which had $39 billion in revenue in 2025.
Making the case for the deal
Gintzig touted what he said were the benefits of the WakeMed deal: greater purchasing power when buying supplies, more advanced specialty care and mental health services, up to 3,300 new health care jobs and financial support for building a patient tower on the Raleigh campus and a facility in Garner.
When asked if he saw WakeMed closing without the strategic combination, Gintzig said no.
“Do I see it starting a spiral of not being able to add the technology and the facilities and the people, particularly at the Raleigh campus? Yes,” he said. “It’s expensive, and you’re going to invest in redoing a place to keep the same revenue, right? So that’s the challenge.
“If we had a tower… it’s new patients and new revenue,” he said. “When we’re moved forward with the Garner campus, it’s new patients and new revenue.”
Leaders of both hospitals said the two organizations have similar values with a focus on closing health care equity gaps.
Once the hospitals join forces, they said, WakeMed will be able to offer financial assistance to families that earn up to 400 percent of the federal poverty level, matching Atrium’s current policy and more generous than WakeMed’s current policy.
“Anyone below 300 percent of the poverty level won’t even get a bill,” said Steve Smoot, Advocate’s division president for North Carolina and Georgia. That would mean that a family of three earning up to $81,960 a year would be eligible for unbilled care.
Concerns about costs, oversight
The deal calls for Atrium to serve as WakeMed’s “sole member,” meaning it would be the primary decision maker for the hospital’s day-to-day operations. There would be a board consisting of eight members chosen by the Wake County commissioners and six chosen by Atrium.
As the sole member, Atrium could remove any of those board members for reasons ranging from being “disruptive,” failing to “work reasonably, respectfully or collegially,” or for conduct that could reasonably be expected to be “detrimental to the reputation, mission or operations of, or cause economic harm to, the corporation,” according to the proposed articles of incorporation.
The proposal drew swift criticism after some of the details became public. Raleigh Mayor Janet Cowell called it “a raw deal.” State Auditor Dave Boelick called for “greater scrutiny” of the deal, and State Treasurer Brad Briner expressed concern that the combined power of WakeMed and Atrium would drive up the costs of the health insurance plan for state employees in two markets where many of them reside.
At the commissioners meeting, Josh Ward, a hospital-based physician who works at Duke Health, cited research showing that hospital consolidation almost always leads to higher health care prices and does not necessarily improve care.
“The bottom line is that consolidation in health care is bad for patients and health care workers alike,” he said. “This pattern across our state and country continues to drive up costs, worsen access to care and further puts workers at a disadvantage.”
Michael Rudd of Raleigh, a WakeMed patient, said he wanted to make sure the deal was structured to ensure accountability. “We would want to make sure that any merger of WakeMed with Atrium realizes the benefits that they’re promising,” he said. “What would we lose if it didn’t go well?”
Rudd suggested setting up the transaction so that there’s “an off-ramp, or a lookback period, or some kind of measurable success … I think (that) would be really important.”
More approvals still needed
If the Wake County commissioners approve the deal, it would still require review by the state attorney general and the Federal Trade Commission, which, under the Biden administration, had stepped up scrutiny of transactions involving hospitals in different markets.
Attorney General Jeff Jackson’s office said in an emailed statement that it planned to review the proposed transaction carefully.
“Our focus is on ensuring patients can continue to get high-quality healthcare they can afford, no matter where in the state they seek care,” the statement said.
And since the deal became better known last week, lawmakers in the General Assembly have filed several bills that would allow for more legislative scrutiny.
Senate Bill 978 would give the state auditor, attorney general and state treasurer new authority to review and potentially challenge major hospital transactions, while also adding whistleblower protections for healthcare workers, limiting hospital noncompete clauses and capping nonprofit hospital CEO pay at 400 times the lowest-paid full-time worker’s compensation. A different bill filed last week, Senate Bill 961, would reform how hospital authority commissioners function.
Whether those bills apply to the proposed WakeMed-Atrium combination depends on whether they clear the legislature before the deal is finalized.
Mial, the Wake County commissioners’ chair, said after Monday evening’s meeting that it’s up to WakeMed to convince the public during the 90-day pause.
“They must lead the charge on this, from the standpoint of making sure they are letting the people of Wake County know what this is about,” Mial said. “Because in order for them to move forward, if we don’t have the public support of this, it’s going to be a difficult task.”
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