Cone Health expands westward amid Triad hospital turf battle

Cone Health filed a certificate-of-need application for a new $320 million hospital in Forsyth County, the latest move in a Triad hospital turf battle that has sharpened since Atrium Health Wake Forest Baptist won Greensboro approval for a $246 million hospital in August 2023.

The Greensboro-based system said it would appeal that decision and argued that state regulators had acted “arbitrarily and capriciously.” Cone Health also said the proposed Atrium hospital would become a key path for patients who need more than routine care to reach Winston-Salem, a direct challenge to how the region’s highest-acuity patients are funneled between the two systems.

Atrium Health Wake Forest Baptist, based in Winston-Salem, has not been standing still in Guilford County. The system announced an additional $163 million investment in Greensboro for a five-story outpatient surgery center, a medical office building and a cancer center at 2909 Horse Pen Creek Rd, building on a footprint that began with its first Greensboro clinic in 2006. State approval for the Greensboro hospital required Atrium to begin operations at the Greensboro Medical Center by July 2026.

Cone’s new Forsyth County proposal pushes the fight in the opposite direction. Coverage of the filing described the project as a 56-bed hospital in southeast Forsyth County, a move that would extend Cone’s Triad operations into an area where rivals already have a stronger hold. Novant Health also weighed in during the Greensboro review with written opposition, underscoring how closely the region’s other systems are watching the same corridor of growth.

This is more than a single building race. The real contest is over patient referrals, physician recruitment, employer contracts and insurer leverage, all of which follow where the biggest systems put their money. If Cone keeps expanding west while Atrium keeps pouring capital into Greensboro, Guilford County could end up with more facilities and more jobs, but also with a deeper pull of talent and investment toward competing county lines.