2019 North Carolina's Best Hospitals.

Our annual hospitals report dives into the data to determine which medical centers are most successful at their fundamental goal: providing quality care for patients. The result is Business North Carolina's 2019 Best Hospitals list.

The list is calculated by the hospitals' performance in 25 metrics, including information provided by the U.S. Centers for Medicare if Medicaid Services. We examine patient-satisfaction surveys, rates of commonly acquired hospital infections, and readmission and death rates for common procedures. Also considered are safety report cards from The Leapfrog Group, a Washington, D.C.-based nonprofit, and ratings from insurer Blue Cross and Blue Shield and U.S. News & World Report. We rank the state's adult, acute-care medical centers with at least 50 beds, excluding specialty and psychiatric hospitals.

While the top two performers on this year's list employ a combined 18,000 people and include about 1,500 beds, the list shows that being part of a large, multihospital system isn't a requirement to perform at a high level. In four of the last five years, CarolinaEast Medical Center in New Bern has landed in the top five, while CaroMont Regional Medical Center in Gastonia has appeared three times.

"You can't find a hospital this size in the state with the sophistication and breadth of services that we have," says CarolinaEast CEO Ray Leggett III. But with rising health care costs and increased consolidation, how much longer will the state's independent health care systems be able to stand on their own?

"Right now, we've been successful enough clinically, operationally and financially. We're a strong organization," says Leggett, who has worked at the New Bern medical center for nearly three decades, including 10 years as CEO. "I have seen health care change so much over the last 28 years. Who the heck knows in five to 10 years?"

01 (TIE) CONE HEALTH (1) GREENSBORO

BEDS: 802 | 2018 RANK: 4 | CEO: TERRY AKIN

Cone has expanded from its flagship Moses H. Cone Memorial Hospital, which opened in 1953, to a six-hospital system that employs about 12,000 people. Recent investments include the $100 million, 196,000-square-foot Cone Health Women's and Children's Center, expected to open later this year at Cone Hospital's main campus. Cone's Triad Healthcare Network ranks among the top-performing Medicare accountable care organizations in the U.S., according to federal data. Launched in 2012, the network of about 2,000 providers deploys health care professionals to monitor patients after surgeries and other procedures, yielding fewer return visits.

Cone faces increasing competition from larger Winston-Salem-based Novant Health and Wake Forest Baptist Health as the systems jockey in the Triad, which lacks the explosive growth of Charlotte and the Triangle.

01 (TIE) UNC REX HEALTHCARE RALEIGH

BEDS: 660 | 2018 RANK: 2 | PRESIDENT: STEVE BURRISS

It's been three years since UNC Health Care changed the name of its Raleigh health system to UNC Rex Healthcare, 15 years after purchasing the not-for-profit organization. Since then, the university-led system has shown an innovative, growth-minded strategy. In 2012, it launched Rex Health Ventures, one of the nation's first venture-capital funds run by a community hospital. It has made about a dozen investments. Construction will start this spring on a $65 million cancer center that is expected to open by early 2021, more than doubling space dedicated to cancer care.

UNC Rex faces nimble Triangle-based competitors in WakeMed and Duke University Health as the region's rapid population growth provides a steady stream of potential new customers.

03 MISSION HOSPITAL ASHEVILLE

BEDS: 730 | 2018 RANK: 1 | PRESIDENT: JILL HOGGARD GREEN

Mission gained muscle after Nashville, Tenn.-based HCA Healthcare completed its $1.5 billion purchase of the 12,000-employee system last month. HCA, a publicly traded company with 2018 revenue of $46.7 billion, plans to build a 120-bed behavioral health hospital in Asheville, replace the aging Angel Medical Center in Franklin, complete the build-out of a $400 million medical tower already under...