"As Atrium Health executives received an average 21% pay raise in 2025, reaching millions for top leaders, questions intensify regarding the financial implications for patients and the broader healthcare landscape, particularly as the system seeks to merge with WakeMed."
The financial disclosures from Atrium Health reveal a notable increase in compensation for its top executives in 2025, with an average rise of 21 percent. This surge in executive pay, detailed in records shared with North Carolina Health News and The Charlotte Ledger, has occurred concurrently with Atrium’s pursuit of a significant combination with WakeMed Health & Hospitals, a Raleigh-based entity. The released figures highlight a compensation range for eleven executives from approximately $906,000 to $5.2 million. This trend in executive compensation is being closely examined by state officials, independent experts, and residents who are raising critical questions about how this potential merger will impact healthcare costs, patient choices, and the overall accessibility of care, especially for those in Wake County and the broader Triangle region. The focus on executive pay serves as a focal point for understanding the financial dynamics at play and the potential governance shifts that could occur if Atrium gains substantial control over WakeMed.
Atrium Health, a prominent Charlotte-based healthcare system, has reported record financial performance in 2025, with revenues reaching $14.1 billion and a surplus of $1.66 billion over expenses – a figure equivalent to profit for a non-profit organization, marking a 26 percent increase from the previous year. These impressive financial results, however, are being viewed through a critical lens as the system seeks regulatory and governmental approval for its proposed merger with WakeMed Health & Hospitals. The compensation data, made public through a joint effort by North Carolina Health News and The Charlotte Ledger, shows a substantial increase in pay for Atrium’s senior leadership.
Specifically, Chief Financial Officer Bradley Clark saw the most dramatic increase in his compensation, with an 83 percent rise that brought his earnings to $5.18 million. Atrium Health has previously articulated a strategy of offering competitive compensation to attract and retain executive talent capable of managing increasingly intricate and expansive hospital networks. This justification for high executive pay is being weighed against concerns about affordability and accessibility for patients, particularly in the context of the WakeMed merger.
Notably absent from the publicly released Atrium executive compensation report is Gene Woods, the CEO of Advocate Health, Atrium’s parent company. Woods’ 2024 compensation reportedly totaled $25.8 million, as indicated by Advocate’s tax filings. Atrium has clarified that Woods’ exclusion from the Atrium-specific report is due to his role as an executive of Advocate Health rather than directly with the Atrium hospital authority. The full extent of Woods’ 2025 compensation will become public knowledge once Advocate Health files its federal tax return, which is typically done in November.
The financial disparities and executive compensation trends are particularly relevant for patients in Wake County and the surrounding Triangle area. The proposed combination with WakeMed has ignited debate about its potential consequences, with particular emphasis on whether it will lead to increased healthcare costs or a reduction in patient choice. State officials, independent healthcare analysts, and community members are actively pressing for answers to these critical questions before any decision on the merger is finalized.
The financial backdrop against which these executive pay raises are occurring is one of robust revenue growth for Atrium Health. The reported $14.1 billion in revenue for 2025 and the $1.66 billion surplus represent significant financial success. It is important to note that these figures exclude the financial contributions from Wake Forest Baptist Health and the hospitals acquired in Illinois and Wisconsin, which were integrated into Advocate Health in 2022. This strong financial performance provides Atrium with a seemingly solid foundation, yet it also raises questions about the necessity and proportionality of executive compensation increases, especially when contrasted with the financial realities faced by many patients.
Among the executives for whom comparable 2024 figures are available, the average salary increase in 2025 was 21.5 percent. While this represents a significant raise, it is lower than the substantial 41 percent average increase experienced the previous year, as documented in a prior report by North Carolina Health News. Even with this moderation, the compensation figures remain substantial. For instance, Chief Clinical Officer Scott Rissmiller earned $4.59 million, a 14 percent increase, and Chief Legal Officer Brett Denton’s compensation rose by 15.9 percent to $4.48 million.
To provide a comparative perspective, WakeMed CEO Donald Gintzig earned approximately $1.9 million in 2024. Novant Health CEO Carl Armato, a competitor in the North Carolina market, reported earnings of around $8.2 million in the same period. These figures underscore the considerable difference in executive compensation between the systems and highlight the potential financial leverage Atrium might wield in a combined entity.
The issue of executive compensation in the non-profit hospital sector has also drawn legislative attention. State Sen. Jim Burgin has introduced Senate Bill 978, which proposes capping the pay of non-profit hospital CEOs at 400 times the compensation of the lowest-paid full-time employee. This bill has advanced through two Senate committees and is currently with the Senate Appropriations Committee. However, legislative activity has largely paused until after the November elections, leaving the future of such potential regulations uncertain.
The proposed combination of Atrium Health and WakeMed Health & Hospitals is structured such that Atrium would become WakeMed’s corporate member, granting it significant oversight and control. The systems have publicly committed to at least $2 billion in capital investment and the creation of 3,300 new jobs over a ten-year period. However, a review of the public transfer agreement by NC Health News indicates that this commitment is framed as an intention for capital expenditures rather than a guaranteed investment. Because WakeMed was historically county-owned, the Wake County Commissioners hold the authority to approve changes to its articles of incorporation and the transfer agreement, a critical step before the deal can proceed. As of late August, no vote had been scheduled for this matter.
Concerns about potential price increases for patients are a central theme in the discussion surrounding the merger. While both WakeMed and Atrium assert that the combination "won’t drive up your health care costs," and WakeMed CEO Donald Gintzig has stated that WakeMed would continue to negotiate its own insurance rates, evidence suggests a potential for higher costs. Data from the State Health Plan indicates that it currently pays Atrium 15 to 40 percent more than WakeMed for identical services. Gintzig himself has expressed a desire for WakeMed to be paid at Atrium’s rates, noting the significant disparity in reimbursement.
Further complicating the price question is an analysis conducted by Brown University. This study examined Atrium’s 2020 merger with Wake Forest Baptist Health and found that average inpatient prices at the combined entity rose by 28 percent between 2020 and 2024. This increase was notably higher than the 20 percent rise observed at other North Carolina hospitals during the same period. While this analysis demonstrates faster price growth following a consolidation involving Atrium, it does not definitively prove causation. Moreover, WakeMed has not formally agreed to cap future price increases as part of the current merger proposal.
The financial health of WakeMed itself has also become a point of contention. Nancy Kane, a professor emerita of health policy and management at the Harvard T.H. Chan School of Public Health, reviewed WakeMed’s finances for NC Health News and calculated a total margin of 15 percent for the first nine months of fiscal year 2026. This margin is substantially higher than the typical 3 to 5 percent she observes in similar organizations, leading her to characterize the deal as a "financial opportunity deal" rather than a necessity driven by financial distress.
Hayden Rooke-Ley, an assistant professor of health law at Brown University, suggests that Wake County commissioners possess considerable leverage in the negotiations, potentially more than has been publicly acknowledged. He advises that "There’s not much they couldn’t ask for here." Brianna Miller of United States of Care, a health policy non-profit, pointed to a precedent in Indiana where two hospitals agreed to over 45 conditions, including price caps, to secure state approval for their merger. Governor Josh Stein’s office has also communicated to WakeMed that the proposed combination "deserves close scrutiny and careful consideration," indicating a level of official concern.
Charity care is another area where the two systems’ practices diverge and present a potential point of negotiation. Both Atrium and WakeMed provide free care to families earning up to 300 percent of the federal poverty level, with Atrium extending partial assistance up to 400 percent. However, WakeMed’s net charity care costs represented about 4 percent of its patient revenue in 2024, compared to just 1 percent across Atrium’s North Carolina hospitals, according to data from the National Academy for State Health Policy’s hospital cost tool, as cited by NC Health News. This difference in the provision of charity care could be a factor in the ongoing discussions and the conditions imposed on the merger.
For patients in Wake County, the immediate impact of the proposed merger is not yet apparent, and their current insurance coverage remains unchanged. Individuals insured through the State Health Plan, which covers many state employees and teachers, and those with employer-sponsored plans are advised to verify that both WakeMed and Atrium facilities are within their network coverage. Utilizing insurer cost estimate tools before scheduling any medical procedures is also a prudent step.
Patients who are uninsured or have lower incomes are encouraged to inquire about financial assistance programs at either system before or after receiving care, as both organizations offer such support. Residents who wish to voice their opinions on the proposed combination should monitor the agendas of the Wake County Board of Commissioners and participate in public comment opportunities. The board has already postponed a vote on the merger once to allow for additional public input, signaling the sensitivity and importance of community engagement in this decision-making process.
The next opportunity to gain insight into executive compensation will be when Advocate Health files its annual tax return, expected in November. For now, the public record is characterized by rising executive pay at Atrium Health, the system’s record revenues, a pre-existing price differential between Atrium and WakeMed, and research suggesting that hospital consolidation can lead to increased prices. The two healthcare systems, however, maintain that their proposed merger will not result in higher costs for patients. The unfolding situation underscores the complex interplay between executive compensation, corporate strategy, and the fundamental goal of providing accessible and affordable healthcare. The upcoming decision by Wake County Commissioners will be a pivotal moment, shaping the future of healthcare delivery in the region and setting a precedent for similar consolidation efforts.
