The state of Nevada has continued its ascent to the leading cost position in the nation as it was ranked 6^th lowest three years ago, 2^nd two years ago, and first in the current national study.  Not surprisingly, the Las Vegas metro area was among the five lowest cost metro areas.  Some might be surprised, though, that two California metro areas lead the way for cost position.  It’s important to note that the HCI is adjusted for cost-of-living, so, this allows for higher cost-of-living areas to be normalized in the study.  Our remaining four states in the top five have all been consistently lower cost in the research.  Interestingly, though, is that three of the five (ND, SD, MT) represent hospitals that are typically smaller and rural which are found to have higher cost positions nationally.  Likely, this relationship stems from smaller, rural hospitals having fixed cost levels that are not balanced against the same levels of patient throughput that larger facilities would have, as well as, competition for labor that might not be fully reflected in the wage index designation.

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