California hospitals were found to have the highest reimbursements over costs, whereas Utah is last in the country with a negative reimbursement rate related to costs.
CANTON, Mass., April 14, 2025 /PRNewswire-PRWeb/ -- Today The Phia Group, a leading healthcare cost containment firm, has released a data analysis for hospitals across the United States showing that there is no correlation between the quality of care patients receive and the amount that the providers are reimbursed for services over costs. This Cost-to-Allowance analysis and the previously released The Phia Group Healthcare Index, a state-by-state ranking that exposed no connection between quality and cost in healthcare across the country, further highlights the lack of price transparency in the healthcare system across the United States. Overall the Cost-to-Allowance data shows that higher reimbursements relative to costs appear to be driven by market dynamics, such as cost of living, lack of available alternatives, and proximity to services in a given area, rather than quality outcomes.
"Unlike the rest of our economy and consumer behavior patterns, when it comes to healthcare costs, the cost of the service and/or product does not correlate with the quality of the service or product," says Adam V. Russo, CEO of The Phia Group. "People always say that you get what you pay for and while that may be true when talking about buying a car, a pair of shoes or a television, it does not apply to medical procedures such as having a baby or undergoing knee replacement surgery. Until the American public can see actual quality and pricing transparency like they do with every other purchase they make, this anomalous situation will continue. There needs to be a heightened level of engaged consumerism in healthcare and the fact that fewer than 25% of the facilities in this country have even met the pricing transparency requirements that were put in place over four years ago shows that hospitals have very little interest in sharing information."
California was found to have the highest positive average delta, meaning that its hospitals are getting higher reimbursements. Conversely, Utah is last in the country and, in fact, does not get aggregated reimbursements above providers' reported cost structures. Below are the rankings for all 50 states:
- California
- New York
- Vermont
- Maine
- Massachusetts
- Connecticut
- Alabama
- Rhode Island
- Louisiana
- Minnesota
- Arkansas
- Hawaii
- Florida
- Mississippi
- Missouri
- Kansas
- New Jersey
- Nevada
- Texas
- New Hampshire
- New Mexico
- Washington
- Oklahoma
- Michigan
- West Virginia
- Tennessee
- District of Columbia
- Illinois
- Oregon
- Nebraska
- Iowa
- South Carolina
- Colorado
- Georgia
- Wisconsin
- Ohio
- North Dakota
- Kentucky
- Pennsylvania
- Arizona
- Virginia
- Indiana
- Alaska
- North Carolina
- Idaho
- South Dakota
- Wyoming
- Montana
- Delaware
- Utah
To generate these rankings, The Phia Group analyzed facility data from publicly available CMS sources, incorporating both quality metrics and cost data derived from hospital cost reports and federal quality reports.
The Phia Group is the nation's leading provider of healthcare cost containment solutions offering comprehensive claims recovery, plan document, and consulting services designed to contain healthcare costs and protect plan assets. By delivering industry-leading consultation and cost containment solutions, The Phia Group empowers plans to achieve their goals. Learn more at phiagroup.com.
DISCLAIMER
The Phia Group's analysis was performed using publicly available data for general informational purposes only. The final ranking is based on broad cost and quality metrics and may not reflect individual circumstances.
ABOUT THE PHIA GROUP
The Phia Group, LLC, headquartered in Canton, Massachusetts, is a leading provider of healthcare cost containment solutions. With offices across the United States, The Phia Group offers comprehensive claims recovery, plan document, and consulting services designed to contain health care costs and protect plan assets. By delivering industry-leading consultation and cost containment solutions, The Phia Group empowers plans to achieve their goals. Learn more at phiagroup.com.
Media Contact
Tess Darci, The Phia Group, 1 7817185239, [email protected], https://www.phiagroup.com/
SOURCE The Phia Group
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