Medicare Fee-For-Service (FFS) Hospital Readmissions: Q Q1 2017

Transcription

1 Medicare Fee-For-Service (FFS) Hospital Readmissions: Q Q State of Please contact Michelle Pastrano via at or by phone at for additional information. This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. CA-11SOW-C

2 Overview Table 1: 30-Day All-Cause Readmission Rates Q Q Baseline Current (CY 2013) Q Q Q Q Q to Q ,632/747,457 34,198/181,881 34,043/178,834 33,980/179,201 35,501/193, ,722/733, % 18.8% 19.0% 19.0% 18.4% 18.8% Nation % Table 2: Number of Emergency Department (ED) Visits Q Q Q Q Q Q , , , ,755 Table 3: Number of Observation Stays Q Q Q Q Q Q ,214 29,066 29,116 28,022 1 National data are obtained from the Integrated Care for Populations and Communities (ICPC) Quarterly Scorecard and the most recent data available are through December 31, August 2017 (Q Q1 2017) Page 1

3 Table 4: All-Cause Average Readmissions Rates by Region Region Average Rate Region % Region % Region % Region % Region % Region % Region % Region % Region % Region % Region % Region % Region % Region % Region % Region % Region % Region % Region % Region % Region % August 2017 (Q Q1 2017) Page 2

4 Figure 1: and National Outpatient ED Visits, Observation Stays, and Inpatient Admissions 2,3 2 ED visits and observation stays resulting in an inpatient stay are not included in this calculation. 3 National data are obtained from the ICPC Quarterly Scorecard and the most recent data available are through December 31, August 2017 (Q Q1 2017) Page 3

5 Table 5: Discharge Distribution after Inpatient Hospitalization for All Causes Q Q Readmits 30-Day Readmits to Same Hospital 30-Day Readmits to Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 17.4% 342,036 59, % % % % % % % SNF* 21.6% 176,438 38, % % % % % % % HHA** 19.3% 147,545 28, % % % % % % % Hospice 3.3% 18, % % % % % % % Other 22.6% 48,699 10, % % % % % % % Total 18.8% 733, , % % % % % % % *Skilled Nursing Facility (SNF) **Home Health Agency (HHA) Figure 2: 30-Day All-Cause Readmission Rates 5 4 An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 5 National data are obtained from the ICPC Quarterly Scorecard and the most recent data available are through December 31, August 2017 (Q Q1 2017) Page 4

6 Table 6: Discharge Distribution after Inpatient Hospitalization for Acute Myocardial Infarction (AMI) Q Q Readmits 30-Day Readmits to Same Hospital 30-Day Readmits to Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 15.5% 9,101 1, % % % % % % % SNF 25.7% 2, % % % % % % % HHA 21.5% 2, % % % % % % % Hospice 2.0% % % % % % % % Other 27.6% 1, % % % % % % % Total 18.7% 15,911 2,972 1, % 1, % % % % % % Figure 3: 30-Day AMI Readmission Rates 7 6 An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 7 National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are through June 30, August 2017 (Q Q1 2017) Page 5

7 Table 7: Discharge Distribution after Inpatient Hospitalization for Heart Failure (HF) Q Q Readmits 30-Day Readmits to Same Hospital 30-Day Readmits to Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 24.9% 18,223 4,543 3, % 1, % % % 1, % % % SNF 27.8% 7,787 2,165 1, % % % % % % % HHA 28.0% 10,144 2,842 2, % % % % % % % Hospice 4.0% 1, % % % % % % % Other 33.2% 1, % % % % % % % Total 26.0% 39,296 10,217 7, % 2, % 1, % 1, % 2, % 2, % 2, % Figure 4: 30-Day HF Readmission Rates 9 8 An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 9 National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are through June 30, August 2017 (Q Q1 2017) Page 6

8 Table 8: Discharge Distribution after Inpatient Hospitalization for Coronary Artery Bypass Graft (CABG) Q Q Day Readmits to 30-Day Readmits to Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 10.0% 1, % % % % % % % SNF 21.8% % % % % % % % HHA 12.4% 1, % % % % % % % Hospice 0.0% ND 0 ND 0 ND 0 ND 0 ND 0 ND 0 ND Other 24.2% % % % % % % % Total 14.7% 3, % % % % % % % Figure 5: 30-Day CABG Readmission Rates An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 11 National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are through June 30, August 2017 (Q Q1 2017) Page 7

9 Table 9: Discharge Distribution after Inpatient Hospitalization for Pneumonia (PNE) Q Q Day Readmits to 30-Day Readmits to Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 16.4% 17,309 2,847 2, % % % % % % % SNF 24.7% 15,218 3,764 2, % 1, % % % 1, % % % HHA 21.8% 9,679 2,112 1, % % % % % % % Hospice 2.5% 2, % % % % % 6 9.8% % Other 19.5% 3, % % % % % % % Total 19.7% 48,130 9,467 6, % 2, % 1, % 1, % 2, % 1, % 1, % Figure 6: 30-Day PNE Readmission Rates An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 13 National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are through June 30, August 2017 (Q Q1 2017) Page 8

10 Table 10: Discharge Distribution after Inpatient Hospitalization for Chronic Obstructive Pulmonary Disease (COPD) Q Q Day Readmits to 30-Day Readmits to Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 21.0% 12,984 2,722 2, % % % % % % % SNF 26.7% 5,237 1, % % % % % % % HHA 23.6% 5,544 1,307 1, % % % % % % % Hospice 4.1% % % % % % % % Other 26.7% 1, % % % % % % % Total 22.6% 25,978 5,879 4, % 1, % % % 1, % 1, % 1, % Figure 7: 30-Day COPD Readmission Rates An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 15 National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are through June 30, August 2017 (Q Q1 2017) Page 9

11 Table 11: Discharge Distribution after Inpatient Hospitalization for Total Hip/Knee Replacement (THA/TKA) Q Q Day Readmits to 30-Day Readmits to Readmits Same Hospital Different Hospital Days to Readmission Setting 30-Day Within 0 3 Days 4 7 Days 8 14 Days Days Days Group Discharged To Readmit Rate Discharges 30 Days N % N % N % N % N % N % N % Home 3.1% 7, % % % % % % % SNF 6.3% 6, % % % % % % % HHA 3.4% 16, % % % % % % % Hospice 0.0% ND 0 ND 0 ND 0 ND 0 ND 0 ND 0 ND Other 5.9% 1, % % % % % 6 9.8% % Total 4.0% 32,022 1, % % % % % % % Figure 8: 30-Day THA/TKA Readmission Rates An entry of ND, or missing data point, indicates that data were unavailable for the specified time period. 17 National data are obtained from the Hospital Compare website and are calculated using the 30-day risk adjustment standardized methodology for the CMS Hospital Readmission Reduction Program. The most recent data available are through June 30, August 2017 (Q Q1 2017) Page 10

12 Methodology and Data Source Information The dashboard provides information regarding your state s all-cause, acute myocardial infarction (AMI), heart failure (HF), coronary artery bypass graft (CABG), pneumonia (PNE), chronic obstructive pulmonary disease (COPD), and total hip/knee replacement (THA/TKA) 30-day readmissions. Rates are calculated using hospital inpatient claims for Medicare Fee-For-Service (FFS) beneficiaries. Planned readmissions are excluded from this analysis. Data in this report are limited to Medicare FFS Part-A data for discharges from April 1, 2016, to March 31, International Classification of Diseases (ICD)-10 codes are used to calculate rates starting from October Readmission rates in this report are not calculated using the 30-day risk standardized methodology for the Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Reduction Program or found on hospitalcompare.hhs.gov. Readmission rates are updated quarterly with the most current time period s data. As more mature data become available, historic data may change slightly to reflect the updated data. The time periods illustrated in this document are examples only and may not reflect the most current data period. Pages 1 through 3 contain the following information. 1 Summary table 3 Regional map 2 Emergency department (ED) visits and observation stays tables 4 Outpatient ED visits, observation stays, and inpatient admissions graphs 1 Example Dashboard (Pages 1 through 3) 2 18 The Complete Standard Analytical Table (CSAT) data file was used for this analysis. The CSAT data file is provided to HSAG by CMS. The CSAT data file includes Part A and Part B claims for FFS beneficiaries. Please note that the results obtained from CSAT may vary from your own state s results. Page A

13 3 4 Example Outpatient ED Visits, Observation Stays, and Inpatient Admissions Dashboard Page B

14 1 Summary Table The summary table contains your state s Baseline and Current 30-day readmission rates, including the numerator and denominator for each quarter. All rates are calculated from Medicare inpatient claims for FFS beneficiaries. See page E for measure definitions. The summary table also includes the national rate. Due to availability of the data, the national rates may be calculated from a different time period. 2 ED Visits and Observation Stays Tables The ED visits and observations stays tables provide the count of ED visits and observations stays, respectively, for each quarter in the current report period. ED visits and observation stays resulting in an inpatient stay are not included in the counts. 3 Regional Map The state of was divided into 21 regions, which are defined similarly to the regions established by the Hospital Council of Northern and Central, the Hospital Association of Southern, and the Hospital Association of San Diego and Imperial Counties. Aggregate readmission rates are calculated for each region using the hospitals located in the region. The table shows regional readmission rates for each region. 4 Outpatient ED Visits, Observation Stays, and Inpatient Admissions The two graphs depict the volume of outpatient ED visits, observation stays, and inpatient admissions for the state and the nation. The purpose of each is to monitor acute care utilization at the state and national levels. The counts are calculated for quarterly periods from Medicare acute care claims for FFS beneficiaries. Claims are classified based on hierarchy rules similar to Medicare bundled payment rules. Each encounter counts as only one of three types: (1) inpatient admission, (2) observation stay, or (3) ED visit. Therefore, ED visits and observation stays that result in an inpatient stay are counted as an inpatient stay. ED visits that result in an observation stay, but not an inpatient stay, are counted as an observation stay. Page C

15 Pages 4 through 10 provide the following data for all-cause and disease-specific 30-day readmissions: 5 Discharge distribution table 6 Line graph Example Dashboard (discharge distribution and line graph) Discharge Distribution Table The discharge distribution table shows the 30-day readmission rates by discharge setting, the proportion of readmissions that occurred back to your hospital or another hospital, and the number of days from discharge to readmission. Readmissions from home, skilled nursing facilities (SNFs), home health agencies (HHAs), and hospice are determined by the patient discharge status on the index hospitalization claim. All other discharge status codes are bucketed into the Other category. Results for the state and your hospital s region are provided for comparison. 6 Line graph The purpose of the readmission graph is to track readmission rates over time. The Line Graph shows your state s improvement in relation to nation. Rates are calculated quarterly. Page D

16 Measure Definitions All-Cause 30-Day Readmission Rates All-cause readmission rates are calculated as the percentage of hospital admissions that occurred within 30 days of an index admission for any condition. Each hospital admission within 30 days following an index admission is considered a readmission (e.g., a beneficiary with four readmissions in the measurement period counts as four separate readmissions). Any beneficiary who dies in the hospital or is transferred to another hospital on the same day is excluded from your facility s calculation. Readmissions from home, SNFs, HHAs, and hospice are determined by the patient discharge status on the index hospitalization claim. Planned Readmissions A planned readmission is a readmission within 30 days of discharge from a short-term acute care hospital that is a scheduled part of the patient s plan of care. Planned readmissions are excluded from this report. Condition-Specific 30-Day Readmission Rates When calculating disease-specific readmission rates, an admission is included if the principal diagnosis/procedure code for the admission specifies that disease (i.e., AMI, HF, CABG, PNE, COPD, and THA/TKA). Condition-specific readmissions include all-cause admissions that occur within 30 days of an index admission for the specific condition (e.g., a beneficiary with an index admission of AMI who is readmitted for a urinary tract infection (UTI) is considered an AMI readmission). Any beneficiary who dies in the hospital or is transferred to another hospital on the same day is excluded from your facility s calculation. The following table lists the codes used to identify the discharges for AMI, HF, CABG, PNE, COPD, and THA/TKA. ED Visits and Observation Stays The following table lists the codes used to identify ED visits and observations stays. Revenue Codes ED Visits 0450, 0451, 0452, 0456, 0459, 0981 HCPCS Observation Stays 0762, 0760 AND G0378 Page E

17 Hospitals by Region ALVARADO HOSPITAL MEDICAL CENTER Region 1 ALVARADO PARKWAY INSTITUTE BEHAVIORAL HEALTH SYSTE AURORA SAN DIEGO EL CENTRO REGIONAL MEDICAL CENTER GROSSMONT HOSPITAL KAISER FOUNDATION HOSPITAL - SAN DIEGO PALOMAR HEALTH DOWNTOWN CAMPUS PARADISE VALLEY HOSPITAL PIONEERS MEMORIAL HEALTHCARE DISTRICT POMERADO HOSPITAL SCRIPPS GREEN HOSPITAL SCRIPPS MEMORIAL HOSPITAL - ENCINITAS SCRIPPS MEMORIAL HOSPITAL LA JOLLA SCRIPPS MERCY HOSPITAL SHARP CHULA VISTA MEDICAL CENTER SHARP CORONADO HOSPITAL AND HLTHCR CTR SHARP MEMORIAL HOSPITAL SHARP MESA VISTA HOSPITAL TRI-CITY MEDICAL CENTER UC SAN DIEGO HEALTH HILLCREST - HILLCREST MED CTR Region 10 ADVENTIST MEDICAL CENTER ADVENTIST MEDICAL CENTER - REEDLEY CLOVIS COMMUNITY MEDICAL CENTER COALINGA REGIONAL MEDICAL CENTER COMMUNITY REGIONAL MEDICAL CENTER FRESNO HEART AND SURGICAL HOSPITAL FRESNO SURGICAL HOSPITAL KAISER FOUNDATION HOSPITAL - FRESNO KAWEAH DELTA MEDICAL CENTER MADERA COMMUNITY HOSPITAL PORTERVILLE DEVELOPMENTAL CENTER SAINT AGNES MEDICAL CENTER SIERRA VIEW MEDICAL CENTER TULARE REGIONAL MEDICAL CENTER Region 11 COMMUNITY HOSPITAL OF THE MONTEREY PENINSULA GEORGE L MEE MEMORIAL HOSPITAL HAZEL HAWKINS MEMORIAL HOSPITAL NATIVIDAD MEDICAL CENTER SALINAS VALLEY MEMORIAL HOSPITAL Region 12 DOCTORS MEDICAL CENTER EMANUEL MEDICAL CENTER JOHN C FREMONT HEALTHCARE DISTRICT MEMORIAL MEDICAL CENTER MEMORIAL HOSPITAL LOS BANOS MERCY MEDICAL CENTER OAK VALLEY HOSPITAL DISTRICT STANISLAUS SURGICAL HOSPITAL Region 13 EL CAMINO HOSPITAL GOOD SAMARITAN HOSPITAL KAISER FOUNDATION HOSPITAL-SAN JOSE KAISER FOUNDATION HOSPITAL-SANTA CLARA KAISER PERMANENTE PSYCHIATRIC HEALTH FACILITY- SANT O'CONNOR HOSPITAL REGIONAL MEDICAL CENTER OF SAN JOSE SAINT LOUISE REGIONAL HOSPITAL SAN JOSE BEHAVIORAL HEALTH SANTA CLARA VALLEY MEDICAL CENTER DOMINICAN HOSPITAL STANFORD HEALTH CARE Region 14 KAISER FOUNDATION HOSPITAL - REDWOOD CITY KAISER FOUNDATION HOSPITAL - SOUTH SAN FRANCISCO MENLO PARK SURGICAL HOSPITAL MILLS-PENINSULA MEDICAL CENTER SAN MATEO MEDICAL CENTER SANTA CRUZ COUNTY PSYCHIATRIC HEALTH FACILITY SEQUOIA HOSPITAL SETON MEDICAL CENTER SUTTER MATERNITY & SURGERY CENTER OF SANTA CRUZ CALIFORNIA PACIFIC MEDICAL CTR - ST. LUKE'S CAMPUS WATSONVILLE COMMUNITY HOSPITAL Region 15 CALIFORNIA PACIFIC MEDICAL CTR-DAVIES CAMPUS HOSP CALIFORNIA PACIFIC MEDICAL CTR-PACIFIC CAMPUS HOSP CHINESE HOSPITAL FREMONT HOSPITAL JEWISH HOME KAISER FOUNDATION HOSPITAL - SAN FRANCISCO LAGUNA HONDA HOSPITAL & REHABILITATION CENTER LANGLEY PORTER PSYCHIATRIC INSTITUTE SAINT FRANCIS MEMORIAL HOSPITAL SAN FRANCISCO GENERAL HOSPITAL ST. MARY'S MEDICAL CENTER TELECARE HERITAGE PSYCHIATRIC HEALTH FACILITY ALAMEDA HOSPITAL UCSF MEDICAL CENTER Region 16 ALTA BATES SUMMIT MEDICAL CENTER ALTA BATES SUMMIT MEDICAL CENTER - ALTA BATES CAMP CONTRA COSTA REGIONAL MEDICAL CENTER EDEN MEDICAL CENTER HIGHLAND HOSPITAL Page F

18 JOHN MUIR BEHAVIORAL HEALTH CENTER KAISER FOUNDATION HOSPITAL - ANTIOCH JOHN MUIR MEDICAL CENTER - CONCORD CAMPUS KAISER FOUNDATION HOSPITAL - FREMONT JOHN MUIR MEDICAL CENTER - WALNUT CREEK CAMPUS KAISER FOUNDATION HOSPITAL - OAKLAND/RICHMOND KAISER FOUNDATION HOSPITAL - SAN LEANDRO KAISER FOUNDATION HOSPITAL - VACAVILLE KAISER FOUNDATION HOSPITAL - WALNUT CREEK KAISER FOUNDATION HOSPITAL AND REHAB CENTER NORTHBAY MEDICAL CENTER SAN LEANDRO HOSPITAL SAN RAMON REGIONAL MEDICAL CTR ST. HELENA HOSPITAL CENTER FOR BEHAVIORAL HEALTH ST. ROSE HOSPITAL STANFORD HEALTH CARE - VALLEYCARE SUTTER DELTA MEDICAL CENTER SUTTER SOLANO MEDICAL CENTER WASHINGTON HOSPITAL Region 17 DAMERON HOSPITAL DOCTORS HOSPITAL OF MANTECA KAISER FOUNDATION HOSPITAL MANTECA LODI MEMORIAL HOSPITAL MARK TWAIN MEDICAL CENTER SAN JOAQUIN GENERAL HOSPITAL SONORA REGIONAL MEDICAL CENTER ST. JOSEPH'S BEHAVIORAL HEALTH CENTER ST. JOSEPH'S MEDICAL CENTER OF STOCKTON SUTTER AMADOR HOSPITAL SUTTER TRACY COMMUNITY HOSPITAL Region 18 BARTON MEMORIAL HOSPITAL HERITAGE OAKS HOSPITAL KAISER FOUNDATION HOSP SO SACRAMENTO KAISER FOUNDATION HOSPITAL - ROSEVILLE KAISER FOUNDATION HOSPITAL - SACRAMENTO MARSHALL MEDICAL CENTER MERCY GENERAL HOSPITAL MERCY HOSPITAL OF FOLSOM MERCY SAN JUAN MEDICAL CENTER METHODIST HOSPITAL OF SACRAMENTO SIERRA NEVADA MEMORIAL HOSPITAL SIERRA VISTA HOSPITAL, INC SUTTER AUBURN FAITH HOSPITAL SUTTER CENTER FOR PSYCHIATRY SUTTER DAVIS HOSPITAL SUTTER MEDICAL CENTER, SACRAMENTO SUTTER ROSEVILLE MEDICAL CENTER TAHOE FOREST HOSPITAL UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER WOODLAND MEMORIAL HOSPITAL Region 19 AURORA BEHAVIORAL HEALTHCARE-SANTA ROSA, LLC COLUSA REGIONAL MEDICAL CENTER EASTERN PLUMAS HOSPITAL - PORTOLA CAMPUS ENLOE MEDICAL CENTER FEATHER RIVER HOSPITAL GLENN MEDICAL CENTER ORCHARD HOSPITAL OROVILLE HOSPITAL PLUMAS DISTRICT HOSPITAL RIDEOUT MEMORIAL HOSPITAL SEMPERVIRENS SENECA DISTRICT HOSPITAL ST. ELIZABETH COMMUNITY HOSPITAL SUTTER SURGICAL HOSPITAL - NORTH VALLEY Region 2 ARROWHEAD REGIONAL MEDICAL CENTER BARSTOW COMMUNITY HOSPITAL BEAR VALLEY COMMUNITY HOSPITAL CANYON RIDGE HOSPITAL CHINO VALLEY MEDICAL CENTER COLORADO RIVER MEDICAL CENTER COMMUNITY HOSPITAL OF SAN BERNARDINO CORONA REGIONAL MEDICAL CENTER DESERT REGIONAL MEDICAL CENTER DESERT VALLEY HOSPITAL EISENHOWER MEDICAL CENTER HEMET VALLEY MEDICAL CENTER HI-DESERT MEDICAL CENTER JOHN F KENNEDY MEMORIAL HOSPITAL KAISER FOUNDATION HOSPITAL FONTANA KAISER FOUNDATION HOSPITAL, RIVERSIDE KAISER FOUNDATION HOSPITAL-MORENO VALLEY LOMA LINDA BEHAVIORAL MED CTR LOMA LINDA UNIVERSITY CHILDREN'S HOSPITAL LOMA LINDA UNIVERSITY MEDICAL CENTER LOMA LINDA UNIVERSITY MEDICAL CENTER-MURRIETA MENIFEE VALLEY MEDICAL CENTER MONTCLAIR HOSPITAL MEDICAL CENTER MOUNTAINS COMMUNITY HOSPITAL PACIFIC GROVE HOSPITAL PALO VERDE HOSPITAL PARKVIEW COMMUNITY HOSPITAL MEDICAL CENTER REDLANDS COMMUNITY HOSPITAL RIVERSIDE COMMUNITY HOSPITAL RIVERSIDE UNIVERSITY HEALTH SYSTEM-MEDICAL CENTER SAN ANTONIO REGIONAL HOSPITAL SAN GORGONIO MEMORIAL HOSPITAL SOUTHWEST HEALTHCARE SYSTEM ST. BERNARDINE MEDICAL CENTER ST. MARY MEDICAL CENTER TEMECULA VALLEY HOSPITAL VICTOR VALLEY GLOBAL MEDICAL CENTER Region 20 FRANK R HOWARD MEMORIAL HOSPITAL HEALDSBURG DISTRICT HOSPITAL JEROLD PHELPS COMMUNITY HOSPITAL KAISER FOUNDATION HOSPITAL KAISER FOUNDATION HOSPITAL-SANTA ROSA MAD RIVER COMMUNITY HOSPITAL MARIN GENERAL HOSPITAL MENDOCINO COAST DISTRICT HOSPITAL NOVATO COMMUNITY HOSPITAL PETALUMA VALLEY HOSPITAL QUEEN OF THE VALLEY MEDICAL CENTER REDWOOD MEMORIAL HOSPITAL SANTA ROSA MEMORIAL HOSPITAL SONOMA DEVELOPMENTAL CENTER SONOMA VALLEY HOSPITAL SONOMA WEST MEDICAL CENTER ST. HELENA HOSPITAL ST. HELENA HOSPITAL-CLEARLAKE Page G

19 ST. JOSEPH HOSPITAL SUTTER COAST HOSPITAL SUTTER LAKESIDE HOSPITAL SUTTER SANTA ROSA REGIONAL HOSPITAL UKIAH VALLEY MEDICAL CENTER Region 21 BANNER LASSEN MEDICAL CENTER FAIRCHILD MEDICAL CENTER MAYERS MEMORIAL HOSPITAL MERCY MEDICAL CENTER MT SHASTA MERCY MEDICAL CENTER REDDING MODOC MEDICAL CENTER PATIENTS' HOSPITAL OF REDDING SHASTA REGIONAL MEDICAL CENTER SURPRISE VALLEY COMMUNITY HOSPITAL TRINITY HOSPITAL Region 3 AHMC ANAHEIM REGIONAL MEDICAL CENTER ANAHEIM GLOBAL MEDICAL CENTER CHAPMAN GLOBAL MEDICAL CENTER COLLEGE HOSPITAL COSTA MESA FAIRVIEW DEVELOPMENTAL CENTER FOOTHILL REGIONAL MEDICAL CENTER FOUNTAIN VALLEY REGIONAL HOSPITAL & MEDICAL CENTER HOAG ORTHOPEDIC INSTITUTE GARDEN GROVE HOSPITAL & MEDICAL CENTER HUNTINGTON BEACH HOSPITAL HOAG MEMORIAL HOSPITAL PRESBYTERIAN KAISER FOUNDATION HOSPITAL - ORANGE COUNTY - ANAHE LA PALMA INTERCOMMUNITY HOSPITAL LOS ALAMITOS MEDICAL CENTER MISSION HOSPITAL REGIONAL MED CENTER NEWPORT BAY HOSPITAL ORANGE COAST MEMORIAL MEDICAL CENTER ORANGE COUNTY GLOBAL MEDICAL CENTER PLACENTIA LINDA HOSPITAL SADDLEBACK MEMORIAL MEDICAL CENTER SOUTH COAST GLOBAL MEDICAL CENTER ST. JOSEPH HOSPITAL ST. JUDE MEDICAL CENTER UNIVERSITY OF CALIFORNIA IRVINE MED CENTER WEST ANAHEIM MEDICAL CENTER Region 4 ALHAMBRA HOSPITAL MEDICAL CENTER ANTELOPE VALLEY HOSPITAL AURORA CHARTER OAK AURORA LAS ENCINAS HOSPITAL BEVERLY HOSPITAL BHC ALHAMBRA HOSP CALIFORNIA HOSPITAL MEDICAL CENTER LA CASA COLINA HOSPITAL CATALINA ISLAND MEDICAL CENTER CEDARS-SINAI MEDICAL CENTER CENTINELA HOSPITAL MEDICAL CENTER CITRUS VALLEY MEDICAL CENTER-IC CAMPUS CITY OF HOPE HELFORD CLINICAL RESEARCH HOSPITAL COAST PLAZA HOSPITAL COLLEGE HOSPITAL COLLEGE MEDICAL CENTER COMMUNITY HOSPITAL OF HUNTINGTON PARK COMMUNITY HOSPITAL OF LONG BEACH DEL AMO HOSPITAL DEPT OF STATE HOSPITALS - NAPA EAST LOS ANGELES DOCTORS HOSPITAL ENCINO HOSPITAL MEDICAL CENTER FOOTHILL PRESBYTERIAN HOSPITAL GARDENS REGIONAL HOSPITAL AND MEDICAL CENTER GARFIELD MEDICAL CENTER GLENDALE ADVENTIST MEDICAL CENTER GLENDALE MEM HOSPITAL & HLTH CENTER GLENDORA COMMUNITY HOSPITAL GOOD SAMARITAN HOSPITAL GREATER EL MONTE COMMUNITY HOSPITAL HENRY MAYO NEWHALL HOSPITAL HOLLYWOOD PRESBYTERIAN MEDICAL CENTER HUNTINGTON MEMORIAL HOSPITAL JOYCE EISENBERG KEEFER MEDICAL CENTER KAISER FOUNDATION HOSPITAL - BALDWIN PARK KAISER FOUNDATION HOSPITAL - DOWNEY KAISER FOUNDATION HOSPITAL - LOS ANGELES KAISER FOUNDATION HOSPITAL - PANORAMA CITY KAISER FOUNDATION HOSPITAL - SOUTH BAY KAISER FOUNDATION HOSPITAL - WEST LA KAISER FOUNDATION HOSPITAL - WOODLAND HILLS KECK HOSPITAL OF USC LAC+USC MEDICAL CENTER LAC/HARBOR-UCLA MED CENTER LAC/OLIVE VIEW-UCLA MEDICAL CENTER LAC/RANCHO LOS AMIGOS NATIONAL REHABILITATION CTR LAKEWOOD REGIONAL MEDICAL CENTER LONG BEACH MEMORIAL MEDICAL CENTER LOS ANGELES COMMUNITY HOSPITAL MARINA DEL REY HOSPITAL MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL MEMORIAL HOSPITAL OF GARDENA METHODIST HOSPITAL OF SOUTHERN CA MIRACLE MILE MEDICAL CENTER MISSION COMMUNITY HOSPITAL MONTEREY PARK HOSPITAL MOTION PICTURE & TELEVISION HOSPITAL NORTHRIDGE HOSPITAL MEDICAL CENTER OCEAN VIEW PSYCHIATRIC HEALTH FACILITY OLYMPIA MEDICAL CENTER PACIFIC ALLIANCE MEDICAL CENTER PACIFICA HOSPITAL OF THE VALLEY PALMDALE REGIONAL MEDICAL CENTER PIH HOSPITAL - DOWNEY POMONA VALLEY HOSPITAL MEDICAL CENTER PRESBYTERIAN INTERCOMMUNITY HOSPITAL PROVIDENCE HOLY CROSS MEDICAL CENTER PROVIDENCE LITTLE CO OF MARY MED CTR SAN PEDRO PROVIDENCE LITTLE COMPANY OF MARY MED CTR TORRANCE PROVIDENCE SAINT JOHN'S HEALTH CENTER PROVIDENCE SAINT JOSEPH MEDICAL CTR PROVIDENCE TARZANA MEDICAL CENTER RESNICK NEUROPSYCHIATRIC HOSPITAL AT UCLA RONALD REAGAN U C L A MEDICAL CENTER SAINT FRANCIS MEDICAL CENTER SAINT VINCENT MEDICAL CENTER SAN DIMAS COMMUNITY HOSPITAL SAN GABRIEL VALLEY MEDICAL CENTER SANTA MONICA - UCLA MED CTR & ORTHOPAEDIC HOSPITAL SHERMAN OAKS HOSPITAL SILVER LAKE MEDICAL CENTER SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD ST. MARY MEDICAL CENTER TARZANA TREATMENT CENTER TORRANCE MEMORIAL MEDICAL CENTER USC KENNETH NORRIS JR CANCER HOSPITAL USC VERDUGO HILLS HOSPITAL Page H

20 VALLEY PRESBYTERIAN HOSPITAL WEST COVINA MEDICAL CENTER, INC WEST HILLS HOSPITAL & MEDICAL CENTER WHITE MEMORIAL MEDICAL CENTER AURORA VISTA DEL MAR HOSPITAL WHITTIER HOSPITAL MEDICAL CENTER Region 5 COMMUNITY MEMORIAL HOSPITAL SAN BUENAVENTURA LOS ROBLES HOSPITAL & MEDICAL CENTER OJAI VALLEY COMMUNITY HOSPITAL SIMI VALLEY HOSPITAL & HEALTH CARE SERVICES ST. JOHNS PLEASANT VALLEY HOSPITAL ST. JOHNS REGIONAL MEDICAL CENTER VENTURA COUNTY MEDICAL CENTER Region 6 GOLETA VALLEY COTTAGE HOSPITAL LOMPOC VALLEY MEDICAL CENTER MARIAN REGIONAL MEDICAL CENTER SANTA BARBARA COTTAGE HOSPITAL SANTA BARBARA COUNTY PSYCHIATRIC HEALTH FACILITY Region 7 SANTA YNEZ VALLEY COTTAGE HOSPITAL FRENCH HOSPITAL MEDICAL CENTER SIERRA VISTA REGIONAL MEDICAL CENTER TWIN CITIES COMMUNITY HOSPITAL Region 8 ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI VALLEY BAKERSFIELD BEHAVIORAL HEALTHCARE HOSPITAL, LLC BAKERSFIELD HEART HOSPITAL BAKERSFIELD MEMORIAL HOSPITAL DELANO REGIONAL MEDICAL CENTER GOOD SAMARITAN HOSPITAL KERN MEDICAL CENTER KERN VALLEY HEALTHCARE DISTRICT MERCY HOSPITAL RIDGECREST REGIONAL HOSPITAL SAN JOAQUIN COMMUNITY HOSPITAL Region 9 MAMMOTH HOSPITAL NORTHERN INYO HOSPITAL SOUTHERN INYO HOSPITAL Page I