Medicare Fee-For-Service (FFS) Hospital Readmissions: Q4 2013 Q3 2014 State of California Please contact Michelle Pastrano-Bower via email at mpastrano@hsag.com or by phone at 818.265.4648 for additional information. This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for California, 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. Publication No. CA-11SOW-C.3-06302015-01
Statewide Overview 1 Table 1: 30-Day All-Cause Readmission Rates Q4 2013 Q3 2014 California Nation 1 Baseline (CY 2013) Current Q4 13 Q1 14 Q2 14 Q3 14 18.6% 18.4% 18.3% 18.3% 18.3% 138,758/747,069 33,131/180,312 34,380/188,245 32,672/178,916 31,352/171,423 Table 2: Number of Emergency Department (ED) Visits Q4 2013 Q3 2014 Q4 2013 Q1 2014 Q2 2014 Q3 2014 18.0% California 266,441 271,714 273,935 275,208 Table 3: Number of Observation Stays Q4 2013 Q3 2014 Q4 2013 Q1 2014 Q2 2014 Q3 2014 California 28,804 27,456 27,649 27,875 Table 4: All-Cause Average Readmissions Rates by Region [state_img] Region Average Rate Region 9 8.5% Region 7 12.6% Region 20 14.2% Region 11 14.2% Region 6 14.4% Region 21 14.6% Region 14 14.8% Region 5 16.5% Region 13 16.9% Region 18 17.1% Region 17 17.2% Region 3 17.3% Region 16 17.5% Region 10 17.9% Region 1 18.2% Region 2 18.2% Region 12 18.2% Region 15 18.4% Region 19 19.5% Region 8 20.0% Region 4 21.0% 1 Data Source: ICPC Quarterly Scorecard (January 1, 2013, through December 31, 2013). California Statewide June 2015 Page 1
Figure 1: California and National Outpatient ED Visits, Observation Stays, and Inpatient Admissions 2,3 300 California ED Visits California Observation Stays California Admissions Encounters by Thousands 250 200 150 100 50 0 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 National ED Visits National Observation Stays National Admissions 4 Encounters by Millions 3.5 3 2.5 2 1.5 1 0.5 0 Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 2 ED visits and observations stays resulting in an inpatient stay are not included in this calculation. 3 National data are unavailable for Q1 2014 through Q3 2014. California Statewide June 2015 Page 2
Table 5: Discharge Distribution after Inpatient Hospitalization for All Causes Q4 2013 Q3 2014 Group Setting Discharged To 30-Day Readmit Rate Discharges Readmits within 30 Days Same Hospital Different Hospital N % N % Days to Readmission 0-3 Days 4-7 Days 8-14 Days 15-21 Days 22-30 Days N % N % N % N % N % Home 17.2% 353,622 60,757 43,259 71.2% 17,498 28.8% 10,439 17.2% 11,622 19.1% 15,235 25.1% 11,703 19.3% 11,758 19.4% SNF 20.8% 170,745 35,519 25,347 71.4% 10,172 28.6% 4,993 14.1% 6,458 18.2% 9,232 26.0% 7,316 20.6% 7,520 21.2% California HHA 19.2% 126,002 24,209 18,811 77.7% 5,398 22.3% 3,908 16.1% 4,771 19.7% 6,256 25.8% 4,694 19.4% 4,580 18.9% Hospice 3.5% 16,384 572 385 67.3% 187 32.7% 111 19.4% 112 19.6% 138 24.1% 106 18.5% 105 18.4% Other 20.1% 52,143 10,478 6,008 57.3% 4,470 42.7% 2,599 24.8% 1,711 16.3% 2,201 21.0% 1,797 17.2% 2,170 20.7% Total 18.3% 718,896 131,535 93,810 71.3% 37,725 28.7% 22,050 16.8% 24,674 18.8% 33,062 25.1% 25,616 19.5% 26,133 19.9% Figure 2: 30-Day All-Cause Readmission Rates 4 State Nation All-Cause Readmission Rate 20.0% 19.5% 19.0% 18.5% 18.0% 17.5% 17.0% 16.5% 16.0% 15.5% Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 4 National data are obtained from the ICPC Quarterly Scorecard (January 1, 2013, through December 31, 2013). California Statewide June 2015 Page 3
Table 6: Discharge Distribution after Inpatient Hospitalization for Acute Myocardial Infarction (AMI) Q4 2013 Q3 2014 Group Setting Discharged To 30-Day Readmit Rate Discharges Readmits within 30 Days Same Hospital Different Hospital N % N % Days to Readmission 0-3 Days 4-7 Days 8-14 Days 15-21 Days 22-30 Days N % N % N % N % N % Home 16.2% 8,593 1,395 940 67.4% 455 32.6% 315 22.6% 280 20.1% 318 22.8% 233 16.7% 249 17.8% SNF 24.3% 2,371 575 383 66.6% 192 33.4% 93 16.2% 129 22.4% 153 26.6% 87 15.1% 113 19.7% California HHA 23.0% 2,213 509 376 73.9% 133 26.1% 91 17.9% 89 17.5% 154 30.3% 91 17.9% 84 16.5% Hospice 4.1% 341 14 10 71.4% 4 28.6% 2 14.3% 3 21.4% 3 21.4% 2 14.3% 4 28.6% Other 27.7% 1,044 289 156 54.0% 133 46.0% 111 38.4% 49 17.0% 43 14.9% 41 14.2% 45 15.6% Total 19.1% 14,562 2,782 1,865 67.0% 917 33.0% 612 22.0% 550 19.8% 671 24.1% 454 16.3% 495 17.8% Figure 3: 30-Day AMI Readmission Rates 5 State Nation 25.0% AMI Readmission Rate 20.0% 15.0% 10.0% 5.0% 0.0% Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 5 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 from July 1, 2010, through June 30, 2013. California Statewide June 2015 Page 4
Table 7: Discharge Distribution after Inpatient Hospitalization for Heart Failure (HF) Q4 2013 Q3 2014 Group Setting Discharged To 30-Day Readmit Rate Discharges Readmits within 30 Days Same Hospital Different Hospital N % N % Days to Readmission 0-3 Days 4-7 Days 8-14 Days 15-21 Days 22-30 Days N % N % N % N % N % Home 24.0% 17,043 4,094 3,089 75.5% 1,005 24.5% 607 14.8% 719 17.6% 1,010 24.7% 880 21.5% 878 21.4% SNF 27.3% 6,580 1,794 1,323 73.7% 471 26.3% 242 13.5% 297 16.6% 474 26.4% 375 20.9% 406 22.6% California HHA 25.4% 7,704 1,954 1,536 78.6% 418 21.4% 276 14.1% 352 18.0% 498 25.5% 428 21.9% 400 20.5% Hospice 4.7% 1,049 49 38 77.6% 11 22.4% 9 18.4% 11 22.4% 13 26.5% 9 18.4% 7 14.3% Other 29.5% 1,723 509 299 58.7% 210 41.3% 126 24.8% 88 17.3% 110 21.6% 83 16.3% 102 20.0% Total 24.6% 34,099 8,400 6,285 74.8% 2,115 25.2% 1,260 15.0% 1,467 17.5% 2,105 25.1% 1,775 21.1% 1,793 21.3% Figure 4: 30-Day HF Readmission Rates 6 State Nation 30.0% HF Readmission Rate 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 6 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 from July 1, 2010, through June 30, 2013. California Statewide June 2015 Page 5
Table 8: Discharge Distribution after Inpatient Hospitalization for Pneumonia (PNE) Q4 2013 Q3 2014 Group Setting Discharged To 30-Day Readmit Rate Discharges Readmits within 30 Days Same Hospital Different Hospital N % N % Days to Readmission 0-3 Days 4-7 Days 8-14 Days 15-21 Days 22-30 Days N % N % N % N % N % Home 15.9% 12,254 1,949 1,500 77.0% 449 23.0% 358 18.4% 331 17.0% 488 25.0% 379 19.4% 393 20.2% SNF 22.4% 6,345 1,419 1,053 74.2% 366 25.8% 174 12.3% 250 17.6% 375 26.4% 303 21.4% 317 22.3% California HHA 20.4% 4,682 955 772 80.8% 183 19.2% 151 15.8% 200 20.9% 255 26.7% 178 18.6% 171 17.9% Hospice 3.0% 735 22 15 68.2% 7 31.8% 2 9.1% 5 22.7% 5 22.7% 7 31.8% 3 13.6% Other 19.4% 1,695 329 177 53.8% 152 46.2% 90 27.4% 51 15.5% 72 21.9% 44 13.4% 72 21.9% Total 18.2% 25,711 4,674 3,517 75.2% 1,157 24.8% 775 16.6% 837 17.9% 1,195 25.6% 911 19.5% 956 20.5% Figure 5: 30-Day PNE Readmission Rates 7 State Nation PNE Readmission Rate 20.5% 20.0% 19.5% 19.0% 18.5% 18.0% 17.5% 17.0% 16.5% 16.0% 15.5% Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 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 from July 1, 2010, through June 30, 2013. California Statewide June 2015 Page 6
Table 9: Discharge Distribution after Inpatient Hospitalization for Chronic Obstructive Pulmonary Disease (COPD) Q4 2013 Q3 2014 Group Setting Discharged To 30-Day Readmit Rate Discharges Readmits within 30 Days Same Hospital Different Hospital N % N % Days to Readmission 0-3 Days 4-7 Days 8-14 Days 15-21 Days 22-30 Days N % N % N % N % N % Home 20.8% 12,496 2,597 2,001 77.1% 596 22.9% 412 15.9% 386 14.9% 677 26.1% 554 21.3% 568 21.9% SNF 24.9% 3,987 991 725 73.2% 266 26.8% 133 13.4% 158 15.9% 276 27.9% 220 22.2% 204 20.6% California HHA 24.6% 3,963 973 796 81.8% 177 18.2% 130 13.4% 180 18.5% 259 26.6% 206 21.2% 198 20.3% Hospice 6.7% 345 23 15 65.2% 8 34.8% 3 13.0% 5 21.7% 6 26.1% 3 13.0% 6 26.1% Other 26.4% 1,510 398 242 60.8% 156 39.2% 102 25.6% 68 17.1% 89 22.4% 65 16.3% 74 18.6% Total 22.3% 22,301 4,982 3,779 75.9% 1,203 24.1% 780 15.7% 797 16.0% 1,307 26.2% 1,048 21.0% 1,050 21.1% Figure 6: 30-Day COPD Readmission Rates 8 State Nation 25.0% COPD Readmission Rate 24.0% 23.0% 22.0% 21.0% 20.0% 19.0% 18.0% Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 8 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 from July 1, 2010, through June 30, 2013. California Statewide June 2015 Page 7
Table 10: Discharge Distribution after Inpatient Hospitalization for Total Hip/Knee Replacement (THA/TKA) Q4 2013 Q3 2014 Group Setting Discharged To 30-Day Readmit Rate Discharges Readmits within 30 Days Same Hospital Different Hospital N % N % Days to Readmission 0-3 Days 4-7 Days 8-14 Days 15-21 Days 22-30 Days N % N % N % N % N % Home 3.6% 5,999 218 133 61.0% 85 39.0% 49 22.5% 42 19.3% 46 21.1% 41 18.8% 40 18.3% SNF 5.7% 8,662 490 351 71.6% 139 28.4% 90 18.4% 75 15.3% 120 24.5% 100 20.4% 105 21.4% California HHA 3.2% 14,476 456 310 68.0% 146 32.0% 97 21.3% 87 19.1% 113 24.8% 82 18.0% 77 16.9% Hospice 28.6% 7 2 1 50.0% 1 50.0% 1 50.0% 1 50.0% 0 0.0% 0 0.0% 0 0.0% Other 6.0% 1,829 110 75 68.2% 35 31.8% 21 19.1% 15 13.6% 35 31.8% 23 20.9% 16 14.5% Total 4.1% 30,973 1,276 870 68.2% 406 31.8% 258 20.2% 220 17.2% 314 24.6% 246 19.3% 238 18.7% Figure 7: 30-Day THA/TKA Readmission Rates 9 State Nation THA/TKA Readmission Rate 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Q2 2011 Q3 2011 Q4 2011 Q1 2012 Q2 2012 Q3 2012 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 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 from July 1, 2010, through June 30, 2013. California Statewide June 2015 Page 8
Methodology and Data Source Information The dashboard provides information regarding the state s all-cause, acute myocardial infarction (AMI), heart failure (HF), 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. Data in this report are limited to Medicare FFS Part-A data for discharges from October 1, 2013, through September 30, 2014. 10 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. The time periods illustrated in this document are examples only and may not reflect the most current data period. Pages 1 and 2 contain the following information. 1 Summary table 3 2 Emergency department (ED) visits and observation stays tables 4 Regional map Outpatient ED visits, observation stays, and inpatient admissions graphs 1 Example Dashboard (Pages 1 and 2) 3 2 10 The 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. California Statewide June 2015 Page A
Example Outpatient ED Visits, Observation Stays, and Inpatient Admissions Dashboard 4 1 Summary Table The summary table contains the 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 D for measure definitions. The summary table also includes the national rate. Due to availability of the data, the national rate may be calculated from a different time period. 2 ED Visits and Observation Stays Tables The ED visits and observation stays tables provide the count of ED visits and observation 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 California was divided into 21 regions, which are defined similarly to the regions established by the Hospital Council of Northern and Central California, the Hospital Association of Southern California, 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. California Statewide June 2015 Page B
Pages 3 through 8 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) 5 6 5 Discharge Distribution Table The discharge distribution table shows the 30-day readmission rates by discharge setting, the proportion of readmissions that occurred back to the admitting 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. 6 Line Graph The purpose of the readmission line graph is to track readmission rates over time. The line graph shows the state s (green line) improvement in relation to the nation (orange line). Rates are calculated quarterly. California Statewide June 2015 Page C
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 the calculation. Readmissions from home, SNFs, HHAs, and hospice are determined by the patient discharge status on the index hospitalization claim. Condition-Specific 30-Day Readmission Rates When calculating condition-specific readmission rates, an admission is included if the principal diagnosis/procedure code for the admission specifies that disease (i.e., AMI, HF, 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 the calculation. The following table lists the codes used to identify the discharges for AMI, HF, PNE, COPD, and THA/TKA. Disease Diagnosis Codes AMI 11 410.00, 410.01, 410.10, 410.11, 410.20, 410.21, 410.30, 410.31, 410.40, 410.41, 410.50, 410.51, 410.60, 410.61, 410.70, 410.71, 410.80, 410.81, 410.90, 410.91 HF 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428 PNE 480.0, 480.1, 480.2, 480.3, 480.8, 480.9, 481.0, 482.0, 482.1, 482.2, 482.3, 482.31, 482.32, 482.39, 482.4, 482.41, 482.42, 482.49, 482.81, 482.82, 482.83, 482.84, 482.89, 482.9, 483.0, 483.1, 483.8, 485.0, 486.0, 487.0, 488.11 COPD 491.21, 491.22, 491.8, 491.9, 492.8, 493.20, 493.21, 493.22, 496, 518.81*, 518.82*, 518.84*, 799.1* Procedure Procedural Codes THA/TKA 12 81.51, 81.54 * Principal diagnosis when combined with a secondary diagnosis of COPD (491.21, 491.22, 493.21, or 493.22) ED Visits and Observation Stays The following table lists the codes used to identify ED visits and observation stays. Revenue Codes HCPCS ED Visits 0450, 0451, 0452, 0456, 0459, 0981 Observation Stays 0762, 0760 AND G0378 11 If AMI is found to be the principal diagnosis for the first admission and the readmission has a primary diagnosis of 410.x2, the original discharge is not included in the admission count. 12 This only includes elective primary THA/TKA procedures. California Statewide June 2015 Page D
California Hospitals by Region Region 1: San Diego/Imperial Alvarado Hospital Medical Center Palomar Health Downtown Campus Scripps Mercy Hospital Alvarado Parkway Institute Behavioral Health System Aurora San Diego Paradise Valley Hospital Pioneers Memorial Healthcare District Sharp Chula Vista Medical Center Sharp Coronado Hospital And Healthcare Center El Centro Regional Medical Center Pomerado Hospital Sharp Memorial Hospital Fallbrook Hospital Scripps Green Hospital Sharp Mesa Vista Hospital Grossmont Hospital Scripps Memorial Hospital - Encinitas Tri-City Medical Center Kaiser Foundation Hospital - San Diego Scripps Memorial Hospital La Jolla University Of California San Diego Medical Center Region 2: San Bernardino/Riverside Arrowhead Regional Medical Center Hi-Desert Medical Center Parkview Community Hospital Medical Center Barstow Community Hospital John F Kennedy Memorial Hospital, Inc. Redlands Community Hospital Bear Valley Community Hospital Kaiser Foundation Hospital Fontana Riverside Community Hospital Canyon Ridge Hospital Kaiser Foundation Hospital, Riverside Riverside County Regional Medical Center Chino Valley Medical Center Kaiser Foundation Hospital-Moreno Valley San Antonio Community Hospital Colorado River Medical Center Loma Linda Behavioral Med Ctr San Gorgonio Memorial Hospital Community Hospital Of San Bernardino Loma Linda University Medical Center Southwest Healthcare System Corona Regional Medical Center Loma Linda University Medical Center-Murrieta St. Bernardine Medical Center Desert Regional Medical Center Menifee Valley Medical Center St Mary Medical Center Desert Valley Hospital Montclair Hospital Medical Center Temecula Valley Hospital Eisenhower Medical Center Mountains Community Hospital Victor Valley Community Hospital Hemet Valley Medical Center Palo Verde Hospital Vista Behavioral Hospital Region 3: Orange AHMC Anaheim Regional Medical Center Hoag Orthopedic Institute Placentia Linda Hospital Anaheim General Hospital Huntington Beach Hospital Saddleback Memorial Medical Center Chapman Medical Center Kaiser Foundation Hospital Anaheim St Joseph Hospital Coastal Communities Hospital La Palma Intercommunity Hospital St Jude Medical Center College Hospital Costa Mesa Los Alamitos Medical Center University Of California Irvine Med Center Fairview Developmental Center Mission Hospital Regional Med Center West Anaheim Medical Center Fountain Valley Regional Hospital & Medical Center Newport Bay Hospital Western Medical Center Hosp Anaheim Garden Grove Hospital & Medical Center Orange Coast Memorial Medical Center Western Medical Center Santa Ana Hoag Memorial Hospital Presbyterian California Statewide June 2015 Page E
Region 4: Los Angeles Alhambra Hospital Medical Center Hollywood Community Hospital Of Hollywood Pacific Hospital Of Long Beach Antelope Valley Hospital Med Center Hollywood Presbyterian Medical Center Pacifica Hospital Of The Valley Aurora Charter Oak Huntington Memorial Hospital Palmdale Regional Medical Center Aurora Las Encinas Hospital Joyce Eisenberg Keefer Medical Center Pomona Valley Hospital Medical Center Bellflower Medical Center Kaiser Foundation Hospital - Baldwin Park Presbyterian Intercommunity Hospital Beverly Hospital Kaiser Foundation Hospital - Downey Providence Holy Cross Medical Center BHC Alhambra Hosp Brotman Medical Center Kaiser Foundation Hospital - Los Angeles Kaiser Foundation Hospital - Panorama City Providence Little Co Of Mary Med Ctr San Pedro Providence Little Company Of Mary Med Ctr Torrance California Hospital Medical Center La Kaiser Foundation Hospital - South Bay Providence Saint Joseph Medical Ctr Catalina Island Medical Center Kaiser Foundation Hospital - West La Providence Tarzana Medical Center Cedars-Sinai Medical Center Kaiser Foundation Hospital - Woodland Hills Resnick Neuropsychiatric Hospital At UCLA Centinela Hospital Medical Center Keck Hospital Of USC Ronald Reagan UCLA Medical Center Citrus Valley Medical Center-IC Campus Lac/Harbor-UCLA Med Center Saint Francis Medical Center City Of Hope Helford Clinical Research Hospital Lac/Olive View-UCLA Medical Center Saint John's Health Center Coast Plaza Hospital Lac/Rancho Los Amigos National Rehabilitation Ctr Saint Vincent Medical Center College Hospital LAC+USC Medical Center San Dimas Community Hospital College Medical Center Lakewood Regional Medical Center San Gabriel Valley Medical Center Community And Mission Hospital Of Huntington Park Lanterman Developmental Center Santa Monica - UCLA Med Ctr & Orthopaedic Hospital Community Hospital Of Long Beach Long Beach Memorial Medical Center Sherman Oaks Hospital Del Amo Hospital Los Angeles Community Hospital Silver Lake Medical Center Doctors Hospital Of West Covina, Inc. Los Angeles Metropolitan Medical Ctr St Mary Medical Center Downey Regional Medical Center Marina Del Rey Hospital Tarzana Treatment Center East Los Angeles Doctors Hospital Memorial Hospital Of Gardena Temple Community Hospital East Valley Hospital Medical Center Methodist Hospital Of Southern Ca Torrance Memorial Medical Center Encino Hospital Medical Center Miracle Mile Medical Center Tri-City Regional Medical Center Foothill Presbyterian Hospital Mission Community Hospital - Panorama USC Kenneth Norris Jr Cancer Hospital Garfield Medical Center Monterey Park Hospital Valley Presbyterian Hospital Glendale Adventist Medical Center Motion Picture & Television Hospital Verdugo Hills Hospital Glendale Mem Hospital & Health Center Northridge Hospital Medical Center West Hills Hospital & Medical Center Good Samaritan Hospital Olympia Medical Center White Memorial Medical Center Greater El Monte Community Hospital Pacific Alliance Medical Center Whittier Hospital Medical Center Henry Mayo Newhall Memorial Hospital California Statewide June 2015 Page F
Region 5: Ventura Aurora Vista Del Mar Hospital Ojai Valley Community Hospital St Johns Pleasant Valley Hospital Community Memorial Hospital San Buenaventura Santa Barbara County Psychiatric Health Facility St John s Regional Medical Center Los Robles Hospital & Medical Center Simi Valley Hospital & Health Care Services Ventura County Medical Center Region 6: Santa Barbara Goleta Valley Cottage Hospital Marian Regional Medical Center Santa Ynez Valley Cottage Hospital Lompoc Valley Medical Center Santa Barbara Cottage Hospital Region 7: San Luis Obispo Arroyo Grande Community Hospital Ridgecrest Regional Hospital Twin Cities Community Hospital French Hospital Medical Center Sierra Vista Regional Medical Center Region 8: Kern Bakersfield Heart Hospital Good Samaritan Hospital Mercy Hospital Bakersfield Memorial Hospital Kern Medical Center San Joaquin Community Hospital Delano Regional Medical Center Kern Valley Healthcare District Tehachapi Hospital Region 9: Inyo/Mono Mammoth Hospital Northern Inyo Hospital Southern Inyo Hospital Region 10: Madera/Fresno/Kings/Tulare Adventist Medical Center Corcoran District Hospital Madera Community Hospital Adventist Medical Center - Reedley Fresno Heart And Surgical Hospital Porterville Developmental Center Central Valley General Hospital Fresno Surgical Hospital Saint Agnes Medical Center Clovis Community Medical Center Kaiser Foundation Hospital - Fresno Sierra View District Hospital Coalinga Regional Medical Center Kaweah Delta Medical Center Tulare Regional Medical Center Community Regional Medical Center Region 11: Monterey/San Benito Community Hospital Of The Monterey Peninsula Hazel Hawkins Memorial Hospital Salinas Valley Memorial Hospital George L Mee Memorial Hospital Natividad Medical Center Region 12: Stanislaus/Merced/Mariposa Doctors Medical Center Kaiser Permanente Psychiatric Health Facility-Sant Mercy Medical Center Emanuel Medical Center Inc. Memorial Medical Center Oak Valley District Hospital John C Fremont Healthcare District Memorial Hospital Los Banos Stanislaus Surgical Hospital California Statewide June 2015 Page G
Region 13: Santa Clara El Camino Hospital Kaiser Foundation Hospital-Santa Clara Saint Louise Regional Hospital Good Samaritan Hospital O'Connor Hospital Santa Clara Valley Medical Center Kaiser Foundation Hospital-San Jose Regional Medical Center Of San Jose Stanford Hospital Region 14: San Mateo/Santa Cruz Dominican Hospital Langley Porter Psychiatric Institute Sequoia Hospital Jewish Home Menlo Park Surgical Hospital Seton Medical Center Kaiser Foundation Hospital - Redwood City Peninsula Medical Center Sutter Maternity & Surgery Center Of Santa Cruz Kaiser Foundation Hospital - South San Francisco San Mateo Medical Center Watsonville Community Hospital Region 15: San Francisco California Pacific Medical Ctr - St. Luke's Campus John Muir Behavioral Health Center St Mary's Medical Center California Pacific Medical Ctr-Davies Campus Hosp California Pacific Medical Ctr-Pacific Campus Hosp Kaiser Foundation Hospital - San Francisco Laguna Honda Hospital & Rehabilitation Center St. Helena Hospital Center For Behavioral Health Telecare Heritage Psychiatric Health Facility Chinese Hospital Saint Francis Memorial Hospital UCSF Medical Center Fremont Hospital San Francisco General Hospital Region 16: Solano/Contra Costa/Alameda Alameda County Medical Center John Muir Medical Center - Walnut Creek Campus Northbay Vacavalley Hospital Alameda Hospital Kaiser Foundation Hospital - Antioch San Leandro Hospital Alta Bates Summit Medical Center Kaiser Foundation Hospital - Vacaville San Ramon Regional Medical Ctr Alta Bates Summit Medical Center - Alta Bates Camp Kaiser Foundation Hospital - Walnut Creek St Rose Hospital Contra Costa Regional Medical Center Kaiser Foundation Hospital And Rehab Center Sutter Delta Medical Center Doctors Medical Center-San Pablo Kaiser Foundation Hospital Fremont/Hayward Sutter Solano Medical Center Eden Medical Center Kaiser Foundation Hospital Oakland/Richmond Valleycare Medical Center John Muir Medical Center - Concord Campus Northbay Medical Center Washington Hospital Region 17: San Joaquin/Amador/Calaveras/Tuolumne/Alpine Dameron Hospital Mark Twain St Joseph's Hospital St Josephs Med Center Of Stockton Doctors Hospital Of Manteca San Joaquin General Hospital Sutter Amador Hospital Heritage Oaks Hospital Sierra Vista Hospital, Inc. Sutter Center For Psychiatry Kaiser Foundation Hospital Manteca Sonora Regional Medical Center Sutter Tracy Community Hospital Lodi Memorial Hospital California Statewide June 2015 Page H
Region 18: Yolo/Sacramento/Nevada/Placer/El Dorado Barton Memorial Hospital Mercy Hospital Of Folsom Sutter General Hospital Kaiser Foundation Hosp So Sacramento Mercy San Juan Medical Center Sutter Roseville Medical Center Kaiser Foundation Hospital - Roseville Methodist Hospital Of Sacramento Tahoe Forest Hospital Kaiser Foundation Hospital - Sacramento Sierra Nevada Memorial Hospital University Of California Davis Medical Center Marshall Medical Center (1-Rh) Sutter Auburn Faith Hospital Woodland Memorial Hospital Mercy General Hospital Sutter Davis Hospital Region 19: Sutter/Yuba/Sierra/Plumas/Tehama/Glenn/Colusa/Butte Aurora Behavioral Healthcare-Santa Rosa, LLC. Feather River Hospital Sempervirens Biggs Gridley Memorial Hospital Glenn Medical Center Seneca District Hospital Colusa Regional Medical Center Oroville Hospital St Elizabeth Community Hospital Eastern Plumas Hospital - Portola Campus Plumas District Hospital Sutter Surgical Hospital - North Valley Enloe Medical Center Rideout Memorial Hospital Region 20: Marin/Napa/Sonoma/Lake/Mendocino/Humboldt/Del Norte Frank R Howard Memorial Hospital Novato Community Hospital Sonoma Valley Hospital Healdsburg District Hospital Palm Drive Hospital St Helena Hospital Jerold Phelps Community Hospital Petaluma Valley Hospital St Joseph Hospital Kaiser Foundation Hospital Queen Of The Valley Medical Center Sutter Coast Hospital Kaiser Foundation Hospital-Santa Rosa Redbud Community Hospital Sutter Lakeside Hospital Mad River Community Hospital Redwood Memorial Hospital Sutter Medical Center Of Santa Rosa Marin General Hospital Santa Rosa Memorial Hospital Ukiah Valley Medical Center/Hospital D Mendocino Coast District Hospital Sonoma Developmental Center Region 21: Siskiyou/Modoc/Trinity/Shasta/Lassen Banner Lassen Medical Center Mercy Medical Center Redding Shasta Regional Medical Center Fairchild Medical Center Modoc Medical Center Surprise Valley Community Hospital Mayers Memorial Hospital Patients' Hospital Of Redding Trinity Hospital Mercy Medical Center Of Mt Shasta California Statewide June 2015 Page I