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Daily Archives: December 10, 2015

Medicare Penalizes 758 Hospitals For Safety Incidents

As it expands the types of infections it scrutinizes, the federal government is penalizing 758 hospitals with higher rates of patient safety incidents, Medicare records released late Wednesday show.

More than half of the hospitals that face the penalties, including some major urban hospitals, also were punished last year. Among the hospitals getting fines for the first time were some well-known institutions, including Stanford Health Care in Northern California, Denver Health Medical Center and two satellite hospitals run by the Mayo Clinic Health System in Minnesota, according to the federal data.

Medicare will lower all its payments to the penalized hospitals by 1 percent over the course of the federal fiscal year, which runs through September 2016. In total, Medicare estimates the penalties will cost hospitals $364 million.

Get the data

Looking for more on your hospital or state?

  • Full List: 758 Hospitals Penalized For Patient Safety
  • Download as PDF
  • Download as XLS

The penalties, created by the 2010 health law, are the toughest sanctions Medicare has taken on hospital safety, and they remain contentious. Patient safety advocates worry the fines are not large enough to alter hospital behavior and that they only examine a small portion of the types of mistakes that take place. Medicare plans to add more types of conditions in future years.

“I think the penalties are important,” said Helen Haskell, a prominent patient advocate. “I think it’s the only thing that gets people’s attention. My concern is the measures stay strong or even be strengthened.”

Hospitals say the penalties are counterproductive and unfairly levied against places that have made progress in safety but have not caught up to most facilities. They are also bothered that the health law requires Medicare to punish a quarter of hospitals each year.

“What bothers me the most is when people are improving and get that penalty, that’s money that could be invested into better care,” said Dr. Mark Jarrett, chief quality officer for the North Shore-LIJ Health System on Long Island, which had two hospitals penalized this year. “Taking the money away, all you’ve done is to make it harder for hospitals to function.”

The penalties are one prong of the health law’s mandate to leverage taxpayer dollars to improve hospital quality. Each year, Medicare also docks the pay of hospitals with too many patients coming back within a month, and it doles out bonuses and penalties to hospitals based on patient satisfaction scores, death rates and other performance measures.

Bed in a modern clinic corridor

Nonetheless, Medicare payments to most hospitals continue to be based primarily on the number and nature of the services they conduct, a system that health care experts say encourages hospitals to perform more procedures and focus on complex—and lucrative—ones.

“For hospitals, complications are still profitable,” said Dr. Martin Makary, a pancreatic surgeon and researcher at Johns Hopkins Medicine in Baltimore who studies safety. “Much of what we do in health care still has the incentives aligned the wrong way.”

This second round of the Hospital-Acquired Condition Reduction Program was based on the government’s assessment of the frequency in 2013 and 2014 of infections in patients with central lines inserted into veins, urinary catheters and incisions from colon surgeries and hysterectomies. Those infection rates comprise 75 percent of Medicare’s evaluation.

The rest is based on eight other complications, such as surgical tears, collapsed lungs, broken hips and reopened wounds between July 2012 and June 2014. Most of these complications were part of last year’s penalty assessments, but the infections from colon operations and hysterectomies were added to the calculations this year.

In practice, only about one in six hospitals are getting the penalty because Congress exempted veterans hospitals, children’s hospitals and “critical access” hospitals, which are generally the sole providers in their area.

In releasing the numbers, Medicare said average hospital performance improved for two of the three measures that the government relied on for the penalties both last year and this year. Infections from catheters used to collect urine from patients who are not mobile increased slightly over the year.

The HAC penalties have come under criticism by the hospital industry and researchers. A paper in the Journal of the American Medical Association examined the first year of the program and found that the hospitals that were penalized were more likely to have characteristics usually associated with quality. These included accreditation by the Joint Commission, the presence of the most extensive types of trauma centers and more nurses per patient.

Daron Cowley, a spokesman for Intermountain Healthcare in Salt Lake City, said in a statement that the penalty evaluation is “flawed and there are clearly refinements and changes needed.” Intermountain’s flagship hospital in Murray, Utah, has been penalized both years. Cowley said the penalty assessments do not properly consider the “substantial variations in size and number of procedures performed” by different hospitals.

Another paper published in May in The American Journal of Infection Control suggested that while health experts recommend hospitals use urinary catheters as rarely as possible to limit the chance of infections, those same hospitals may look worse because the catheters are mostly used in the sickest patients, who are more prone to infections.

A number of hospitals, such as those run by UCLA Health, have focused on decreasing the use of catheters in response to the penalty program. Both UCLA Medical Center, Santa Monica and Ronald Reagan UCLA Medical Center were penalized this year. Dr. Robert Cherry, chief medical and quality officer of UCLA Health, said in a statement that infection rates decreased this year.

A total of 407 hospitals were penalized both years of the program. (A full list of all penalized hospitals can be viewed here.)

Dr. Ashish Jha, a Harvard researcher, said the penalties are only based on a fraction of the types of medical problems patients can experience. “The most common cause of problems in hospitals is medication errors, which remain absent from this program,” he said. “Ultimately unless we get to clinically based, validated measures of patient safety, we’re not going to be able to move the needle.”

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758 Hospitals Penalized For Patient Safety In 2016: Data Table

Medicare is lowering its 2016 payments by 1 percent for 758 hospitals with high rates of potentially avoidable infections and complications such as blood clots, bed sores and falls. This is the second year of the Hospital-Acquired Conditions Reduction Program, which was mandated by the federal health law to reduce patient injuries. Below are the hospitals being penalized:

Full KHN Story: Medicare Penalizes 758 Hospitals For Safety Incidents
Download the Data: XLS| PDF

Hospital City State Also
Penalized
In 2015
ALASKA REGIONAL HOSPITAL ANCHORAGE AK Y
MT EDGECUMBE HOSPITAL SITKA AK
CENTRAL PENINSULA GENERAL HOSPITAL SOLDOTNA AK
BROOKWOOD MEDICAL CENTER BIRMINGHAM AL Y
L V STABLER MEMORIAL HOSPITAL GREENVILLE AL
SPRINGHILL MEMORIAL HOSPITAL MOBILE AL Y
SHOALS HOSPITAL MUSCLE SHOALS AL
RUSSELLVILLE HOSPITAL RUSSELLVILLE AL Y
D C H REGIONAL MEDICAL CENTER TUSCALOOSA AL Y
NORTHWEST MEDICAL CENTER WINFIELD AL
WHITE RIVER MEDICAL CENTER BATESVILLE AR Y
CHAMBERS MEMORIAL HOSPITAL DANVILLE AR Y
PHYSICIANS’ SPECIALTY HOSPITAL FAYETTEVILLE AR Y
WASHINGTON REGIONAL MEDICAL CENTER FAYETTEVILLE AR
WADLEY REGIONAL MEDICAL CENTER AT HOPE HOPE AR
NATIONAL PARK MEDICAL CENTER HOT SPRINGS AR
NORTH METRO MEDICAL CENTER JACKSONVILLE AR
ST BERNARDS MEDICAL CENTER JONESBORO AR Y
BAPTIST HEALTH MEDICAL CENTER-HOT SPRINGS COUNTY MALVERN AR
ARIZONA ORTHOPEDIC AND SURGICAL SPECIALITY HOSP CHANDLER AZ Y
FLAGSTAFF MEDICAL CENTER FLAGSTAFF AZ
FLORENCE HOSPITAL AT ANTHEM, LLC FLORENCE AZ Y
BANNER THUNDERBIRD MEDICAL CENTER GLENDALE AZ
ABRAZO WEST CAMPUS GOODYEAR AZ
HONORHEALTH DEER VALLEY MEDICAL CENTER PHOENIX AZ
MARICOPA MEDICAL CENTER PHOENIX AZ Y
YAVAPAI REGIONAL MEDICAL CENTER-EAST CAMPUS PRESCOTT VALLEY AZ
MT GRAHAM REGIONAL MEDICAL CENTER SAFFORD AZ
BANNER IRONWOOD MEDICAL CENTER SAN TAN VALLEY AZ Y
SCOTTSDALE SHEA MEDICAL CENTER SCOTTSDALE AZ
SELLS INDIAN HEALTH SERVICE HOSPITAL SELLS AZ Y
BANNER-UNIVERSITY MEDICAL CENTER TUCSON CAMPUS TUCSON AZ Y
ST JOSEPH’S HOSPITAL TUCSON AZ
TUCSON MEDICAL CENTER TUCSON AZ Y
WHITERIVER PHS INDIAN HOSPITAL WHITERIVER AZ
ANAHEIM GLOBAL MEDICAL CENTER ANAHEIM CA
KAISER FOUNDATION HOSPITAL – ANTIOCH ANTIOCH CA Y
BAKERSFIELD HEART HOSPITAL BAKERSFIELD CA
KERN MEDICAL CENTER BAKERSFIELD CA
SAN JOAQUIN COMMUNITY HOSPITAL BAKERSFIELD CA Y
PROVIDENCE SAINT JOSEPH MEDICAL CTR BURBANK CA
EDEN MEDICAL CENTER CASTRO VALLEY CA
CLOVIS COMMUNITY MEDICAL CENTER CLOVIS CA Y
ARROWHEAD REGIONAL MEDICAL CENTER COLTON CA Y
JOHN MUIR MEDICAL CENTER – CONCORD CAMPUS CONCORD CA Y
SHARP CORONADO HOSPITAL AND HLTHCR CTR CORONADO CA Y
FAIRVIEW DEVELOPMENTAL CENTER COSTA MESA CA Y
DELANO REGIONAL MEDICAL CENTER DELANO CA
EL CENTRO REGIONAL MEDICAL CENTER EL CENTRO CA Y
SONOMA DEVELOPMENTAL CENTER ELDRIDGE CA
SCRIPPS MEMORIAL HOSPITAL – ENCINITAS ENCINITAS CA Y
NORTHBAY MEDICAL CENTER FAIRFIELD CA
KAISER FOUNDATION HOSPITAL – FREMONT FREMONT CA Y
COMMUNITY REGIONAL MEDICAL CENTER FRESNO CA Y
SAINT AGNES MEDICAL CENTER FRESNO CA Y
USC VERDUGO HILLS HOSPITAL GLENDALE CA
MARIN GENERAL HOSPITAL GREENBRAE CA Y
ADVENTIST MEDICAL CENTER HANFORD CA
COMMUNITY HOSPITAL OF HUNTINGTON PARK HUNTINGTON PARK CA
GEORGE L MEE MEMORIAL HOSPITAL KING CITY CA
SCRIPPS GREEN HOSPITAL LA JOLLA CA Y
ANTELOPE VALLEY HOSPITAL LANCASTER CA Y
LOMA LINDA UNIVERSITY MEDICAL CENTER LOMA LINDA CA Y
COLLEGE MEDICAL CENTER LONG BEACH CA
LONG BEACH MEMORIAL MEDICAL CENTER LONG BEACH CA Y
CEDARS-SINAI MEDICAL CENTER LOS ANGELES CA
EAST LOS ANGELES DOCTORS HOSPITAL LOS ANGELES CA Y
KECK HOSPITAL OF USC LOS ANGELES CA Y
RONALD REAGAN U C L A MEDICAL CENTER LOS ANGELES CA Y
SAINT FRANCIS MEDICAL CENTER LYNWOOD CA
CONTRA COSTA REGIONAL MEDICAL CENTER MARTINEZ CA Y
RIDEOUT MEMORIAL HOSPITAL MARYSVILLE CA Y
MENLO PARK SURGICAL HOSPITAL MENLO PARK CA
PROVIDENCE HOLY CROSS MEDICAL CENTER MISSION HILLS CA Y
MISSION HOSPITAL REGIONAL MED CENTER MISSION VIEJO CA
MEMORIAL MEDICAL CENTER MODESTO CA
STANISLAUS SURGICAL HOSPITAL MODESTO CA Y
QUEEN OF THE VALLEY MEDICAL CENTER NAPA CA Y
NORTHRIDGE HOSPITAL MEDICAL CENTER NORTHRIDGE CA Y
HIGHLAND HOSPITAL OAKLAND CA
KAISER FOUNDATION HOSPITAL – OAKLAND/RICHMOND OAKLAND CA Y
TRI-CITY MEDICAL CENTER OCEANSIDE CA
CHAPMAN GLOBAL MEDICAL CENTER ORANGE CA Y
ST JOSEPH HOSPITAL ORANGE CA Y
MISSION COMMUNITY HOSPITAL PANORAMA CITY CA Y
PLACENTIA LINDA HOSPITAL PLACENTIA CA Y
LANTERMAN DEVELOPMENTAL CENTER POMONA CA Y
PORTERVILLE DEVELOPMENTAL CENTER PORTERVILLE CA Y
PATIENTS’ HOSPITAL OF REDDING REDDING CA
KAISER FOUNDATION HOSPITAL – REDWOOD CITY REDWOOD CITY CA Y
ADVENTIST MEDICAL CENTER – REEDLEY REEDLEY CA
KAISER FOUNDATION HOSP SO SACRAMENTO SACRAMENTO CA
KAISER FOUNDATION HOSPITAL – SACRAMENTO SACRAMENTO CA
ST HELENA HOSPITAL SAINT HELENA CA Y
SCRIPPS MERCY HOSPITAL SAN DIEGO CA Y
UNIVERSITY OF CALIFORNIA SAN DIEGO MEDICAL CENTER SAN DIEGO CA Y
CALIFORNIA PACIFIC MEDICAL CTR – ST. LUKE’S CAMPUS SAN FRANCISCO CA
CALIFORNIA PACIFIC MEDICAL CTR-DAVIES CAMPUS HOSP SAN FRANCISCO CA
CALIFORNIA PACIFIC MEDICAL CTR-PACIFIC CAMPUS HOSP SAN FRANCISCO CA
SAN GABRIEL VALLEY MEDICAL CENTER SAN GABRIEL CA Y
KAISER FOUNDATION HOSPITAL-SAN JOSE SAN JOSE CA Y
REGIONAL MEDICAL CENTER OF SAN JOSE SAN JOSE CA
ORANGE COUNTY GLOBAL MEDICAL CENTER SANTA ANA CA Y
PROVIDENCE SAINT JOHN’S HEALTH CENTER SANTA MONICA CA
SANTA MONICA – UCLA MED CTR & ORTHOPAEDIC HOSPITAL SANTA MONICA CA Y
SIMI VALLEY HOSPITAL & HEALTH CARE SERVICES SIMI VALLEY CA Y
SONORA REGIONAL MEDICAL CENTER SONORA CA
BARTON MEMORIAL HOSPITAL SOUTH LAKE TAHOE CA
STANFORD HEALTH CARE STANFORD CA
DAMERON HOSPITAL STOCKTON CA
PACIFICA HOSPITAL OF THE VALLEY SUN VALLEY CA Y
LAC/HARBOR-UCLA MED CENTER TORRANCE CA Y
TORRANCE MEMORIAL MEDICAL CENTER TORRANCE CA
TULARE REGIONAL MEDICAL CENTER TULARE CA
EMANUEL MEDICAL CENTER TURLOCK CA Y
SAN ANTONIO REGIONAL HOSPITAL UPLAND CA Y
KAISER FOUNDATION HOSPITAL – VACAVILLE VACAVILLE CA Y
KAISER FOUNDATION HOSPITAL AND REHAB CENTER VALLEJO CA Y
VENTURA COUNTY MEDICAL CENTER VENTURA CA Y
JOHN MUIR MEDICAL CENTER – WALNUT CREEK CAMPUS WALNUT CREEK CA Y
KAISER FOUNDATION HOSPITAL – WALNUT CREEK WALNUT CREEK CA
WEST HILLS HOSPITAL & MEDICAL CENTER WEST HILLS CA
MOTION PICTURE & TELEVISION HOSPITAL WOODLAND HILLS CA Y
UNIVERSITY COLO HEALTH MEMORIAL HOSPITAL CENTRAL COLORADO SPRINGS CO
DENVER HEALTH MEDICAL CENTER DENVER CO
VALLEY VIEW HOSPITAL ASSOCIATION GLENWOOD SPRINGS CO Y
GOOD SAMARITAN MEDICAL CENTER LAFAYETTE CO
ORTHOCOLORADO HOSPITAL AT ST ANTHONY MED CAMPUS LAKEWOOD CO Y
CENTURA HEALTH-ST MARY CORWIN MEDICAL CENTER PUEBLO CO Y
STERLING REGIONAL MEDCENTER STERLING CO Y
CONNECTICUT HOSPICE INC,THE BRANFORD CT Y
BRIDGEPORT HOSPITAL BRIDGEPORT CT Y
DANBURY HOSPITAL DANBURY CT Y
JOHN DEMPSEY HOSPITAL FARMINGTON CT Y
GREENWICH HOSPITAL ASSOCIATION GREENWICH CT
HARTFORD HOSPITAL HARTFORD CT Y
ST FRANCIS HOSPITAL & MEDICAL CENTER HARTFORD CT
MANCHESTER MEMORIAL HOSPITAL MANCHESTER CT Y
MIDDLESEX HOSPITAL MIDDLETOWN CT
HOSPITAL OF CENTRAL CONNECTICUT, THE NEW BRITAIN CT Y
YALE-NEW HAVEN HOSPITAL NEW HAVEN CT Y
LAWRENCE & MEMORIAL HOSPITAL NEW LONDON CT
NORWALK HOSPITAL ASSOCIATION NORWALK CT Y
STAMFORD HOSPITAL STAMFORD CT Y
CHARLOTTE HUNGERFORD HOSPITAL TORRINGTON CT
SAINT MARYS HOSPITAL WATERBURY CT
WATERBURY HOSPITAL WATERBURY CT Y
WINDHAM COMM MEM HOSP & HATCH HOSP WILLIMANTIC CT Y
GEORGE WASHINGTON UNIV HOSPITAL WASHINGTON DC Y
HOWARD UNIVERSITY HOSPITAL WASHINGTON DC
MEDSTAR WASHINGTON HOSPITAL CENTER WASHINGTON DC Y
PROVIDENCE HOSPITAL WASHINGTON DC Y
SIBLEY MEMORIAL HOSPITAL WASHINGTON DC Y
BAYHEALTH – KENT GENERAL HOSPITAL DOVER DE Y
JFK MEDICAL CENTER ATLANTIS FL
MANATEE MEMORIAL HOSPITAL BRADENTON FL Y
SOUTH LAKE HOSPITAL CLERMONT FL Y
BROWARD HEALTH CORAL SPRINGS CORAL SPRINGS FL Y
HEART OF FLORIDA REGIONAL MEDICAL CENTER DAVENPORT FL Y
GULF COAST MEDICAL CENTER LEE MEM HEALTH SYSTEM FORT MYERS FL Y
LEE MEMORIAL HOSPITAL FORT MYERS FL Y
NORTH FLORIDA REGIONAL MEDICAL CENTER GAINESVILLE FL
MEMORIAL HOSPITAL JACKSONVILLE JACKSONVILLE FL Y
UF HEALTH JACKSONVILLE JACKSONVILLE FL Y
LOWER KEYS MEDICAL CENTER KEY WEST FL
ED FRASER MEMORIAL HOSPITAL MACCLENNY FL Y
WUESTHOFF MEDICAL CENTER-MELBOURNE MELBOURNE FL Y
JACKSON MEMORIAL HOSPITAL MIAMI FL Y
WEST KENDALL BAPTIST HOSPITAL MIAMI FL
FLORIDA HOSPITAL ORLANDO FL
PUTNAM COMMUNITY MEDICAL CENTER PALATKA FL
MEMORIAL HOSPITAL WEST PEMBROKE PINES FL
BAPTIST HOSPITAL PENSACOLA FL
SACRED HEART HOSPITAL PENSACOLA FL Y
WESTSIDE REGIONAL MEDICAL CENTER PLANTATION FL
ST ANTHONYS HOSPITAL SAINT PETERSBURG FL Y
ST PETERSBURG GENERAL HOSPITAL SAINT PETERSBURG FL Y
SARASOTA MEMORIAL HOSPITAL SARASOTA FL Y
HIGHLANDS REGIONAL MEDICAL CENTER SEBRING FL
FLORIDA HOSPITAL TAMPA TAMPA FL
TAMPA COMMUNITY HOSPITAL TAMPA FL
TAMPA GENERAL HOSPITAL TAMPA FL Y
VENICE REGIONAL MEDICAL CENTER – BAYFRONT HEALTH VENICE FL Y
GOOD SAMARITAN MEDICAL CENTER WEST PALM BEACH FL
PHOEBE PUTNEY MEMORIAL HOSPITAL ALBANY GA
ATHENS REGIONAL MEDICAL CENTER ATHENS GA Y
ATLANTA MEDICAL CENTER – ATL CAMPUS & SOUTH CAMPUS ATLANTA GA Y
EMORY UNIVERSITY HOSPITAL MIDTOWN ATLANTA GA Y
GRADY MEMORIAL HOSPITAL ATLANTA GA Y
PIEDMONT HOSPITAL ATLANTA GA Y
MEDICAL COLLEGE OF GA HOSPITALS AND CLINICS AUGUSTA GA Y
TRINITY HOSPITAL OF AUGUSTA AUGUSTA GA
WELLSTAR COBB HOSPITAL AUSTELL GA Y
GRADY GENERAL HOSPITAL CAIRO GA
CARTERSVILLE MEDICAL CENTER CARTERSVILLE GA Y
NORTHRIDGE MEDICAL CENTER COMMERCE GA
CRISP REGIONAL HOSPITAL CORDELE GA Y
DEKALB MEDICAL CENTER DECATUR GA
ELBERT MEMORIAL HOSPITAL ELBERTON GA
HUTCHESON MEDICAL CENTER FORT OGLETHORPE GA Y
SPALDING REGIONAL HOSPITAL GRIFFIN GA
TAYLOR REGIONAL HOSPITAL HAWKINSVILLE GA
EMORY JOHNS CREEK HOSPITAL JOHNS CREEK GA
GWINNETT MEDICAL CENTER LAWRENCEVILLE GA
MEDICAL CENTER OF CENTRAL GEORGIA MACON GA
WELLSTAR KENNESTONE HOSPITAL MARIETTA GA Y
SGMC BERRIEN CAMPUS NASHVILLE GA
SOUTHEASTERN REGIONAL MEDICAL CENTER NEWNAN GA
SOUTHERN REGIONAL MEDICAL CENTER RIVERDALE GA Y
CANDLER HOSPITAL SAVANNAH GA Y
MEMORIAL HEALTH UNIV MED CEN, INC SAVANNAH GA Y
EMANUEL MEDICAL CENTER SWAINSBORO GA
TIFT REGIONAL MEDICAL CENTER TIFTON GA Y
MEADOWS REGIONAL MEDICAL CENTER VIDALIA GA Y
PALI MOMI MEDICAL CENTER AIEA HI
WAHIAWA GENERAL HOSPITAL WAHIAWA HI
MAUI MEMORIAL MEDICAL CENTER WAILUKU HI
MERCY MEDICAL CENTER-DES MOINES DES MOINES IA
MERCY MEDICAL CENTER-NORTH IOWA MASON CITY IA
TRINITY MUSCATINE MUSCATINE IA
SKIFF MEDICAL CENTER NEWTON IA Y
LAKES REGIONAL HEALTHCARE SPIRIT LAKE IA
COVENANT MEDICAL CENTER WATERLOO IA
ST ALPHONSUS REGIONAL MEDICAL CENTER BOISE ID Y
ST JOSEPH REGIONAL MEDICAL CENTER LEWISTON ID
PORTNEUF MEDICAL CENTER POCATELLO ID Y
NORTHWEST SPECIALTY HOSPITAL POST FALLS ID
MADISON MEMORIAL HOSPITAL REXBURG ID Y
NORTHWEST COMMUNITY HOSPITAL 1 ARLINGTON HEIGHTS IL Y
ST ELIZABETH HOSPITAL BELLEVILLE IL Y
MACNEAL  HOSPITAL BERWYN IL
LOUIS A WEISS MEMORIAL HOSPITAL CHICAGO IL
MERCY HOSPITAL AND MEDICAL CENTER CHICAGO IL Y
MT SINAI HOSPITAL MEDICAL CENTER CHICAGO IL
NORTHWESTERN MEMORIAL HOSPITAL CHICAGO IL Y
PROVIDENT HOSPITAL OF CHICAGO CHICAGO IL
ST BERNARD HOSPITAL CHICAGO IL
DECATUR MEMORIAL HOSPITAL DECATUR IL Y
ST MARYS HOSPITAL DECATUR IL
LITTLE COMPANY OF MARY HOSPITAL EVERGREEN PARK IL Y
PASSAVANT AREA HOSPITAL JACKSONVILLE IL
NORTHWESTERN LAKE FOREST HOSPITAL LAKE FOREST IL Y
EDWARD HOSPITAL NAPERVILLE IL
RICHLAND MEMORIAL HOSPITAL OLNEY IL Y
FRANCISCAN ST JAMES HEALTH OLYMPIA FIELDS IL Y
PALOS COMMUNITY HOSPITAL PALOS HEIGHTS IL Y
SAINT FRANCIS MEDICAL CENTER PEORIA IL Y
SAINT ANTHONY MEDICAL CENTER ROCKFORD IL Y
THE CARLE FOUNDATION HOSPITAL URBANA IL Y
VISTA MEDICAL CENTER EAST WAUKEGAN IL
MIDWESTERN REGION MED CENTER ZION IL
BLUFFTON REGIONAL MEDICAL CENTER BLUFFTON IN
FRANCISCAN ST FRANCIS HEALTH – CARMEL CARMEL IN
INDIANA UNIVERSITY HEALTH NORTH HOSPITAL CARMEL IN
PARKVIEW WHITLEY HOSPITAL COLUMBIA CITY IN
FRANCISCAN ST ELIZABETH HEALTH – CRAWFORDSVILLE CRAWFORDSVILLE IN
FRANCISCAN ST MARGARET HEALTH – DYER DYER IN
ST MARY’S MEDICAL CENTER EVANSVILLE IN
LUTHERAN HOSPITAL OF INDIANA FORT WAYNE IN
ST JOSEPH HOSPITAL FORT WAYNE IN
METHODIST HOSPITALS INC GARY IN Y
ESKENAZI HEALTH INDIANAPOLIS IN Y
INDIANA UNIVERSITY HEALTH INDIANAPOLIS IN Y
ST VINCENT HOSPITAL & HEALTH SERVICES INDIANAPOLIS IN
MEMORIAL HOSPITAL AND HEALTH CARE CENTER JASPER IN Y
COMMUNITY HOWARD REGIONAL HEALTH INC KOKOMO IN Y
MARION GENERAL HOSPITAL MARION IN
FRANCISCAN HEALTHCARE – MUNSTER MUNSTER IN Y
FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES NEW ALBANY IN
RIVERVIEW HEALTH NOBLESVILLE IN
SAINT JOSEPH REGIONAL MEDICAL CENTER – PLYMOUTH PLYMOUTH IN Y
SOUTH CENTRAL KS  MED CENTER ARKANSAS CITY KS Y
SUSAN B ALLEN MEMORIAL HOSPITAL EL DORADO KS
PREMIER SURGICAL INSTITUTE GALENA KS
MERCY HOSPITAL INDEPENDENCE INDEPENDENCE KS
GEARY COMMUNITY HOSPITAL JUNCTION CITY KS
UNIVERSITY OF KANSAS HOSPITAL KANSAS CITY KS Y
SAINT JOHN HOSPITAL LEAVENWORTH KS Y
BLUE VALLEY HOSPITAL, INC OVERLAND PARK KS
MENORAH MEDICAL CENTER OVERLAND PARK KS Y
LABETTE HEALTH PARSONS KS
SALINA SURGICAL HOSPITAL SALINA KS
TAYLOR REGIONAL HOSPITAL CAMPBELLSVILLE KY
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER DANVILLE KY
GEORGETOWN COMMUNITY HOSPITAL GEORGETOWN KY
OWENSBORO HEALTH MUHLENBERG COMMUNITY HOSPITAL GREENVILLE KY Y
JENNIE STUART MEDICAL CENTER HOPKINSVILLE KY
SAINT JOSEPH EAST LEXINGTON KY Y
JEWISH HOSPITAL & ST MARY’S HEALTHCARE LOUISVILLE KY Y
UNIVERSITY OF LOUISVILLE HOSPITAL LOUISVILLE KY Y
ROCKCASTLE REGIONAL HOSPITAL & RESPIRATORY CARE CT MOUNT VERNON KY
CHRISTUS ST FRANCES CABRINI HOSPITAL ALEXANDRIA LA Y
OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER BATON ROUGE LA Y
SURGICAL SPECIALTY CENTER OF BATON ROUGE BATON ROUGE LA
SOUTH CAMERON MEMORIAL HOSPITAL CAMERON LA
LAKEVIEW REGIONAL MEDICAL CENTER COVINGTON LA
ST ELIZABETH HOSPITAL GONZALES LA Y
LEONARD J CHABERT MEDICAL CENTER HOUMA LA Y
LAFAYETTE GENERAL MEDICAL CENTER LAFAYETTE LA
UNIVERSITY HOSPITAL & CLINICS LAFAYETTE LA Y
LAKE CHARLES MEMORIAL HOSPITAL LAKE CHARLES LA
UNIVERSITY HEALTH CONWAY MONROE LA
ST CHARLES SURGICAL HOSPITAL LLC NEW ORLEANS LA
TOURO INFIRMARY NEW ORLEANS LA
TULANE MEDICAL CENTER NEW ORLEANS LA Y
UNIVERSITY MEDICAL CENTER NEW ORLEANS NEW ORLEANS LA Y
GREEN CLINIC SURGICAL HOSPITAL RUSTON LA
UNIVERSITY HEALTH SHREVEPORT SHREVEPORT LA Y
WILLIS KNIGHTON MEDICAL CENTER SHREVEPORT LA Y
SOUTHERN SURGICAL HOSPITAL SLIDELL LA
LANE REGIONAL MEDICAL CENTER ZACHARY LA
BOSTON MEDICAL CENTER CORPORATION BOSTON MA Y
BRIGHAM AND WOMEN’S HOSPITAL BOSTON MA Y
TUFTS MEDICAL CENTER BOSTON MA Y
LAHEY HOSPITAL & MEDICAL CENTER, BURLINGTON BURLINGTON MA Y
FALMOUTH HOSPITAL FALMOUTH MA Y
BAYSTATE FRANKLIN MEDICAL CENTER GREENFIELD MA
HOLYOKE MEDICAL CENTER HOLYOKE MA Y
HALLMARK HEALTH SYSTEM MELROSE MA
NANTUCKET COTTAGE HOSPITAL NANTUCKET MA
NORTH SHORE MEDICAL CENTER SALEM MA Y
SOUTH SHORE HOSPITAL SOUTH WEYMOUTH MA
BAYSTATE MEDICAL CENTER SPRINGFIELD MA
MAINEGENERAL MEDICAL CENTER AUGUSTA ME Y
EASTERN MAINE MEDICAL CENTER BANGOR ME Y
MAINE COAST MEMORIAL HOSPITAL ELLSWORTH ME
CENTRAL MAINE MEDICAL CENTER LEWISTON ME
ST MARYS REGIONAL MEDICAL CENTER LEWISTON ME Y
MAINE MEDICAL CENTER PORTLAND ME Y
MERCY HOSPITAL PORTLAND ME
YORK HOSPITAL YORK ME
SPECTRUM HEALTH BIG RAPIDS HOSPITAL BIG RAPIDS MI
SPARROW CARSON HOSPITAL CARSON CITY MI Y
MIDMICHIGAN MEDICAL CENTER-CLARE CLARE MI
HENRY FORD MACOMB HOSPITAL CLINTON TOWNSHIP MI Y
BEAUMONT HOSPITAL – DEARBORN DEARBORN MI Y
DETROIT RECEIVING HOSPITAL & UNIV HEALTH CENTER DETROIT MI Y
HARPER UNIVERSITY HOSPITAL DETROIT MI Y
SINAI-GRACE HOSPITAL DETROIT MI
HURLEY MEDICAL CENTER FLINT MI Y
MCLAREN FLINT FLINT MI Y
GENESYS REGIONAL MEDICAL CENTER – HEALTH PARK GRAND BLANC MI Y
NORTH OTTAWA COMMUNITY HEALTH CENTER GRAND HAVEN MI
SAINT MARY’S HEALTH CARE GRAND RAPIDS MI
SPECTRUM HEALTH – BUTTERWORTH CAMPUS GRAND RAPIDS MI Y
BORGESS MEDICAL CENTER KALAMAZOO MI Y
OAKLAWN HOSPITAL MARSHALL MI
PROMEDICA MONROE REGIONAL HOSPITAL MONROE MI Y
MCLAREN MACOMB MOUNT CLEMENS MI Y
DOCTORS’ HOSPITAL OF MICHIGAN PONTIAC MI
ST JOSEPH MERCY OAKLAND PONTIAC MI
LAKE HURON MEDICAL CENTER PORT HURON MI Y
TAWAS ST JOSEPH HOSPITAL TAWAS CITY MI
THREE RIVERS HEALTH THREE RIVERS MI
WEST BRANCH REGIONAL MEDICAL CENTER WEST BRANCH MI
MAYO CLINIC HEALTH SYSTEM – ALBERT LEA ALBERT LEA MN
SANFORD BEMIDJI MEDICAL CENTER BEMIDJI MN Y
ESSENTIA HEALTH ST JOSEPH’S MEDICAL CENTER BRAINERD MN Y
CAMBRIDGE MEDICAL CENTER CAMBRIDGE MN Y
ESSENTIA HEALTH DULUTH DULUTH MN
MAYO CLINIC HEALTH SYSTEM – FAIRMONT FAIRMONT MN
DISTRICT ONE HOSPITAL FARIBAULT MN
HUTCHINSON HEALTH HUTCHINSON MN
ABBOTT NORTHWESTERN HOSPITAL MINNEAPOLIS MN
HENNEPIN COUNTY MEDICAL CENTER 1 MINNEAPOLIS MN Y
UNIVERSITY OF MINNESOTA  MEDICAL CENTER, FAIRVIEW MINNEAPOLIS MN Y
ST CLOUD HOSPITAL SAINT CLOUD MN Y
REGIONS HOSPITAL SAINT PAUL MN Y
LAKEVIEW MEMORIAL HOSPITAL STILLWATER MN
RICE MEMORIAL HOSPITAL WILLMAR MN
HEALTHEAST WOODWINDS HOSPITAL WOODBURY MN
FAIRVIEW LAKES MEDICAL CENTER WYOMING MN
BATES COUNTY MEMORIAL HOSPITAL BUTLER MO
SAINT FRANCIS MEDICAL CENTER CAPE GIRARDEAU MO Y
SOUTHEASTHEALTH CAPE GIRARDEAU MO Y
BARNES-JEWISH WEST COUNTY HOSPITAL CREVE COEUR MO Y
SOUTHEASTHEALTH CENTER OF STODDARD COUNTY DEXTER MO
SOUTHEAST HEALTH CENTER OF REYNOLDS COUNTY ELLINGTON MO
TEXAS COUNTY MEMORIAL HOSPITAL HOUSTON MO
TRUMAN MEDICAL CENTER HOSPITAL HILL KANSAS CITY MO Y
SSM ST JOSEPH HOSPITAL WEST LAKE SAINT LOUIS MO Y
NEVADA REGIONAL MEDICAL CENTER NEVADA MO
PROGRESS WEST HOSPITAL O FALLON MO
POPLAR BLUFF REGIONAL MEDICAL CENTER POPLAR BLUFF MO Y
BARNES JEWISH HOSPITAL SAINT LOUIS MO Y
CHRISTIAN HOSPITAL NORTHEAST-NORTHWEST SAINT LOUIS MO Y
SSM HEALTH SAINT LOUIS UNIVERSITY HOSPITAL SAINT LOUIS MO Y
ST ALEXIUS HOSPITAL SAINT LOUIS MO
BARNES-JEWISH ST PETERS HOSPITAL SAINT PETERS MO
JASPER GENERAL HOSPITAL BAY SPRINGS MS Y
MERIT HEALTH RIVER OAKS FLOWOOD MS
MISSISSIPPI BAPTIST MEDICAL CENTER JACKSON MS
SOUTH CENTRAL REG MED CTR LAUREL MS Y
GEORGE REGIONAL HEALTH SYSTEM LUCEDALE MS
MAGEE GENERAL HOSPITAL MAGEE MS
RUSH FOUNDATION HOSPITAL MERIDIAN MS
CHOCTAW HEALTH CENTER PHILADELPHIA MS Y
BAPTIST MEMORIAL HOSPITAL DESOTO SOUTHAVEN MS Y
ST VINCENT HEALTHCARE BILLINGS MT
BOZEMAN DEACONESS HOSPITAL BOZEMAN MT
ST JAMES HEALTHCARE BUTTE MT Y
NORTHERN MONTANA HOSPITAL HAVRE MT Y
THE HEALTHCENTER KALISPELL MT
WAKEMED, CARY HOSPITAL CARY NC Y
UNIVERSITY OF NORTH CAROLINA HOSPITAL CHAPEL HILL NC Y
NOVANT HEALTH PRESBYTERIAN MEDICAL CENTER CHARLOTTE NC Y
NORTH CAROLINA SPECIALTY HOSPITAL DURHAM NC
CAPE FEAR VALLEY MEDICAL CENTER FAYETTEVILLE NC Y
VIDANT MEDICAL CENTER GREENVILLE NC Y
VIDANT DUPLIN  HOSPITAL KENANSVILLE NC
LENOIR MEMORIAL HOSPITAL KINSTON NC
SOUTHEASTERN REGIONAL MEDICAL CENTER LUMBERTON NC Y
WAKEMED, RALEIGH CAMPUS RALEIGH NC Y
NASH GENERAL HOSPITAL ROCKY MOUNT NC Y
RUTHERFORD REGIONAL MEDICAL CENTER RUTHERFORDTON NC Y
CAROLINAS HEALTHCARE SYSTEM CLEVELAND SHELBY NC Y
VIDANT BEAUFORT HOSPITAL WASHINGTON NC
WILMINGTON TREATMENT CENTER WILMINGTON NC Y
ESSENTIA HEALTH-FARGO FARGO ND Y
BRYAN MEDICAL CENTER LINCOLN NE
CHI HEALTH ST ELIZABETH LINCOLN NE
FAITH REGIONAL HEALTH SERVICES NORFOLK NE Y
GREAT PLAINS HEALTH NORTH PLATTE NE Y
METHODIST HOSPITAL OMAHA NE Y
NEBRASKA SPINE HOSPITAL, LLC OMAHA NE
THE NEBRASKA MEDICAL CENTER DBA NEBRASKA MEDICINE OMAHA NE Y
REGIONAL WEST MEDICAL CENTER SCOTTSBLUFF NE
WINNEBAGO HIS HOSPITAL WINNEBAGO NE Y
MARY HITCHCOCK MEMORIAL HOSPITAL LEBANON NH Y
CATHOLIC MEDICAL CENTER MANCHESTER NH Y
OCEAN MEDICAL CENTER BRICK NJ Y
COOPER UNIVERSITY HOSPITAL CAMDEN NJ
TRINITAS REGIONAL MEDICAL CENTER ELIZABETH NJ
CENTRASTATE MEDICAL CENTER FREEHOLD NJ Y
ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL HAMILTON HAMILTON NJ Y
SOUTHERN OCEAN MEDICAL CENTER MANAHAWKIN NJ Y
HACKENSACK-UMC MOUNTAINSIDE MONTCLAIR NJ
ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL NEW BRUNSWICK NJ Y
SAINT PETER’S UNIVERSITY HOSPITAL NEW BRUNSWICK NJ Y
SAINT MICHAEL’S MEDICAL CENTER, INC NEWARK NJ
UNIVERSITY HOSPITAL NEWARK NJ Y
PALISADES MEDICAL CENTER NORTH BERGEN NJ Y
CAPITAL HEALTH MEDICAL CENTER – HOPEWELL PENNINGTON NJ Y
ST LUKE’S WARREN HOSPITAL PHILLIPSBURG NJ
RIVERVIEW MEDICAL CENTER RED BANK NJ
VALLEY HOSPITAL RIDGEWOOD NJ
ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL SOMERSET SOMERVILLE NJ Y
OVERLOOK MEDICAL CENTER SUMMIT NJ Y
CAPITAL HEALTH SYSTEM-FULD CAMPUS TRENTON NJ
INSPIRA MEDICAL CENTER VINELAND VINELAND NJ Y
LOURDES MEDICAL CENTER OF BURLINGTON COUNTY WILLINGBORO NJ
PRESBYTERIAN HOSPITAL ALBUQUERQUE NM Y
UNM HOSPITAL ALBUQUERQUE NM Y
SAN JUAN REGIONAL MEDICAL CENTER FARMINGTON NM Y
CHRISTUS ST VINCENT REGIONAL MEDICAL CENTER SANTA FE NM
NORTHERN NAVAJO MEDICAL CENTER SHIPROCK NM Y
GILA REGIONAL MEDICAL CENTER SILVER CITY NM Y
CARSON TAHOE REGIONAL MEDICAL CENTER CARSON CITY NV
SIERRA SURGERY HOSPITAL CARSON CITY NV
BANNER CHURCHILL COMMUNITY HOSPITAL FALLON NV
ST ROSE DOMINICAN HOSPITALS – SIENA CAMPUS HENDERSON NV Y
HARMON HOSPITAL LAS VEGAS NV Y
MOUNTAINVIEW HOSPITAL LAS VEGAS NV Y
SPRING VALLEY HOSPITAL MEDICAL CENTER LAS VEGAS NV
UNIVERSITY MEDICAL CENTER LAS VEGAS NV Y
VALLEY HOSPITAL MEDICAL CENTER LAS VEGAS NV Y
NORTH VISTA HOSPITAL NORTH LAS VEGAS NV Y
SAINT MARY’S REGIONAL MEDICAL CENTER RENO NV
NYE REGIONAL MEDICAL CENTER TONOPAH NV Y
SOUTH LYON MEDICAL CENTER YERINGTON NV
ALBANY MEDICAL CENTER HOSPITAL ALBANY NY
ST PETER’S HOSPITAL ALBANY NY
SOUTHSIDE HOSPITAL BAY SHORE NY Y
ST JOSEPH HOSPITAL BETHPAGE NY
JACOBI MEDICAL CENTER BRONX NY Y
MONTEFIORE MEDICAL CENTER BRONX NY Y
ST BARNABAS HOSPITAL BRONX NY Y
BROOKDALE HOSPITAL MEDICAL CENTER BROOKLYN NY Y
BROOKLYN HOSPITAL CENTER AT DOWNTOWN CAMPUS BROOKLYN NY Y
CONEY ISLAND HOSPITAL BROOKLYN NY Y
KINGS COUNTY HOSPITAL CENTER BROOKLYN NY Y
KINGSBROOK JEWISH MEDICAL CENTER BROOKLYN NY Y
LUTHERAN MEDICAL CENTER BROOKLYN NY Y
WYCKOFF HEIGHTS MEDICAL CENTER BROOKLYN NY Y
KALEIDA HEALTH BUFFALO NY Y
MERCY HOSPITAL BUFFALO NY
ST JOHN’S EPISCOPAL HOSPITAL AT SOUTH SHORE FAR ROCKAWAY NY Y
FLUSHING HOSPITAL MEDICAL CENTER FLUSHING NY
GENEVA GENERAL HOSPITAL GENEVA NY
GLEN COVE HOSPITAL GLEN COVE NY
EASTERN LONG ISLAND HOSPITAL GREENPORT NY
ST JAMES MERCY HOSPITAL HORNELL NY Y
COLUMBIA MEMORIAL HOSPITAL HUDSON NY Y
CAYUGA MEDICAL CENTER AT ITHACA ITHACA NY
JAMAICA HOSPITAL MEDICAL CENTER JAMAICA NY Y
NORTH SHORE UNIVERSITY HOSPITAL MANHASSET NY Y
MASSENA MEMORIAL HOSPITAL MASSENA NY Y
NORTHERN WESTCHESTER HOSPITAL MOUNT KISCO NY Y
LONG ISLAND JEWISH MEDICAL CENTER NEW HYDE PARK NY
MONTEFIORE NEW ROCHELLE HOSPITAL NEW ROCHELLE NY
LENOX HILL HOSPITAL NEW YORK NY Y
METROPOLITAN HOSPITAL CENTER NEW YORK NY
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CTR PLATTSBURGH NY Y
NORTHERN DUTCHESS HOSPITAL RHINEBECK NY
ST FRANCIS HOSPITAL, ROSLYN ROSLYN NY
SARATOGA HOSPITAL SARATOGA SPRINGS NY Y
UNIVERSITY HOSPITAL ( STONY BROOK ) STONY BROOK NY Y
GOOD SAMARITAN HOSPITAL OF SUFFERN SUFFERN NY
CROUSE HOSPITAL SYRACUSE NY Y
ST JOSEPH’S HOSPITAL HEALTH CENTER SYRACUSE NY
ST ELIZABETH MEDICAL CENTER UTICA NY Y
WESTCHESTER MEDICAL CENTER VALHALLA NY Y
GOOD SAMARITAN HOSPITAL MEDICAL CENTER WEST ISLIP NY
WHITE PLAINS HOSPITAL CENTER WHITE PLAINS NY
ST JOHN’S RIVERSIDE HOSPITAL YONKERS NY
ST JOSEPH’S MEDICAL CENTER YONKERS NY Y
AKRON GENERAL MEDICAL CENTER AKRON OH
SUMMA HEALTH SYSTEMS HOSPITALS AKRON OH
SAMARITAN REGIONAL HEALTH SYSTEM ASHLAND OH
UNIVERSITY HOSPITALS AHUJA MEDICAL CENTER BEACHWOOD OH Y
BELLEVUE HOSPITAL BELLEVUE OH
ADENA REGIONAL MEDICAL CENTER CHILLICOTHE OH Y
CLEVELAND CLINIC CLEVELAND OH Y
LUTHERAN HOSPITAL CLEVELAND OH
METROHEALTH SYSTEM CLEVELAND OH Y
ST VINCENT CHARITY MEDICAL CENTER CLEVELAND OH Y
WOODS AT PARKSIDE,THE COLUMBUS OH Y
GRAND LAKE HEALTH SYSTEM SAINT MARYS OH
MERCY TIFFIN HOSPITAL TIFFIN OH
MERCY ST ANNE HOSPITAL TOLEDO OH
MERCY ST VINCENT MEDICAL CENTER TOLEDO OH Y
UNIVERSITY OF TOLEDO MEDICAL CENTER TOLEDO OH Y
SURGICAL HOSPITAL AT SOUTHWOODS YOUNGSTOWN OH
CHICKASAW NATION MEDICAL CENTER ADA OK Y
PUSHMATAHA COUNTY TOWN OF ANTLERS HOSPITAL ANTLERS OK
ALLIANCEHEALTH BLACKWELL BLACKWELL OK Y
HILLCREST HOSPITAL CUSHING CUSHING OK Y
SUMMIT MEDICAL CENTER EDMOND OK Y
LINDSAY MUNICIPAL HOSPITAL LINDSAY OK
NORMAN REGIONAL HOSPITAL AUTHORITY NORMAN OK
O U MEDICAL CENTER OKLAHOMA CITY OK Y
NEWMAN MEMORIAL HOSPITAL SHATTUCK OK Y
ST ANTHONY SHAWNEE HOSPITAL SHAWNEE OK
OKLAHOMA STATE UNIVERSITY MEDICAL CENTER TULSA OK
SOUTHWESTERN REGIONAL MEDICAL CENTER, INC TULSA OK Y
TULSA SPINE & SPECIALTY HOSPITAL TULSA OK
CRAIG GENERAL HOSPITAL VINITA OK
WAGONER COMMUNITY HOSPITAL WAGONER OK
ASANTE ASHLAND COMMUNITY HOSPITAL ASHLAND OR Y
LEGACY MOUNT HOOD MEDICAL CENTER GRESHAM OR Y
WILLAMETTE VALLEY MEDICAL CENTER MCMINNVILLE OR
PROVIDENCE MEDFORD MEDICAL CENTER MEDFORD OR Y
SAINT ALPHONSUS MEDICAL CENTER – ONTARIO, INC ONTARIO OR
LEGACY EMANUEL MEDICAL CENTER PORTLAND OR Y
LEGACY GOOD SAMARITAN MEDICAL CENTER PORTLAND OR Y
PROVIDENCE ST VINCENT MEDICAL CENTER PORTLAND OR Y
SANTIAM MEMORIAL HOSPITAL STAYTON OR Y
LEHIGH VALLEY HOSPITAL ALLENTOWN PA Y
SACRED HEART HOSPITAL ALLENTOWN PA
SURGICAL SPECIALTY CENTER AT COORDINATED HEALTH ALLENTOWN PA Y
HERITAGE VALLEY BEAVER BEAVER PA Y
COORDINATED HEALTH ORTHOPEDIC HOSPITAL BETHLEHEM PA
GEISINGER – BLOOMSBURG HOSPITAL BLOOMSBURG PA
MAIN LINE HOSPITAL BRYN MAWR CAMPUS BRYN MAWR PA Y
BRANDYWINE HOSPITAL COATESVILLE PA Y
GEISINGER MEDICAL CENTER DANVILLE PA Y
MERCY FITZGERALD HOSPITAL DARBY PA
ELLWOOD CITY HOSPITAL ELLWOOD CITY PA
EPHRATA COMMUNITY HOSPITAL EPHRATA PA Y
SAINT VINCENT HOSPITAL ERIE PA Y
GETTYSBURG HOSPITAL GETTYSBURG PA
J C BLAIR MEMORIAL HOSPITAL HUNTINGDON PA
KANE COMMUNITY HOSPITAL KANE PA
ACMH HOSPITAL KITTANNING PA Y
LANCASTER GENERAL HOSPITAL LANCASTER PA
GNADEN HUETTEN MEMORIAL HOSPITAL LEHIGHTON PA
HEART OF LANCASTER REGIONAL MEDICAL CENTER LITITZ PA
PALMERTON HOSPITAL PALMERTON PA Y
MAIN LINE HOSPITAL PAOLI PAOLI PA Y
ALBERT EINSTEIN MEDICAL CENTER PHILADELPHIA PA Y
CANCER TREATMENT CENTERS OF AMERICA PHILADELPHIA PA Y
HAHNEMANN UNIVERSITY HOSPITAL PHILADELPHIA PA
HOSPITAL OF UNIV OF PENNSYLVANIA PHILADELPHIA PA Y
PENNSYLVANIA HOSPITAL PHILADELPHIA PA Y
ST JOSEPH’S HOSPITAL PHILADELPHIA PA Y
THOMAS JEFFERSON UNIVERSITY HOSPITAL PHILADELPHIA PA Y
ALLEGHENY GENERAL HOSPITAL PITTSBURGH PA
UPMC PRESBYTERIAN SHADYSIDE PITTSBURGH PA Y
WESTERN PENNSYLVANIA HOSPITAL PITTSBURGH PA
PUNXSUTAWNEY AREA HOSPITAL PUNXSUTAWNEY PA
READING HOSPITAL READING PA
NASON HOSPITAL ROARING SPRING PA Y
GRAND VIEW HOSPITAL SELLERSVILLE PA Y
GEISINGER WYOMING VALLEY MEDICAL CENTER WILKES BARRE PA Y
MEMORIAL HOSPITAL YORK PA Y
WELLSPAN SURGERY AND REHABILITATION HOSPITAL YORK PA
NEWPORT HOSPITAL NEWPORT RI
OUR LADY OF FATIMA HOSPITAL NORTH PROVIDENCE RI Y
MIRIAM HOSPITAL PROVIDENCE RI
RHODE ISLAND HOSPITAL PROVIDENCE RI Y
ROGER WILLIAMS MEDICAL CENTER PROVIDENCE RI
KENT COUNTY MEMORIAL HOSPITAL WARWICK RI
WESTERLY HOSPITAL WESTERLY RI Y
AIKEN REGIONAL MEDICAL CENTER AIKEN SC Y
MARLBORO PARK HOSPITAL BENNETTSVILLE SC
BON SECOURS-ST FRANCIS XAVIER HOSPITAL CHARLESTON SC
MUSC MEDICAL CENTER CHARLESTON SC Y
TRIDENT MEDICAL CENTER CHARLESTON SC
CHESTER REGIONAL MEDICAL CENTER CHESTER SC
PALMETTO HEALTH BAPTIST COLUMBIA SC Y
PALMETTO HEALTH RICHLAND COLUMBIA SC Y
CONWAY MEDICAL CENTER CONWAY SC Y
MARY BLACK HEALTH SYSTEM GAFFNEY GAFFNEY SC Y
SELF REGIONAL HEALTHCARE GREENWOOD SC
HILTON HEAD REGIONAL MEDICAL CENTER HILTON HEAD ISLAND SC
SPRINGS MEMORIAL HOSPITAL LANCASTER SC
GHS OCONEE MEMORIAL  HOSPITAL SENECA SC Y
SPARTANBURG REGIONAL MEDICAL CENTER SPARTANBURG SC Y
TUOMEY HEALTHCARE SYSTEM SUMTER SC
BROOKINGS HEALTH SYSTEM BROOKINGS SD
SANFORD USD MEDICAL CENTER SIOUX FALLS SD Y
ERLANGER MEDICAL CENTER CHATTANOOGA TN Y
MEMORIAL HEALTHCARE SYSTEM, INC CHATTANOOGA TN
GATEWAY MEDICAL CENTER CLARKSVILLE TN Y
HOUSTON COUNTY COMMUNITY HOSPITAL ERIN TN
TRISTAR HENDERSONVILLE MEDICAL CENTER HENDERSONVILLE TN Y
JACKSON-MADISON COUNTY GENERAL HOSPITAL JACKSON TN
WELLMONT HOLSTON VALLEY MEDICAL CENTER KINGSPORT TN
TENNOVA HEALTHCARE KNOXVILLE TN
THE UNIVERSITY OF TN MEDICAL CENTER KNOXVILLE TN Y
LIVINGSTON REGIONAL HOSPITAL LIVINGSTON TN
BAPTIST MEMORIAL HOSPITAL MEMPHIS TN Y
REGIONAL ONE HEALTH MEMPHIS TN Y
TRUSTPOINT HOSPITAL MURFREESBORO TN
METRO NASHVILLE GENERAL HOSPITAL NASHVILLE TN
SAINT THOMAS WEST HOSPITAL NASHVILLE TN
WELLMONT HAWKINS COUNTY MEMORIAL HOSPITAL ROGERSVILLE TN
METHODIST HEALTHCARE FAYETTE HOSPITAL SOMERVILLE TN Y
HIGHLANDS MEDICAL CENTER SPARTA TN
BAPTIST ST ANTHONY’S HOSPITAL AMARILLO TX
CARE REGIONAL MEDICAL CENTER ARANSAS PASS TX
SETON MEDICAL CENTER AUSTIN AUSTIN TX Y
ST DAVID’S SOUTH AUSTIN MEDICAL CENTER AUSTIN TX Y
UNIVERSITY MEDICAL CENTER AT BRACKENRIDGE AUSTIN TX Y
BAPTIST BEAUMONT HOSPITAL BEAUMONT TX
TEXAS HEALTH HARRIS METHODIST HURST-EULESS-BEDFORD BEDFORD TX
PHYSICIANS CENTRE,THE BRYAN TX
BAYLOR MEDICAL CENTER AT CARROLLTON CARROLLTON TX Y
BAYLOR SCOTT & WHITE EMERGENCY MEDICAL CENTER AT C CEDAR PARK TX
GOODALL WITCHER HOSPITAL CLIFTON TX Y
SCOTT & WHITE HOSPITAL- COLLEGE STATION COLLEGE STATION TX
BAYLOR UNIVERSITY MEDICAL CENTER DALLAS TX Y
PARKLAND HEALTH AND HOSPITAL SYSTEM DALLAS TX Y
TEXAS HEALTH PRESBYTERIAN HOSPITAL  DALLAS DALLAS TX Y
UT SOUTHWESTERN UNIVERSITY HOSPITAL ST PAUL DALLAS TX Y
TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON DENTON TX
NIX COMMUNITY GENERAL HOSPITAL DILLEY TX
MOORE COUNTY HOSPITAL DISTRICT DUMAS TX
UNIVERSITY MEDICAL CENTER OF EL PASO EL PASO TX Y
BAYLOR SCOTT AND WHITE ALL SAINTS MEDICAL CENTER FORT WORTH TX Y
JPS HEALTH NETWORK FORT WORTH TX Y
PLAZA MEDICAL CENTER OF FORT WORTH FORT WORTH TX
CENTENNIAL MEDICAL CENTER FRISCO TX
UNIVERSITY OF TEXAS MEDICAL BRANCH GALVESTON TX Y
BAYLOR SCOTT & WHITE MEDICAL CENTER  GRAPEVINE GRAPEVINE TX Y
HILL REGIONAL HOSPITAL HILLSBORO TX Y
CHI ST LUKE’S HEALTH BAYLOR COLLEGE OF MEDICINE ME HOUSTON TX
DOCTORS HOSPITAL TIDWELL HOUSTON TX
HARRIS HEALTH SYSTEM HOUSTON TX
HOPEBRIDGE HOSPITAL HOUSTON TX Y
ST LUKE’S HOSPITAL AT THE VINTAGE HOUSTON TX
BAYLOR MEDICAL CENTER AT IRVING IRVING TX
EAST TEXAS MEDICAL CENTER JACKSONVILLE JACKSONVILLE TX Y
MEDICAL ARTS HOSPITAL LAMESA TX
COVENANT HOSPITAL LEVELLAND LEVELLAND TX Y
GOOD SHEPHERD MEDICAL CENTER MARSHALL MARSHALL TX
RIO GRANDE REGIONAL HOSPITAL MCALLEN TX Y
NORTH HILLS HOSPITAL NORTH RICHLAND HILLS TX Y
MEMORIAL HERMANN BAPTIST ORANGE HOSPITAL ORANGE TX
SURGERY SPECIALTY HOSPITALS OF AMERICA SE HOUSTON PASADENA TX
BAYLOR REGIONAL MEDICAL CENTER AT PLANO PLANO TX
MEDICAL CENTER OF PLANO PLANO TX Y
THE HEART HOSPITAL BAYLOR PLANO PLANO TX Y
SCOTT & WHITE HOSPITAL-ROUND ROCK ROUND ROCK TX
SETON MEDICAL CENTER WILLIAMSON ROUND ROCK TX
CHRISTUS SANTA ROSA HOSPITAL SAN ANTONIO TX
INNOVA HOSPITAL SAN ANTONIO SAN ANTONIO TX
NIX HEALTH CARE SYSTEM SAN ANTONIO TX Y
UNIVERSITY HEALTH SYSTEM SAN ANTONIO TX Y
COGDELL MEMORIAL HOSPITAL SNYDER TX
TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHLAKE SOUTHLAKE TX
SUGAR LAND SURGICAL HOSPITAL LLP SUGAR LAND TX
SCOTT & WHITE MEMORIAL HOSPITAL TEMPLE TX Y
ST LUKES LAKESIDE HOSPITAL THE WOODLANDS TX Y
INTERMOUNTAIN MEDICAL CENTER MURRAY UT Y
THE ORTHOPEDIC SPECIALTY HOSPITAL MURRAY UT Y
MCKAY DEE HOSPITAL OGDEN UT Y
CASTLEVIEW HOSPITAL PRICE UT Y
UTAH VALLEY REGIONAL MEDICAL CENTER PROVO UT Y
RIVERTON HOSPITAL RIVERTON UT Y
LDS HOSPITAL SALT LAKE CITY UT Y
SALT LAKE REGIONAL MEDICAL CENTER SALT LAKE CITY UT Y
ST MARKS HOSPITAL SALT LAKE CITY UT Y
UNIVERSITY HEALTH CARE/UNIV HOSPITALS AND  CLINICS SALT LAKE CITY UT Y
BEAR RIVER VALLEY HOSPITAL TREMONTON UT Y
BEDFORD MEMORIAL HOSPITAL BEDFORD VA
UNIVERSITY OF VIRGINIA MEDICAL CENTER CHARLOTTESVILLE VA Y
INOVA FAIRFAX HOSPITAL FALLS CHURCH VA Y
WARREN MEMORIAL HOSPITAL FRONT ROYAL VA
CENTRA  HEALTH, INC LYNCHBURG VA Y
SMYTH COUNTY COMMUNITY HOSPITAL MARION VA
BON SECOURS DEPAUL MEDICAL CENTER NORFOLK VA Y
SENTARA NORFOLK GENERAL HOSPITAL NORFOLK VA
HIRAM W. DAVIS MEDICAL CENTER PETERSBURG VA Y
LEWISGALE HOSPITAL PULASKI PULASKI VA
MEDICAL COLLEGE OF VIRGINIA HOSPITALS RICHMOND VA Y
CARILION ROANOKE MEMORIAL HOSPITAL ROANOKE VA Y
STAFFORD HOSPITAL, LLC STAFFORD VA Y
SENTARA NORTHERN VIRGINIA MEDICAL CENTER WOODBRIDGE VA
BRATTLEBORO MEMORIAL HOSPITAL BRATTLEBORO VT
NORTHWESTERN MEDICAL CENTER INC SAINT ALBANS VT
MULTICARE AUBURN MEDICAL CENTER AUBURN WA Y
HIGHLINE MEDICAL CENTER BURIEN WA
SWEDISH ISSAQUAH ISSAQUAH WA
KENNEWICK GENERAL HOSPITAL KENNEWICK WA Y
MULTICARE GOOD SAMARITAN HOSPITAL PUYALLUP WA Y
VALLEY MEDICAL CENTER RENTON WA Y
HARBORVIEW MEDICAL CENTER SEATTLE WA Y
SWEDISH MEDICAL CENTER SEATTLE WA Y
SWEDISH MEDICAL CENTER / CHERRY HILL SEATTLE WA Y
DEACONESS HOSPITAL SPOKANE WA Y
PROVIDENCE HOLY FAMILY HOSPITAL SPOKANE WA Y
PROVIDENCE SACRED HEART MEDICAL CENTER SPOKANE WA Y
VALLEY HOSPITAL SPOKANE WA
LEGACY SALMON CREEK MEDICAL CENTER VANCOUVER WA
PEACEHEALTH SOUTHWEST MEDICAL CENTER VANCOUVER WA
YAKIMA VALLEY MEMORIAL HOSPITAL YAKIMA WA
MIDWEST ORTHOPEDIC SPECIALTY HOSPITAL FRANKLIN WI Y
ST VINCENT HOSPITAL GREEN BAY WI Y
UNIVERSITY OF WI  HOSPITALS & CLINICS AUTHORITY MADISON WI Y
HOLY FAMILY MEMORIAL MANITOWOC WI Y
MINISTRY SAINT JOSEPHS HOSPITAL MARSHFIELD WI Y
MILE BLUFF MEDICAL CENTER MAUSTON WI Y
WHEATON FRANCISCAN HEALTHCARE ST FRANCIS MILWAUKEE WI Y
WHEATON FRANCISCAN ST JOSEPH MILWAUKEE WI Y
DIVINE SAVIOR HEALTHCARE PORTAGE WI
WHEATON FRANCISCAN HEALTHCARE ALL SAINTS RACINE WI Y
MINISTRY SAINT MARYS HOSPITAL RHINELANDER WI
UW HEALTH PARTNERS  WATERTOWN REGIONAL MED CTR WATERTOWN WI Y
WAUKESHA MEMORIAL HOSPITAL WAUKESHA WI
ASPIRUS WAUSAU HOSPITAL WAUSAU WI Y
ST JOSEPHS COMMUNITY HOSPITAL OF WEST BEND WEST BEND WI
CABELL HUNTINGTON HOSPITAL INC HUNTINGTON WV Y
CAMDEN CLARK MEDICAL CENTER PARKERSBURG WV Y
PLEASANT VALLEY HOSPITAL POINT PLEASANT WV
OHIO VALLEY MEDICAL CENTER WHEELING WV Y
MOUNTAIN VIEW REGIONAL HOSPITAL CASPER WY Y
SAGEWEST HEALTH CARE RIVERTON WY

Source: Kaiser Health News analysis of data from the U.S. Centers for Medicare & Medicaid Services

NOTE: The penalties cover reimbursements from October 2015 through September 2016. Hospitals for veterans, children and other select groups are exempted, including “critical access hospitals,” which serve geographic areas where they are often the only providers.

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Where Are STDs Rampant? Google Wants To Help Researchers Find Out

With sexually transmitted diseases on the rise, researchers at the University of Illinois at Chicago think they might have a powerful new weapon to fight their spread: Google searches.

The nation’s leading search engine has quietly begun giving researchers access to its data troves to develop analytical models for tracking infectious diseases in real time or close to it. UIC is one of at least four academic institutions that have received access so far, along with the U.S. Centers for Disease Control and Prevention.

Researchers can mine Google data to identify searched phrases that spiked during previous upticks in a particular disease. Then, they measure the frequency of those searches in real time to estimate the number of emerging cases. For instance, a jump in gonorrhea might coincide with more people searching “painful urination” or other symptoms.

“If this works, it could revolutionize STD surveillance,” said Supriya Mehta, an associate professor of epidemiology at the UIC School of Public Health.

This KHN story also ran on NPR. It can be republished for free (details). logo npr

Search trends can be broken down by city and state, weighted according to their significance and combined with other data sources to give a snapshot of where disease is spreading well before public health agencies report the number of verified cases.

“We’re hoping for a bit of creativity to flourish around this,” Christian Stefansen, Google disease trends senior engineer, said during a visit to UIC last month, where he spoke to about 100 people about lessons Google learned in its attempts to mine data for public health. “There’s no shortage of communicable diseases, sadly.”

Sexually transmitted diseases are a growing threat, worsened by the progress of antibiotic-resistant strains, according to the CDC.  The agency reported in November that STDs, including chlamydia, gonorrhea and syphilis, all increased in 2014, with chlamydia reaching a record of more than 1.4 million new cases. Diagnoses are highest in 15- to 24-year olds, an age group where technology use also is high.

Public health advocates have long salivated over the idea of using Internet searches to track all sorts of diseases but were limited to the publicly available Google Trends tool.  It restricts the number of phrases that can be tracked and does not report searches that fall below certain undisclosed volume thresholds.

Google invited infectious disease researchers to apply for unrestricted access to search data in August as it disbanded its own real-time tracking tool, Flu Trends. Launched in 2008, Flu Trends broke ground but presistently overpredicted cases, and Google came under fire from some researchers for not disclosing its methodology. According to a paper published in Science by some independent researchers, Flu Trends stumbled because it used search terms that correlated with flu season but not actual cases of the flu and failed to adjust after Google introduced “search suggest” and other features to guide users to information.

Google is the most commonly used search engine in the U.S., with a 63.9 percent market share in October, according to comScore, a Reston, Va.-based analytics company.

Google searches can be tracked by city, providing more refined data than the national and multi-state data reported by the CDC. “It’s a phenomenal data  feed to work with, and there’s a lot that can be done with it from a research standpoint,” said Jeffrey Shaman, an associate professor in environmental health sciences at Columbia University’s Mailman School of Public Health, which was given access to the data.

But no matter how great it is, some researchers say they can’t rely on Google alone. Take flu, which is furthest along of any real-time disease-tracking effort, with at least nine teams working with the CDC on 12 forecasting models for the current season. This fall Boston Children’s Hospital and Harvard Medical School launched HealthMap FluCast, a tool that gives one- and two-week predictions by incorporating Google searches with the CDC’s weekly surveillance reports; electronic medical records from athenahealth; and Flu Near You, a website of patient-reported data.

In a recent paper FluCast architects say with multiple data sources they produce “more accurate and robust real-time flu predictions than any other existing system.” Co-founder John Brownstein said in an interview that FluCast will eventually add data from Twitter, though it’s “taking time to get the data in order.”

While flu patients may find it therapeutic to tweet about their high fevers, pounding headaches and extreme exhaustion, people who suspect they have a sexually transmitted illness are unlikely to vent about their symptoms via social media.

“In no way shape or form is someone going to tweet, ‘I have bumps on my vulva. Do you think it’s an STI?’” said Amy Johnson, a UIC PhD candidate who’s been studying the feasibility of using search data for tracking sexually transmitted infections.

Mehta agreed: “Because STDs are so stigmatized and personal, Twitter is not going to work for that.”

Robust STD tracking systems might incorporate additional search engines such as Yahoo! and Bing as well as weekly surveillance reports from local health departments, Johnson said.

Overreliance on one source is particularly risky if it’s a private company such as Google, which could remove access at any time. Even the CDC is hedging its bets; Matthew Biggerstaff, an epidemiologist who leads flu tracking efforts there, said the national health agency is exploring whether it can measure visits to its own website as a reliable disease indicator “so we have something that’s more of a public data set.”

And it remains to be seen just how real-time data could be used by public health agencies and providers. In the coming months, the CDC will be asking state and local health departments what type of flu data they want — real-time versus three-month forecasting, for example — and how they would use it, Biggerstaff said.

“Producing it and showing that it works is different than operationalizing it,” Biggerstaff said. “It’s still new in terms of incorporating it into a public health data stream.”

Then, there’s the issue of public trust. Researchers emphasize that no one’s privacy will be violated. Even with their unprecedented data access, researchers will not be able to tell who performs a query, what their sex or ethnicity is, or even what neighborhood that person lives in, Johnson said.

“I’m not going to knock on their door and tell their wife or their husband they have a sexually transmitted infection,” Johnson said. “It’s important for people on the individual level to know it’s about community health.”

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