your surgery survival guide (consumer reports)

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DONt get harmeD iN the hOspital Jacqueline Birnbaums father might have lived if not for a hospital-acquired infection she feels could have been avoided.

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surgery is scary. It usually involves having your body cut open, and sometimes things go wrong. You react badly to anes-thesia, or suffer breathing or heart prob-lems. Or maybe the surgeon nicks a blood vessel, leaves an instrument inside, or even operates on the wrong body part.

Less dramatic but often as serious and far

more common is when things go wrong after you leave the operating room. Up to 30 percent of patients suffer infections, heart attacks, strokes, or other complica-tions after surgery and sometimes even die as a result. Thats what happened to Marvin Birnbaum, a retired New York City court reporter, after he developed an infection following hip replacement surgery, his daughter Jacqueline says.

Perhaps scariest of all, though many hospitals now gather data on those prob-lems, patients for the most part remain in the dark about surgical safety. Industry insiders have access to some of that infor-mation because hospitals track how well patients do and report results to state and national officials.

Plus, some hospitals submit data to na-tional registries so that they can see how they stack up against one another. But

that safety information remains largely hidden from patients.

Consumers have very little to go on when trying to select a hospital for sur-gery, not knowing which ones do a good job at keeping surgery patients safe and which ones dont, says Lisa McGiffert, director of Consumers Unions Safe Patient Project. They might as well just throw a scalpel at a dartboard.

Our new surgery Ratings are part of an ongoing effort to shed light on hospital quality and to push the health care indus-try toward more transparency. Because patients and their families shouldnt have to make such important decisions with so little information, McGiffert says.

Showing the data Our Ratings for the first time make public a measure that some hospitals now use to

Your safer-surgery survival guideOur Ratings of 2,463 U.S. hospitals can help you find the right one

Inside

hospitals that make the grade page 33Check up on your hospital page 35six steps to safer surgery page 36

Whats behind our surgery ratings page 37surgery ratings page 37

32 consumer reports s e p t e m b e r 2 01 3

feature safer surgery

track qualitythe percentage of Medicare patients undergoing surgery who die in the hospital or stay longer than expected.

We looked at results for 27 kinds of scheduled surgeries, which we combined into an overall surgery Rating, and also developed Ratings for five of those proce-dures: back surgery, replacements of the hip or knee, and procedures to remove blockages in arteries in the heart (angio-plasty) or neck (carotid artery surgery).

To develop the Ratings, we worked with MPA, a health care consulting firm with expertise in analyzing medical claims and clinical records. This project uses billing claims that hospitals submitted to Medi-care for patients 65 and older, from 2009 through 2011, and covers 2,463 hospitals in all 50 states plus Washington, D.C., and Puerto Rico.

The beauty of this approach is that pre-ventable complications correlate with post-operative length of stay, says Arnold Millstein, M.D., M.P.H., director of the Clinical Excellence Research Center at Stanford University. He was not involved in our analysis but has studied how hospi-tals measure and improve quality. This is about as good as complications measure-ment can be when using existing claims data, he says.

Some experts say that may not be good enough. For one thing, factors other than complications can contribute to extended hospital stays. In addition, we are con-cerned that the methods used to generate these performance ratings have not been validated against gold-standard measures, says David M. Shahian, M.D., vice presi-dent of the Lawrence Center for Quality and Safety at Massachusetts General Hos-pital. They are based on claims data rather than clinical data from patient records.

In addition, our surgery Ratings are just one indication of a hospitals performance. There are a lot of dimensions to hospital quality, and no single measure captures everything, says Peter Cram, M.D., di-rector of general medicine at the Univer-sity of Iowa Carver College of Medicine.

But we think our Ratings offer vital infor-mation to patients and hospitals. We wish we had access to more comprehensive, standardized information, but this is the best that is available, says John Santa, M.D., M.P.H., medical director of Con-sumer Reports Health. Our surgery Rat-ings give patients more information so that they can make informed choices be-fore surgery, he adds. And we hope that

by highlighting performance differences, we can motivate hospitals to improve.

What we found Our analysis offers important and surpris-ing insights for patients and hospitals: Some hospitals do a much better job than others. Our Ratings reflect wide variation, sometimes between hospitals only a few miles apart. For example, the Greater Bal-timore Medical Center earned high marks in our overall surgery Rating, as well as for several individual procedures. But the Johns Hopkins Bayview Medical Center, also in Baltimore, got a low Rating. A rep-resentative for the hospital said, We han-dle many complex cases and are always looking for ways to address any opportuni-ties for improvement. Teaching hospitals, thought to represent the nations best and the recipients of gen-erous federal funding, often fell short in our surgery Ratings. Though some did rate high, on average teaching hospitals per-formed no better than other hospitals. Urban and rural hospitals can excel. We found several urban hospitals that did well

despite often serving poorer, sicker pa-tients, including Mount Sinai Hospital in New York and University Hospitals Case Medical Center in Cleveland. And rural hospitals actually did better, on average, than other hospitals. Big-name hospitals dont always live up to their reputation when it comes to these surgery Ratings. For example, though several Mayo Clinic hospitals did well, others rated only average. And the Mayo Clinic Health System in Austin, Minn., got a low overall Rating. Hospital choice matters more for some procedures than for others. For example, we found wider variation for several sur-geries, including hip and knee replace-ments and back surgery, than for others, such as colon surgery and hysterectomy. Specialty hospitals tended to do better. For example, six of the top performers for carotid artery surgery were heart hospitals. But thats not always the case. For example, Hospital for Special Surgery in New York, which specializes in orthopedics, earned high marks in our other Ratings that focus on infections related to surgical incisions. ph

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turNarOuND Marcia Nelson, M.D., helped lead efforts to improve a struggling California hospital.

In this its 100th anniversary year, enloe medical Center in Chico, Calif., made our list of high-performing hospitals. but seven years ago, it was in troublepatient satisfaction scores had hit rock bottom, key physicians and hospital leaders had left, and patient deaths had drawn the scrutiny of state and national officials. It wasnt the hospital we wanted it to be, says marcia Nelson, m.D., vice president of medical affairs for the nonprofit hospital. We committed to becoming a patient-centered environment. she points to a yearly quality summit, where departments showcase results and choose initiatives for the coming year. some people think this organization-wide focus on quality is something all hospitals do, she says. It isnt. Its something special we do, and we are seeing the benefit.

One hospitals success story


Fortunately, experts have developed ways to reduce many complications. For example, some hospitals have actually eliminated infections introduced through intravenous catheters by following a checklist. The best hospitals pay attention to detail, says Ateev Mehrotra, M.D., a lecturer at Harvard Medical School and a policy analyst at the nonprofit RAND Cor-poration. Its often the accumulation of a lot of little things instead of one big thing that leads to a worse outcome, he says.

Little reason to improve Unfortunately, hospitals often have little incentive to improve patient safety. The

longer a patient stays in the hospital and the more tests and treatments he or she undergoes, the more money the hospital often makes, according to a study in the April 17, 2013, issue of the Journal of the American Medical Association.

Researchers looked at 12 institutions in a single hospital system and found that for privately insured patients, hospitals made $30,000 or more per patient when things went wrong. For Medicare patients, they also tended to make more, but it was closer to an additional $2,000.

Experts dont think that hospitals sabo-tage patient safety. In all my years of clin-ical practice, I never saw or heard of anyone intentionally causing a complication,

But it got low marks in our hip and knee surgery Ratings, which look at how surgery patients fare over their entire hospital stay. A representative for the hospital said, The results are not consistent with the data from our own research or with data from state and federal agencies.

What can go wrongProblems during or after surgery often start small, then escalate, sometimes with devastating effect. Case in point: Marvin Birnbaum.

The only thing holding him back from enjoying retirement was a painful left hip, his daughter says. So he decided to get it replaced at St. Lukes-Roosevelt Hospital Center in New York. The surgery itself went well. But what followed was hor-rific, she says, as her 85-year-old father and his team of doctors battled infection.

After running an eight-week gantlet of treatments, including open-heart surgery to treat an infected heart valve, her fathers body finally shut down. He spent two more weeks in a persistent vegetative state before the family made the agonizing decision to remove life support, says Birnbaum, a music therapist at New York University.

St. Lukes-Roosevelt earned a low overall surgery Rating but scored well on commu-nications with patients and pain manage-ment in our previous hospital Ratings. A representative says its mortality rates for joint replacement surgeries are within the averages for New York hospitals. Even under these high standards, pa-tients, unfortunately, still can develop complications, he says. It is a challenge that every hospital faces.

Her fathers downward spiral started, Birnbaum says, with one of the most com-mon and serious types of complicationsan infection he contracted in the hospital after the procedure. Surgical incisions, catheters, and intravenous lines give bacteria direct access to a patients bloodstream.

Surgery patients are also prone to blood clots, in part because reduced mobility prevents blood from circulating. Clots that break off and travel to the heart or lungs can be deadly. And the combination of ly-ing flat and shallow breathing hampers the bodys ability to clear the lungs, leav-ing patients susceptible to pneumonia.

Those are the most common serious complications. But of course, anyone re-cuperating in a hospital after surgery is vulnerable to a host of other mishaps, such as drug allergies or interactions, and falls.

Well-known hospitals dont always live up to their reputations.

Hospitals that make the gradeAnne Arundel medical Center, Annapolis, md.Christ Hospital, Cincinnatienloe medical Center, Chico, Calif.Greater baltimore medical Center, baltimorememorial Health system,

Colorado springs, Colo.

Oklahoma Heart Hospital, Oklahoma Citypenrose-st. Francis Health services,

Colorado springs, Colo.

scripps Green Hospital, La Jolla, Calif.trinity rock Island, rock Island, Ill.Yavapai regional medical Center, prescott, Ariz.

We wanted to see which hospitals did well across a broad range of surgeries. So we looked first at hospitals that got our highest overall surgery Rating, then narrowed it down to those that regularly did at least 10 kinds of surgeries and got a high Rating in at least 30 percent of those, without earning a low Rating for any surgery. You might be surprised by the 10 U.S. hospitals, listed alphabetically, that meet that test.

says study author William Berry, M.D., M.P.H., director of the Safe Surgery 2015 initiative at the Harvard School of Public Health. And Medicare now penalizes hos-pitals if readmissions are too high for some conditions. That may encourage them to pay more attention to safety. But some hospitals may continue to avoid doing all that they can to improve patient safety. Berry says his research sends a powerful message to policy makers about problems in the current system, but it may say some-thing entirely different to bean counters concerned primarily with profits.

Whats in a name?Jacqueline Birnbaum says her father chose his hospital because he was familiar with it and it had a good reputation. But as our Ratings show, that may not be enough. As health care has grown more complex, how well a hospital is regarded in the commu-nity or among medical professionals doesnt tell you all that you need to know.

For example, Massachusetts General Hospital earned top scores in U.S. News & World Reports 2012-2013 rankings. And it did well in heart bypass surgery ratings, based on clinical data, that we previously published. But it earned a low mark in these overall surgery Ratings, as well as low Ratings for hip replacement and ca-rotid artery surgery.

Shahian, at Massachusetts General, says the hospital has a robust quality-assessment program based on nationally validated methods. He adds that the hos-pital often cares for complex cases and that Consumer Reports surgery Ratings dont account for the increased risk of these patients.

Even hospitals recognized by experts as


Higher- and lower-rated hospitals for five common surgeriesOur overall surgery ratings, shown on page 37, are based on the percentage of a hospitals medicare patients who die in the hospital or stay longer than expected, for 27 kinds of surgeries combined. below, we show how hospitals rated for five specific surgeries. We looked at hospitals that performed the most of each of those surgeries, and identified hospitals with our highest or lowest ratings in each procedure (listed alphabetically within procedure). Online subscribers can see how hospitals rated in those surgeries at ConsumerReports.org/hospitalratings. A few notable findings:


meeting a rigorous set of industry stan-dards often dont perform better than oth-ers. For example, complication rates for hip replacements were only somewhat lower at hospitals designated as joint replacement Centers of Excellence, according to a Janu-ary 2013 study of 120,000 patients in the

journal Medical Care. The criteria for the Center of Excellence designation make a lot of sense, and we came into this expecting to see a difference, lead author Mehrotra says. The results put consumers in an awk-ward position of not being able to feel as confident about their choice.

How to chooseIdeally, youd be able to peer beyond labels and subjective recommendations and look at hard numbers to see how hospitals stack up. Health care insiders do have access to some of that information. The American College of Surgeons, for example, analyzes

higher-rateD hOspitals lOWer-rateD hOspitals

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KNee replaCemeNt ratiNgChristiana Care Health System Newark, Del. &Z Beaumont HospitalRoyal Oak royal Oak, mich. &BMcBride Clinic Orthopedic Hospital Oklahoma City &Z Florida Hospital Orlando, Fla. &BNew Hanover Regional Medical Center Wilmington, N.C. &Z Hospital for Special Surgery New York &BSaint Francis Hospital and Medical Center Hartford, Conn. &Z Iowa Methodist Medical Center Des moines, Iowa &BSt. Vincents Medical Center Riverside Jacksonville, Fla. &Z NCH Downtown Naples Hospital Naples, Fla. &Bhip replaCemeNt ratiNgOcala Regional Medical Center Ocala, Fla. &Z Hospital for Special Surgery New York &BSaint Francis Hospital and Medical Center Hartford, Conn. &Z Inova Mount Vernon Hospital Alexandria, Va. &BSaint Johns Health Center santa monica, Calif. &Z Massachusetts General Hospital boston &BSwedish Medical Center-First Hill seattle &Z Sentara Leigh Hospital Norfolk, Va. &BWashington Hospital Healthcare System Fremont, Calif. &Z Thomas Jefferson University Hospital philadelphia &BBaCK surgery ratiNg (spinal fusion or disc surgery in the neck or lower back) Boone Hospital Center Columbia, mo. &Z Brookwood Medical Center birmingham, Ala. &BCenter for Spinal Surgery Nashville, tenn. &Z Huntsville Hospital Huntsville, Ala. &BCitrus Memorial Health System Inverness, Fla. &Z The Methodist Hospital Houston &BKansas Spine Hospital Wichita, Kan. &Z St. Vincent Infirmary Medical Center Little rock, Ark. &BSt. Josephs Hospital and Medical Center phoenix &Z Vidant Medical Center Greenville, N.C. &BCOrONary aNgiOplasty ratiNg (a procedure to remove blockages in arteries supplying the heart, combined with the insertion of a stent)Arkansas Heart Hospital Little rock, Ark. &Z Kaweah Delta Medical Center Visalia, Calif. &BKings Daughters Medical Center Ashland, Ky. &Z MedStar Washington Hospital Center Washington, D.C. &BMount Sinai Hospital New York &Z Methodist Healthcare Memphis Hospitals memphis, tenn. &BNew York-Presbyterian Hospital New York &Z North Florida Regional Medical Center Gainesville , Fla. &BSt. Francis Hospital roslyn, N.Y. &Z Palm Beach Gardens Medical Center palm beach Gardens, Fla. &B

St. Joseph Mercy Oakland pontiac, mich. &BCarOtiD artery surgery ratiNg (a procedure to remove blockages in arteries supplying the brain)Baylor Jack and Jane Hamilton Heart and Vascular Hospital Dallas &Z Baptist Health Lexington Lexington, Ky. &BKansas Heart Hospital Wichita, Kan. &Z Baptist St. Anthony Health System Amarillo, texas &BMother Frances HospitalTyler tyler, texas &Z Cookeville Regional Medical Center Cookeville, tenn. &BNebraska Heart Hospital Lincoln, Neb. &Z Massachusetts General Hospital boston &BOklahoma Heart Hospital Oklahoma City &Z St. Francis Hospital roslyn, N.Y. &B

St. John Medical Center tulsa, Okla. &B Member of the Association of American Medical College's Council of Teaching Hospitals. Have the same surgical volumes for the listed procedure.

Better Worse5 4 3 2 1


teaching hospitals were no better than other hospitals for hip, knee, and back surgeries but were better for angioplasty and carotid artery surgery.specialty hospitals tended to do better overall, including for the procedures shown below.scoring high in one procedure is no guarantee of success in others. st. Francis Hospital, in roslyn, N.Y., for example, got our highest rating for angioplasty but our lowest rating for carotid artery surgery.


hospital data as part of its National Surgi-cal Quality Improvement Program (NSQIP). It allows hospitals to gauge how theyre doing compared to other hospitals, and to target specific areas for improvement, says Clifford Ko, M.D., director of the Divi-sion of Research and Optimal Patient Care at the American College of Surgeons.

But most NSQIP data are off-limits to the public. When asked how consumers are supposed to evaluate the quality of their hospital, Ko responded that there really isnt a good answer. It can be a dif-ficult thing for consumers to evaluate the quality of their hospital, he says, be-cause there are so many possible ways to look at it and present the information.

A safer future?Dad always consulted Consumer Re-ports before buying anything, Birn-baum says. She wishes these hospital Ratings had been available when her father had surgery in 2009. People need to know this information, she adds.

Thanks to health care reform, hospitals are encouraged to move to electronic

record keeping, which will make it easier to track data. And some professional organizationssuch as those that focus on eye surgery, heart surgery, and joint replacementare starting to make infor-mation available. The American College of Surgeons, for example, now pub-lishes some of its NSQIP data on the governments Hospital Compare website. And the Society of Thoracic Surgeons now makes information on heart bypass surgery available for many hospitals and surgical groups, which we publish at ConsumerReports.org/heartratings.

But all of those cases involve voluntary reporting, and some are limited to a small number of hospitals. As Berry and his Harvard colleagues help hospitals in-stitute safer surgery practices, one of their biggest frustrations is getting that information to consumers.

If you have ever been a patient, then you have been on the wrong side of the power equation, Berry says. Now is re-

the safest hospitals pay close attention to details.

Check up on your hospital

by tHe numbers 226 Hospitals with highest surgery rating 221 Hospitals with lowest ratingp

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Check up on your surgeon1 look at state licensing boards. Administrators In medicine has links to state medical boards (docboard.org/docfinder.html), which have information on licensing and disciplinary actions against physicians. 1 make sure your doctor is board certified. the American board of medical specialties (CertificationMatters.org) can tell you whether your doctor has completed an approved residency program and passed a written and, in some cases, oral exam in one of at least 24 medical specialty areas.

1 use our hospital ratings. the surgery ratings on page 37 show how hospitals in your area compared. For a list of all rated hospitals, see the ipad version of our story or go to ConsumerReports.org/surgeryratings. subscribers to our website can get more detailed information at ConsumerReports.org/hospitalratings. Once there, click on: Your state for an overview of how hospitals performed in our safety score, which includes information from surgical and nonsurgical patients, as well as ratings on other measures, such as readmissions, bloodstream infections, and communication about drugs. A hospitals name for even more details, including its rating for five surgeries: back surgery, hip and knee replacements, and surgeries to clear blockages in the arteries in the heart (angioplasty) or neck (carotid artery surgery). Whats behind Our ratings for a

1 talk with your surgeon. experts we spoke with said they welcome hard questions because informed patients tend do better. Ask about the percentage of patients seen by the surgeon who suffer infections, blood clots, heart attacks, or other complications; how many patients are readmitted or die within 30 days; and how those percentages compare with national averages. Also ask how often he or she performs the procedure. many surgeons know the answers; if they wont answer, look elsewhere.

detailed description of our methodology. 1 Consider other sources. Good sources include Hospital Compare (hospitalcompare.hhs.gov), state health departments, and the Leapfrog Group (leapfroggroup.org), a nonprofit organization that collects data on hospital quality for employer members and their employees.1 Know what insurance covers. Verify which hospitals are in your plans network (and be aware that even if a hospital is in the network, doctors who practice there may not be); the difference between in-network and out-of-network costs, such as deductibles or coinsurance; and whether your procedure requires pre-authorization. 1 get firsthand experiences. Anecdotal experiences arent always reliable, but it can help to talk to friends and family members (especially those who work in hospitals) about their stay.



six steps to safer surgery

1go preparedstart healthy. be as active as possible in the weeks leading up to surgery. make sure blood pressure and blood sugar are well controlled. If you smoke, quiteven if only temporarilybecause smoking slows recovery and increases your risk of infection.

schedule carefully. Having surgery early in the week is best. research shows that the death rate for patients having scheduled surgeries is higher later in the week and on weekends. staffing may be lighter on weekends, nights, and holidays, and it can take longer to get lab results. time of day may matter, too: earlier surgeries may benefit from a fresher surgical team.

appoint an advocate. Ask a friend or family member to help monitor your care, by asserting your needs and preferences, asking questions, retaining copies of important medical documents, and advocating for you if problems arise. Ideally, your companion should help you during check-in and discharge, and visit daily.

2avoid infections rid your body of harmful bacteria. Carefully follow your surgeons instructions for cleaning your body before you go to the hospital.

get your nose swabbed. that can check for methicillin-resistant staphylococcus aureus (mrsA), a hard-to-treat bacteria you might bring into the hospital with you.

ask about antibiotics. For most in-patient procedures, antibiotics should be started within an hour of your surgery and, in most cases, stopped 24 hours later.

say no to razors. razor nicks provide an opening for infection. If hair must be removed, electric clippers are safer.

stay warm. the drop in body temperature that occurs during surgery can impede blood

flow and impair immune function. Ask whether a surgical blanket or another technique will be used to keep you warm.

insist on clean hands. Ask your nurses, doctors, and anyone who touches you to wash their hands before examining you if you didnt see them do so.

ask every day whether tubes can be removed. the longer urinary catheters, central lines, or breathing tubes stay in your body, the greater your risk of developing a potentially deadly infection.

3prevent blood clots assess your clot risk. make sure your doctor asks about factors such as smoking or use of oral contraceptives that can increase the risk of developing a clot, which can cause leg pain or, more dangerously, travel to your lungs.

ask about prevention. You may need to take blood-thinning medications or to use inflatable cuffs on your legs after surgery to prevent blood clots.

get moving. When youre able, make sure a hospital staff member helps you get out of bed to sit in a chair or walk down the hall.

4protect your heart Know your risk. If you are 50 or older, your doctor should check your risk of having a heart attack or stroke. to assess your risk, use our calculator at ConsumerReports.org/heartrisk.

ask about beta-blockers. If you are at high risk for heart attack or stroke, ask whether you should be given beta-blockers before surgery to protect the heart from stress hormones that can trigger a too-rapid heartbeat. If you already take

beta-blockers, make sure they are not stopped while youre in the hospital.

5Keep breathing talk about sleep apnea. tell your doctor and anesthesiologist whether you have sleep apnea, which can increase the risks of anesthesia and pain medications. If you havent been diagnosed with sleep apnea but have been told that you snore loudly or you are unusually tired during the day, talk to your doctor about being checked for the condition.

Do deep-breathing and coughing exercises. make sure someone teaches you those exercises when you are recovering from surgery. they can help prevent pneumonia and partial collapse of the lungs.

6get the right drugs Bring a drug list. make sure it includes over-the-counter and prescription medications, vitamins, and herbals, as well as any drug allergies.

track your meds. the most common drug errors are inadvertent changes to existing medications. Ask your doctor about any changes to your drug regimen during your hospital stay.

Some hospitals and surgeons now use checklists before procedures to reduce complications, much as airline pilots do before taking off. We think all hospitals should do so. And we think patients and families should use checklists, too, to make sure they do what they can to stay safe while in the hospital. Heres ours:

ally the time to bring the consumers voice into the discussion about quality.

Consumers Union, the policy arm of Consumer Reports, aims to do just that through its Safe Patient Project. It works with patient advocates to highlight the things that can go wrong in hospitals and to urge state and federal governments, as well as hospital administrators, to take steps necessary to improve patient safety.

Safe Patient Project goals include: Expanding public reporting by hospitals on surgical-site infections. Thats now re-quired nationally only for colon surgery and abdominal hysterectomy. Requiring federally funded hospital safety projects to publicly report their results. Establishing a standardized way for pa-tients to report medical errors.

If you think you have been harmed in

the hospital, contact your local or state health department or if you are on Medi-care, your states Medicare Quality Im-provement Organization.

An effective way to get hospitals and legislatures to focus on the problem is for patients to share their stories, says McGiffert at the Safe Patient Project. To tell us yours, go to safepatientproject.org/share-your-story. ph

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how to choose a hospital

Use your smart phone to download the redLaser or shopsavvy app and scan the code for video.

Whats behind our surgery Ratingsthe ratings on the following pages look at how hospitals nationwide compare in avoiding adverse events in medicare patients duringtheir hospital stay for surgery. specifically, the ratings are based on the percentage of a hospitals surgery patients who died in the hospital or stayed longer than expected for their procedure. research shows those measures are correlated with complications, and some hospitals themselves use this approach to monitor quality. to develop the ratings, we worked with mpA, a health care consulting firm with expertise in analyzing billing claims and clinical records data and in helping hospitals use the information to improve patient safety. the analysis looked at medicare claims data from 2009 through 2011 for patients undergoing 27 categories of common

scheduled surgeries. For each hospital, the results for all procedures are combined into an overall surgery rating. In addition, we have ratings for five of those procedures on our website (ConsumerReports.org/hospitalratings): back surgery, replacement of the hip or knee, and surgery to remove blockages in arteries in the heart (angioplasty) or neck (carotid artery surgery). the rates are risk-adjusted based on patient characteristics, such as age, gender, and other health conditions, including high blood pressure and diabetes. the ratings dont take into account complications that became apparent after patients were discharged from the hospital. We have ratings for the 2,463 U.s. acute-care or critical-access hospitals with sufficient medicare fee-for-service in-patient surgical claims data from patients 65 and older.

We dont have ratings for Veterans Affairs hospitals and hospitals that see mostly medicare Advantage patients, such as many Kaiser hospitals, because they use another reporting system. the hospitals shown below are organized by state and listed by their rating. Hospitals with the same rating are alphabetized. For a full description of our methodology, as well as more information on hospitals, go to ConsumerReports.org/hospitalratings.

Hospital name Surgery Rating

ALABAMAJack Hughston Memorial Hospital Phenix City &XThomas Hospital Fairhope &XAndalusia Regional Hospital Andalusia &CBaptist Medical Center East Montgomery &CCrestwood Medical Center Huntsville &CCullman Regional Medical Center Cullman &CDeKalb Regional Medical Center Fort Payne &CHelen Keller Hospital Sheffield &CJackson Hospital and Clinic Montgomery &CMarshall Medical Center North Guntersville &CMarshall Medical Center South Boaz &CMedical Center Enterprise Enterprise &CMedical West Bessemer &CNorthport Medical Center Northport &CPrinceton Baptist Medical Center Birmingham &CProvidence Hospital Mobile &CRussell Medical Center Alexander City &CRussellville Hospital Russellville &CShelby Baptist Medical Center Alabaster &CSouth Baldwin Regional Medical Center Foley &CStringfellow Memorial Hospital Anniston &CVaughan Regional Medical Center Selma &CWalker Baptist Medical Center Jasper &CDCH Regional Medical Center Tuscaloosa &VFlowers Hospital Dothan &VHuntsville Hospital Huntsville &VNortheast Alabama Regional Medical Center Anniston &VSoutheast Alabama Medical Center Dothan &VBaptist Medical Center South Montgomery &BBrookwood Medical Center Birmingham &BDecatur General Hospital Decatur &B


ALABAMA continuedEast Alabama Medical Center Opelika &BEliza Coffee Memorial Hospital Florence &BGadsden Regional Medical Center Gadsden &BMobile Infirmary Medical Center Mobile &BRiverview Regional Medical Center Gadsden &BSpringhill Memorial Hospital Mobile &BSt. Vincent's Birmingham Birmingham &BSt. Vincent's East Birmingham &BTrinity Medical Center Birmingham &BUniversity of Alabama Hospital Birmingham &BALASKAAlaska Native Medical Center Anchorage &CAlaska Regional Hospital Anchorage &CCentral Peninsula General Hospital Soldotna &CFairbanks Memorial Hospital Fairbanks &CMat-Su Regional Medical Center Palmer &CProvidence Alaska Medical Center Anchorage &VARIzoNAArizona orthopedic Surgical Hospital Chandler &ZArizona Spine and Joint Hospital Mesa &ZArrowhead Hospital Glendale &ZBanner Baywood Medical Center Mesa &ZBanner Boswell Medical Center Sun City &ZBanner Heart Hospital Mesa &ZMayo Clinic Hospital Phoenix &ZNorthwest Medical Center Tucson &Zoro Valley Hospital Oro Valley &ZScottsdale Healthcare Thompson Peak Hospital Scottsdale &ZScottsdale Healthcareosborn Medical Center Scottsdale &ZSurgical Specialty Hospital of Arizona Phoenix &ZYavapai Regional Medical Center Prescott &Z


ARIzoNA continuedBanner Del E. Webb Medical Center Sun City West &XMercy Gilbert Medical Center Gilbert &XScottsdale Healthcare Shea Medical Center Scottsdale &XUniversity of Arizona Medical CenterUniversity Campus Tucson &XYavapai Regional Medical CenterEast Prescott Valley &XArizona Regional Medical Center Mesa &CBanner Desert Medical Center Mesa &CBanner Estrella Medical Center Phoenix &CBanner Gateway Medical Center Gilbert &CBanner Good Samaritan Medical Center Phoenix &CBanner Thunderbird Medical Center Glendale &CCarondelet St. Joseph's Hospital Tucson &CCarondelet St. Mary's Hospital Tucson &CCasa Grande Regional Medical Center Casa Grande &CChandler Regional Medical Center Chandler &CFlagstaff Medical Center Flagstaff &CJohn C. Lincoln Deer Valley Hospital Phoenix &CJohn C. Lincoln North Mountain Hospital Phoenix &CKingman Regional Medical Center Kingman &CMountain Vista Medical Center Mesa &Coasis Hospital Phoenix &CParadise Valley Hospital Phoenix &CPayson Regional Medical Center Payson &CPhoenix Baptist Hospital Phoenix &CSierra Vista Regional Health Center Sierra Vista &CSt. Joseph's Hospital and Medical Center Phoenix &CSt. Luke's Medical Center Phoenix &CSummit Healthcare Regional Medical Center Show Low &C

2 consumer reports september 2 01 3


ARIzoNA continuedTMC Healthcare Tucson &CValley View Medical Center Fort Mohave &CVerde Valley Medical Center Cottonwood &CWest Valley Hospital Goodyear &CYuma Regional Medical Center Yuma &CHavasu Regional Medical Center Lake Havasu City &VWestern Arizona Regional Medical Center Bullhead City &VARKANSASArkansas Heart Hospital Little Rock &ZArkansas Surgical Hospital North Little Rock &ZMedical Center of South Arkansas El Dorado &ZMercy Hospital Rogers Rogers &ZPhysicians' Specialty Hospital Fayetteville &XBaxter Regional Medical Center Mountain Home &CConway Regional Medical Center Conway &CJefferson Regional Medical Center Pine Bluff &CMercy Hospital Hot Springs Hot Springs National Park &CNEA Baptist Memorial Hospital Jonesboro &CNorth Arkansas Regional Medical Center Harrison &CNorthwest Medical Center Springdale &Couachita County Medical Center Camden &CSaline Memorial Hospital Benton &CSparks Regional Medical Center Fort Smith &CSt. Bernards Medical Center Jonesboro &CSt. Vincent Medical CenterNorth Sherwood &CSummit Medical Center Van Buren &CUAMS Medical Center Little Rock &CWashington Regional Medical Center Fayetteville &CWhite County Medical Center Searcy &CArkansas Methodist Medical Center Paragould &VMercy Hospital Fort Smith Fort Smith &VNational Park Medical Center Hot Springs &VSaint Mary's Regional Medical Center Russellville &VBaptist Health Medical CenterNorth Little Rock North Little Rock &BBaptist Health Medical CenterLittle Rock Little Rock &BSt. Vincent Infirmary Medical Center Little Rock &BWhite River Medical Center Batesville &BCALIFoRNIAAlvarado Hospital San Diego &ZCentinela Hospital Medical Center Inglewood &ZEisenhower Medical Center Rancho Mirage &ZEnloe Medical Center Chico &ZFrench Hospital Medical Center San Luis Obispo &ZFresno Heart and Surgical Hospital Fresno &ZFresno Surgical Hospital Fresno &ZHoag orthopedic Institute Irvine &Z


CALIFoRNIA continuedMercy Medical Center Redding Redding &Zoroville Hospital Oroville &ZSacramento Medical Center Sacramento &ZSaint John's Health Center Santa Monica &ZScripps Green Hospital La Jolla &ZSequoia Hospital Redwood City &ZShasta Regional Medical Center Redding &ZSt. Helena Hospital Napa Valley Saint Helena &ZSt. Joseph Hospital Orange &ZSutter Lakeside Hospital Lakeport &ZSutter Surgical HospitalNorth Valley Yuba City &ZUC San Diego Health System San Diego &ZUniversity of California, Irvine Healthcare Orange &ZWashington Hospital Healthcare System Fremont &ZAlta Bates Summit Medical Center Berkeley &XAlta Bates Summit Medical CenterSummit Campus Oakland &XBakersfield Heart Hospital Bakersfield &XChapman Medical Center Orange &XClovis Community Medical Center Clovis &XDesert Valley Hospital Victorville &XEl Camino Hospital Mountain View &XFallbrook Hospital Fallbrook &XGoleta Valley Cottage Hospital Santa Barbara &XHenry Mayo Newhall Memorial Hospital Valencia &XJohn F. Kennedy Memorial Hospital Indio &XMarian Medical Center Santa Maria &XMercy General Hospital Sacramento &XMercy Hospitals of Bakersfield Bakersfield &XMethodist Hospital of Sacramento Sacramento &Xolympia Medical Center Los Angeles &XPomerado Hospital Poway &XPresbyterian Intercommunity Hospital Whittier &XProvidence Tarzana Medical Center Tarzana &XRedwood Memorial Hospital Fortuna &XSaddleback Memorial Medical Center Laguna Hills &XSierra Nevada Memorial Hospital Grass Valley &XSt. Elizabeth Community Hospital Red Bluff &XSt. Francis Medical Center Lynwood &XSt. Joseph Hospital Eureka &XSt. Joseph's Medical Center Stockton &XSt. Jude Medical Center Fullerton &XSt. Mary Medical Center Long Beach &XStanislaus Surgical Hospital Modesto &XSutter Amador Hospital Jackson &XSutter Auburn Faith Hospital Auburn &XSutter Davis Hospital Davis &XSutter Medical Center, Sacramento Sacramento &X


CALIFoRNIA continuedThousand oaks Surgical Hospital Thousand Oaks &XVerdugo Hills Hospital Glendale &XAdventist Medical CenterHanford Hanford &CAnaheim Regional Medical Center Anaheim &CArroyo Grande Community Hospital Arroyo Grande &CBarton Memorial Hospital South Lake Tahoe &CBrotman Medical Center Culver City &CCalifornia Pacific Medical Center San Francisco &CCedars-Sinai Medical Center Los Angeles &CChinese Hospital San Francisco &CCity of Hope's Helford Clinical Research Hospital Duarte &CCommunity Hospital of the Monterey Peninsula Monterey &CCommunity Regional Medical Center Fresno &CDameron Hospital Stockton &CDelano Regional Medical Center Delano &CDesert Regional Medical Center Palm Springs &CDoctors Medical CenterSan Pablo Campus San Pablo &CDominican Hospital Santa Cruz &CDowney Regional Medical Center Downey &CEden Medical Center Castro Valley &CEl Centro Regional Medical Center El Centro &CEmanuel Medical Center Turlock &CFeather River Hospital Paradise &CFountain Valley Regional Hospital and Medical Center Fountain Valley &CFrank R. Howard Memorial Hospital Willits &CFremont-Rideout Health Group Marysville &CGarfield Medical Center Monterey Park &CGlendale Memorial Hospital and Health Center Glendale &CGood Samaritan Hospital Los Angeles &CHealdsburg District Hospital Healdsburg &CHemet Valley Medical Center Hemet &CHoag Memorial Hospital Presbyterian Newport Beach &CHollywood Presbyterian Medical Center Los Angeles &CJohn Muir Medical Center, Concord Concord &CJohn Muir Medical Center, Walnut Creek Walnut Creek &CKeck Hospital of USC Los Angeles &CLakewood Regional Medical Center Lakewood &CLodi Memorial Hospital Lodi &CLoma Linda University Medical Center Loma Linda &CLompoc Valley Medical Center Lompoc &CLong Beach Memorial Medical Center Long Beach &CLos Alamitos Medical Center Los Alamitos &CLos Robles Hospital and Medical Center Thousand Oaks &CMarin General Hospital Greenbrae &C




CALIFoRNIA continuedMarina Del Rey Hospital Marina Del Rey &CMarshall Medical Center Placerville &CMemorial Medical Center Modesto &CMercy Hospital of Folsom Folsom &CMercy Medical Center Merced Merced &CMercy Medical Center Mount Shasta Mount Shasta &CMercy San Juan Medical Center Carmichael &CMethodist Hospital of Southern California Arcadia &CMills-Peninsula Health Services Burlingame &CMission Hospital Mission Viejo &CNorthBay Medical Center Fairfield &CNovato Community Hospital Novato &Co'Connor Hospital San Jose &Coakland Medical Center Oakland &Corange Coast Memorial Medical Center Fountain Valley &CPalm Drive Hospital Sebastopol &CPalmdale Regional Medical Center Palmdale &CPalomar Medical Center Escondido &CParkview Community Hospital Medical Center Riverside &CPatients' Hospital of Redding Redding &CPetaluma Valley Hospital Petaluma &CPioneers Memorial Healthcare District Brawley &CPlacentia-Linda Hospital Placentia &CPomona Valley Hospital Medical Center Pomona &CProvidence Holy Cross Medical Center Mission Hills &CProvidence Little Company of Mary Medical Center Torrance &CProvidence Little Company of Mary Medical Center San Pedro San Pedro &CProvidence Saint Joseph Medical Center Burbank &CQueen of the Valley Medical Center Napa &CRancho Springs Medical Center Murrieta &CRedlands Community Hospital Redlands &CRiverside Community Hospital Riverside &CRonald Reagan University of California Los Angeles Medical Center Los Angeles &CSaint Agnes Medical Center Fresno &CSaint Francis Memorial Hospital San Francisco &CSaint Louise Regional Hospital Gilroy &CSalinas Valley Memorial Healthcare System Salinas &CSan Antonio Community Hospital Upland &CSan Gabriel Valley Medical Center San Gabriel &CSan Ramon Regional Medical Center San Ramon &CSanta Barbara Cottage Hospital Santa Barbara &CSanta Clara Medical Center Santa Clara &CSanta Rosa Memorial Hospital Santa Rosa &CScripps Memorial HospitalEncinitas Encinitas &CScripps Memorial HospitalLa Jolla La Jolla &C


CALIFoRNIA continuedScripps Mercy Hospital San Diego &CSharp Chula Vista Medical Center Chula Vista &CSharp Coronado Hospital and Healthcare Center Coronado &CSharp Grossmont Hospital La Mesa &CSharp Memorial Hospital San Diego &CSierra View District Hospital Porterville &CSierra Vista Regional Medical Center San Luis Obispo &CSimi Valley Hospital and Health Care Services Simi Valley &CSonora Regional Medical Center Sonora &CSt. Bernardine Medical Center San Bernardino &CSt. John's Pleasant Valley Hospital Camarillo &CSt. John's Regional Medical Center Oxnard &CSt. Luke's Hospital San Francisco &CSt. Mary's Medical Center San Francisco &CSt. Vincent Medical Center Los Angeles &CStanford Hospital and Clinics Palo Alto &CSutter Maternity and Surgery Center of Santa Cruz Santa Cruz &CSutter Medical Center of Santa Rosa, Chanate Campus Santa Rosa &CSutter Roseville Medical Center Roseville &CSutter Solano Medical Center Vallejo &CSutter Tracy Community Hospital Tracy &CTahoe Forest Hospital District Truckee &CTorrance Memorial Medical Center Torrance &CTri-City Medical Center Oceanside &CUCSF Medical Center San Francisco &CUkiah Valley Medical Center Ukiah &CUniversity of California, Davis Medical Center Sacramento &CVallejo Medical Center Vallejo &CValley Presbyterian Hospital Van Nuys &CValleyCare Medical Center Pleasanton &CWatsonville Community Hospital Watsonville &CWest Anaheim Medical Center Anaheim &CWest Hills Hospital and Medical Center West Hills &CWhite Memorial Medical Center Los Angeles &CAntelope Valley Hospital Lancaster &VBakersfield Memorial Hospital Bakersfield &VBeverly Hospital Montebello &VCommunity Memorial Health System Ventura &VGlendale Adventist Medical Center Glendale &VRegional Medical Center of San Jose San Jose &VSan Joaquin Community Hospital Bakersfield &VSanta Monica-UCLA Medical Center and orthopaedic Hospital Santa Monica &VSt. Joseph Health St. Mary Apple Valley &VSt. Rose Hospital Hayward &VTwin Cities Community Hospital Templeton &V


CALIFoRNIA continuedCitrus Valley Medical Center Inter-Community Campus Covina &BDoctors Medical Center Modesto &BGood Samaritan Hospital San Jose &BHuntington Memorial Hospital Pasadena &BKaweah Delta Medical Center Visalia &BNorthridge Hospital Medical CenterRoscoe Boulevard Campus Northridge &BSeton Medical Center Daly City &BSutter Delta Medical Center Antioch &BCoLoRADoAvista Adventist Hospital Louisville &ZExempla Saint Joseph Hospital Denver &ZMcKee Medical Center Loveland &ZMemorial Health System Colorado Springs &ZorthoColorado Hospital Lakewood &ZPenrose-St. Francis Health Services Colorado Springs &ZPorter Adventist Hospital Denver &ZPoudre Valley Hospital Fort Collins &ZUniversity of Colorado Hospital Aurora &ZValley View Hospital Glenwood Springs &ZAnimas Surgical Hospital Durango &XExempla Lutheran Medical Center Wheat Ridge &XLongmont United Hospital Longmont &XMercy Regional Medical Center Durango &XMontrose Memorial Hospital Montrose &XPresbyterian-St. Luke's Medical Center Denver &XSt. Anthony Hospital Lakewood &XSt. Mary's Hospital and Medical Center Grand Junction &XYampa Valley Medical Center Steamboat Springs &XBoulder Community Hospital Boulder &CCommunity Hospital Grand Junction &CDelta County Memorial Hospital Delta &CExempla Good Samaritan Medical Center Lafayette &CLittleton Adventist Hospital Littleton &CMedical Center of Aurora Aurora &CMedical Center of the Rockies Loveland &CNorth Colorado Medical Center Greeley &CNorth Suburban Medical Center Thornton &CParker Adventist Hospital Parker &CParkview Medical Center Pueblo &CRose Medical Center Denver &CSan Luis Valley Regional Medical Center Alamosa &CSky Ridge Medical Center Lone Tree &CSouthwest Memorial Hospital Cortez &CSt. Anthony North Hospital Westminster &CSt. Mary-Corwin Medical Center Pueblo &CSt. Thomas More Hospital Canon City &CSwedish Medical Center Englewood &CVail Valley Medical Center Vail &CSt. Anthony Summit Medical Center Frisco &B




CoNNECTICUTDanbury Hospital Danbury &ZSaint Francis Hospital and Medical Center Hartford &ZDay Kimball Hospital Putnam &XNew Milford Hospital New Milford &XBridgeport Hospital Bridgeport &CBristol Hospital Bristol &CGreenwich Hospital Greenwich &CGriffin Hospital Derby &CHartford Hospital Hartford &CLawrence + Memorial Hospital New London &CManchester Memorial Hospital Manchester &CMidState Medical Center Meriden &CMiddlesex Hospital Middletown &CMilford Hospital Milford &CNorwalk Hospital Norwalk &CRockville General Hospital Vernon Rockville &CSaint Mary's Hospital Waterbury &CSt. Vincent's Medical Center Bridgeport &CStamford Hospital Stamford &CThe Charlotte Hungerford Hospital Torrington &CThe Hospital of Central Connecticut New Britain &CThe William W. Backus Hospital Norwich &CUniversity of Connecticut Health Center, John Dempsey Hospital Farmington

&C

Waterbury Hospital Waterbury &CWindham Hospital Willimantic &CYale-New Haven Hospital New Haven &CDELAWAREBeebe Medical Center Lewes &XChristiana Care Health System Newark &CNanticoke Memorial Hospital Seaford &CSt. Francis Hospital Wilmington &CBayhealth Medical Center Dover &BDISTRICT oF CoLUMBIAMedStar Georgetown University Hospital Washington, D.C. &CGeorge Washington University Hospital Washington, D.C. &BMedStar Washington Hospital Center Washington, D.C. &BProvidence Hospital Washington, D.C. &BSibley Memorial Hospital Washington, D.C. &BFLoRIDADoctors Hospital of Sarasota Sarasota &ZGulf Breeze Hospital Gulf Breeze &ZGulf Coast Medical Center Panama City &ZMayo Clinic Jacksonville Jacksonville &ZMunroe Regional Medical Center Ocala &Zocala Regional Medical Center Ocala &ZSacred Heart Hospital on the Emerald Coast Miramar Beach &ZTwin Cities Hospital Niceville &ZCape Canaveral Hospital Cocoa Beach &X


FLoRIDA continuedCharlotte Regional Medical Center Punta Gorda &XCitrus Memorial Health System Inverness &XFlorida Hospital DeLand DeLand &XFlorida Hospital Heartland Medical Center Sebring &XFlorida Hospital Waterman Tavares &XNorth Shore Medical Center Miami &XSarasota Memorial Hospital Sarasota &XSt. Anthony's Hospital Saint Petersburg &XWest Boca Medical Center Boca Raton &XBaptist Hospital Pensacola &CBay Medical Center Sacred Heart Panama City &CBayfront Medical Center Saint Petersburg &CBert Fish Medical Center New Smyrna Beach &CBlake Medical Center Bradenton &CBoca Raton Regional Hospital Boca Raton &CBrandon Regional Hospital Brandon &CBrooksville Regional Hospital Brooksville &CBroward Health Medical Center Fort Lauderdale &CBroward Health North Deerfield Beach &CCentral Florida Regional Hospital Sanford &CCoral Gables Hospital Coral Gables &CDelray Medical Center Delray Beach &CDoctors Hospital Coral Gables &CEdward White Hospital Saint Petersburg &CEnglewood Community Hospital Englewood &CFawcett Memorial Hospital Port Charlotte &CFlorida Hospital Fish Memorial Orange City &CFlorida Hospital Memorial Medical Center Daytona Beach &CFlorida Hospital North Pinellas Tarpon Springs &CFlorida Hospital Tampa Tampa &CFlorida Hospital zephyrhills Zephyrhills &CFlorida HospitalCarrollwood Tampa &CFlorida HospitalFlagler Palm Coast &CGood Samaritan Medical Center West Palm Beach &CH. Lee Moffitt Cancer Center and Research Institute Tampa &CHeart of Florida Regional Medical Center Davenport &CHighlands Regional Medical Center Sebring &CHoly Cross Hospital Fort Lauderdale &CIndian River Medical Center Vero Beach &CJackson Hospital Marianna &CLake City Medical Center Lake City &CLake Wales Medical Center Lake Wales &CLakewood Ranch Medical Center Bradenton &CLawnwood Regional Medical Center Fort Pierce &CLee Memorial Hospital Fort Myers &CManatee Memorial Hospital Bradenton &CMease Countryside Hospital Safety Harbor &CMease Hospital Dunedin Dunedin &C


FLoRIDA continuedMedical Center of Trinity Trinity &CMemorial Hospital Miramar Miramar &CMemorial Hospital West Pembroke Pines &CMemorial Hospital of Tampa Tampa &CMorton Plant North Bay Hospital New Port Richey &CMount Sinai Medical Center Miami Beach &CNorth okaloosa Medical Center Crestview &CNorthside Hospital and Heart Institute Saint Petersburg &CNorthwest Medical Center Margate &Coak Hill Hospital Brooksville &Corange Park Medical Center Orange Park &Cosceola Regional Medical Center Kissimmee &CPalm Springs General Hospital Hialeah &CPalms West Hospital Loxahatchee &CPalms of Pasadena Hospital Saint Petersburg &CParrish Medical Center Titusville &CPasco Regional Medical Center Dade City &CPeace River Regional Medical Center Port Charlotte &CPhysicians Regional Medical CenterPine Ridge Naples &CPlantation General Hospital Plantation &CPutnam Community Medical Center Palatka &CRaulerson Hospital Okeechobee &CRegional Medical CenterBayonet Point Hudson &CSacred Heart Hospital of Pensacola Pensacola &CSebastian River Medical Center Sebastian &CSeven Rivers Regional Medical Center Crystal River &CShands Jacksonville Medical Center Jacksonville &CSouth Florida Baptist Hospital Plant City &CSouth Miami Hospital Miami &CSt. Cloud Regional Medical Center Saint Cloud &CSt. Lucie Medical Center Port St. Lucie &CSt. Mary's Medical Center West Palm Beach &CSt. Petersburg General Hospital Saint Petersburg &CSt. Vincent's Medical Center Riverside Jacksonville &CSt. Vincent's Medical Center Southside Jacksonville &CThe Villages Health System The Villages &CUniversity Hospital and Medical Center Tamarac &CVenice Regional Medical Center Venice &CWellington Regional Medical Center West Palm Beach &CWestside Regional Medical Center Plantation &CWinter Haven Hospital Winter Haven &CWuesthoff Medical CenterRockledge Rockledge &CAventura Hospital and Medical Center Aventura &VBaptist Hospital of Miami Miami &V




FLoRIDA continuedBaptist Medical Center Beaches Jacksonville Beach &VBethesda Memorial Hospital Boynton Beach &VBroward Health Coral Springs Coral Springs &VBroward Health Imperial Point Fort Lauderdale &VCape Coral Hospital Cape Coral &VCleveland Clinic Florida Weston &VFort Walton Beach Medical Center Fort Walton Beach &VJ.F.K. Medical Center Atlantis &VJackson Health System Miami &VJupiter Medical Center Jupiter &VLakeland Regional Medical Center Lakeland &VLehigh Regional Medical Center Lehigh Acres &VLower Keys Medical Center Key West &VSouth Bay Hospital Sun City Center &VSouth Lake Hospital Clermont &VSt. Joseph's Hospital Tampa &VTown and Country Hospital Tampa &VUniversity of Miami Hospital Miami &VWest Florida Hospital Pensacola &VWuesthoff Medical CenterMelbourne Melbourne &VBaptist Medical Center Jacksonville &BCapital Regional Medical Center Tallahassee &BFlagler Hospital Saint Augustine &BFlorida Hospital Orlando &BGulf Coast Medical Center Fort Myers &BHalifax Health Medical Center of Daytona Beach Daytona Beach &BHealth Central Ocoee &BHolmes Regional Medical Center Melbourne &BKendall Regional Medical Center Miami &BLargo Medical Center Largo &BLeesburg Regional Medical Center Leesburg &BMartin Health System Stuart &BMemorial Hospital Jacksonville Jacksonville &BMemorial Regional Hospital Hollywood &BMorton Plant Hospital Clearwater &BNCH Downtown Naples Hospital Naples &BNorth Florida Regional Medical Center Gainesville &Borlando Regional Medical Center Orlando &BPalm Beach Gardens Medical Center Palm Beach Gardens &BPalmetto General Hospital Hialeah &BShands at the University of Florida Gainesville &BTallahassee Memorial HealthCare Tallahassee &BTampa General Hospital Tampa &BGEoRGIAAthens Regional Medical Center Athens &X


GEoRGIA continuedFairview Park Hospital Dublin &XHughston Hospital Columbus &XNewton Medical Center Covington &XNortheast Georgia Medical Center Gainesville &XNorthside HospitalCherokee Canton &XRockdale Medical Center Conyers &XAtlanta Medical Center Atlanta &CCandler Hospital Savannah &CCartersville Medical Center Cartersville &CColiseum Northside Hospital Macon &CColquitt Regional Medical Center Moultrie &CDeKalb Medical at North Decatur Decatur &CDoctors Hospital Augusta &CEast Georgia Regional Medical Center Statesboro &CEastside Medical Center Snellville &CEmory Johns Creek Hospital Johns Creek &CEmory University Hospital Atlanta &CEmory University Hospital Midtown Atlanta &CFannin Regional Hospital Blue Ridge &CGeorgia Health Sciences Medical Center Augusta &CGordon Hospital Calhoun &CHamilton Medical Center Dalton &CHenry Medical Center Stockbridge &CHouston Medical Center Warner Robins &CJohn D. Archbold Memorial Hospital Thomasville &CMayo Clinic Health System in Waycross Waycross &CMemorial Health Savannah &CNorth Fulton Regional Hospital Roswell &CNorthside Hospital Atlanta &Coptim Medical CenterTattnall Reidsville &CPhoebe North Albany &CPiedmont Fayette Hospital Fayetteville &CPiedmont Newnan Hospital Newnan &CRedmond Regional Medical Center Rome &CSouthern Regional Medical Center Riverdale &CSpalding Regional Medical Center Griffin &CStephens County Hospital Toccoa &CTanner Medical Center Carrollton &CThe Medical Center Columbus &CTift Regional Medical Center Tifton &CTrinity Hospital of Augusta Augusta &CUniversity Hospital Augusta &CUpson Regional Medical Center Thomaston &CWellStar Cobb Hospital Austell &CWest Georgia Health La Grange &CPhoebe Putney Memorial Hospital Albany &VSaint Joseph's Hospital of Atlanta Atlanta &VSouth Georgia Medical Center Valdosta &V


GEoRGIA continuedSt. Francis Hospital Columbus &VWellStar Douglas Hospital Douglasville &VColiseum Medical Centers Macon &BFloyd Medical Center Rome &BGwinnett Hospital System Lawrenceville &BMedical Center of Central Georgia Macon &BNorthside HospitalForsyth Cumming &BPiedmont Hospital Atlanta &BPiedmont Mountainside Hospital Jasper &BSoutheast Georgia Health System Brunswick Campus Brunswick &BSt. Joseph's Hospital Savannah &BSt. Mary's Health Care System Athens &BWellStar Kennestone Hospital Marietta &BHAWAIICastle Medical Center Kailua &CKuakini Medical Center Honolulu &CMaui Memorial Medical Center Wailuku &CPali Momi Medical Center Aiea &CStraub Clinic & Hospital Honolulu &CQueen's Medical Center Honolulu &BIDAHoKootenai Medical Center Coeur D'Alene &ZPortneuf Medical Center Pocatello &ZSt. Luke's Regional Medical Center Boise &ZNorthwest Specialty Hospital Post Falls &XSt. Luke's Magic Valley Medical Center Twin Falls &XBingham Memorial Hospital Blackfoot &CCassia Regional Medical Center Burley &CEastern Idaho Regional Medical Center Idaho Falls &CMadison Memorial Hospital Rexburg &CMountain View Hospital Idaho Falls &CSaint Alphonsus Medical CenterNampa Nampa &CSaint Alphonsus Regional Medical Center Boise &CSt. Joseph Regional Medical Center Lewiston &CSt. Luke's Wood River Medical Center Ketchum &CWest Valley Medical Center Caldwell &CILLINoISAlton Memorial Hospital Alton &ZDecatur Memorial Hospital Decatur &ZGenesis Medical Center, Illini Campus Silvis &ZSt. Margaret's Hospital Spring Valley &ZTrinity Rock Island Rock Island &ZAdventist Hinsdale Hospital Hinsdale &XAdvocate Good Samaritan Hospital Downers Grove &XAdvocate Good Shepherd Hospital Barrington &XAlexian Brothers Medical Center Elk Grove Village &XCGH Medical Center Sterling &XEdward Hospital Naperville &X



ILLINoIS continuedFHN Memorial Hospital Freeport &XHammond-Henry Hospital Geneseo &XHoly Cross Hospital Chicago &XKatherine Shaw Bethea Hospital Dixon &XMorris Hospital & Healthcare Centers Morris &XNorthwestern Lake Forest Hospital Lake Forest &XPekin Hospital Pekin &XRockford Memorial Hospital Rockford &XRush oak Park Hospital Oak Park &XAdvocate BroMenn Medical Center Normal &CAdvocate Condell Medical Center Libertyville &CAdvocate Illinois Masonic Medical Center Chicago &CAdvocate Lutheran General Hospital Park Ridge &CAdvocate South Suburban Hospital Hazel Crest &CAdvocate Trinity Hospital Chicago &CAnderson Hospital Maryville &CBlessing Hospital Quincy &CCarle Foundation Hospital Urbana &CCentegra HospitalMcHenry McHenry &CCentegra HospitalWoodstock Woodstock &CCentral DuPage Hospital Winfield &CCrossroads Community Hospital Mount Vernon &CDelnor Hospital Geneva &CElmhurst Memorial Hospital Elmhurst &CFranciscan St. James Hospital and Health Centers Olympia Fields &CGateway Regional Medical Center Granite City &CGibson Area Hospital and Health Services Gibson City &CGood Samaritan Regional Health Center Mount Vernon &CGottlieb Memorial Hospital Melrose Park &CGraham Hospital Canton &CHeartland Regional Medical Center Marion &CHerrin Hospital Herrin &CIllinois Valley Community Hospital Peru &CIngalls Memorial Hospital Harvey &CIroquois Memorial Hospital and Resident Home Watseka &CLittle Company of Mary Hospital and Health Care Centers Evergreen Park &CLouis A. Weiss Memorial Hospital Chicago &CLoyola University Medical Center Maywood &CMacNeal Hospital Berwyn &CMcDonough District Hospital Macomb &CMemorial Hospital of Carbondale Carbondale &CMercy Hospital and Medical Center Chicago &CMethodist Medical Center of Illinois Peoria &CMetroSouth Medical Center Blue Island &CMount Sinai Hospital Chicago &CNorthShore University Health System Evanston Hospital Evanston &C


ILLINoIS continuedNorthShore University Health System Skokie Hospital Skokie &CNorthwest Community Hospital Arlington Heights &CNorthwestern Memorial Hospital Chicago &CoSF Saint Anthony Medical Center Rockford &CoSF Saint Elizabeth Medical Center Ottawa &CoSF Saint JamesJohn W. Albrecht Medical Center Pontiac &CoSF St. Joseph Medical Center Bloomington &CoSF St. Mary Medical Center Galesburg &Cour Lady of the Resurrection Medical Center Chicago &CPalos Community Hospital Palos Heights &CPassavant Area Hospital Jacksonville &CProctor Hospital Peoria &CProvena Covenant Medical Center Urbana &CProvena Mercy Medical Center Aurora &CProvena Saint Joseph Hospital Elgin &CProvena St. Mary's Hospital Kankakee &CProvena United Samaritans Medical Center Danville &CResurrection Medical Center Chicago &CRiverside Medical Center Kankakee &CRush University Medical Center Chicago &CRush-Copley Medical Center Aurora &CSaint Anthony's Health Center Alton &CSaint Joseph Hospital Chicago &CSaints Mary & Elizabeth Medical Center Chicago &CSarah Bush Lincoln Health Center Mattoon &CSherman Hospital Elgin &CSilver Cross Hospital New Lenox &CSt. Alexius Medical Center Hoffman Estates &CSt. Anthony's Memorial Hospital Effingham &CSt. Elizabeth's Hospital Belleville &CSt. John's Hospital Springfield &CSt. Mary's Hospital Decatur &CSt. Mary's Hospital Streator &CSwedish Covenant Hospital Chicago &CSwedishAmerican Hospital Rockford &CUniversity of Chicago Medical Center Chicago &CUniversity of Illinois Hospital & Health Sciences System Chicago &CVista Medical Center East Waukegan &CWest Suburban Medical Center Oak Park &CWestlake Hospital Melrose Park &CAdventist La Grange Memorial Hospital La Grange &VProvena Saint Joseph Medical Center Joliet &VSt. Mary's Hospital Centralia &VAdvocate Christ Medical Center Oak Lawn &BGalesburg Cottage Hospital Galesburg &BKishwaukee Community Hospital DeKalb &BMemorial Hospital Belleville &B


ILLINoIS continuedMemorial Medical Center Springfield &BoSF Saint Francis Medical Center Peoria &BSaint Francis Hospital Evanston &BINDIANACommunity Heart and Vascular Hospital Indianapolis &ZIndiana orthopaedic Hospital Indianapolis &ZIndiana University Health Ball Memorial Hospital Muncie &ZIndiana University Health Bloomington Hospital Bloomington &ZMemorial Hospital and Health Care Center Jasper &ZMonroe Hospital Bloomington &Zorthopaedic Hospital of Lutheran Health Network Fort Wayne &ZParkview ortho Hospital Fort Wayne &ZParkview Hospital Randallia Fort Wayne &ZSt. Vincent Heart Center of Indiana Indianapolis &ZCommunity Hospital East Indianapolis &XCommunity Hospital South Indianapolis &XDupont Hospital Fort Wayne &XElkhart General Healthcare System Elkhart &XFranciscan St. Elizabeth HealthLafayette Central Lafayette &XHendricks Regional Health Danville &XMemorial Hospital of South Bend South Bend &XPhysicians' Medical Center New Albany &XPorter Regional Hospital Valparaiso &XSaint Joseph Regional Medical CenterPlymouth Campus Plymouth &XSt. Vincent Carmel Hospital Carmel &XClark Memorial Hospital Jeffersonville &CColumbus Regional Hospital Columbus &CCommunity Hospital Munster &CCommunity Hospital North Indianapolis &CCommunity Hospital of Anderson and Madison County Anderson &CCommunity Howard Regional Hospital Kokomo &CDeaconess Hospital Evansville &CFloyd Memorial Hospital and Health Services New Albany &CFranciscan St. Anthony HealthCrown Point Crown Point &CFranciscan St. Anthony HealthMichigan City Michigan City &CFranciscan St. Elizabeth HealthCrawfords-ville Crawfordsville &CFranciscan St. Elizabeth HealthLafayette East Lafayette &CFranciscan St. Francis HealthIndianapolis Indianapolis &CFranciscan St. Francis HealthMooresville Mooresville &CFranciscan St. Margaret HealthHammond Hammond &CGood Samaritan Hospital Vincennes &CHancock Regional Hospital Greenfield &CIndiana University Health Arnett Hospital Lafayette &CIndiana University Health Goshen Hospital Goshen &C




INDIANA continuedIndiana University Health La Porte Hospital La Porte &CIndiana University Health North Hospital Carmel &CIndiana University Health University Hospital Indianapolis &CIndiana University Health West Hospital Avon &CKing's Daughters' Health Madison &CKosciusko Community Hospital Warsaw &CLutheran Hospital of Indiana Fort Wayne &CMajor Hospital Shelbyville &CMarion General Hospital Marion &CMethodist Hospitals Gary &CReid Hospital and Health Care Services Richmond &CRiverview Hospital Noblesville &CSaint Joseph Regional Medical Center Mishawaka &CSchneck Medical Center Seymour &CSt. Catherine Hospital East Chicago &CSt. Joseph Hospital Fort Wayne &CSt. Joseph Hospital and Health Center Kokomo &CSt. Mary Medical Center Hobart &CSt. Mary's Medical Center of Evansville Evansville &CSt. Vincent Anderson Regional Hospital Anderson &CTerre Haute Regional Hospital Terre Haute &CUnion Hospital Terre Haute &CWitham Memorial Hospital Lebanon &CHenry County Hospital New Castle &VIndiana University Health Tipton Hospital Tipton &VSt. Vincent Indianapolis Hospital Indianapolis &VThe Heart Hospital at Deaconess Gateway Newburgh &VDearborn County Hospital Lawrenceburg &BKentuckiana Medical Center Clarksville &BIoWAMercy Medical CenterNorth Iowa Mason City &ZTrinity Bettendorf Bettendorf &ZIowa Specialty HospitalClarion Clarion &XMahaska Health Partnership Oskaloosa &XMarshalltown Medical & Surgical Center Marshalltown &XMercy Medical CenterDubuque Dubuque &XMercy Medical CenterSioux City Sioux City &Xottumwa Regional Health Center Ottumwa &XSt. Anthony Regional Hospital Carroll &XAlegent Creighton Health Mercy Hospital Council Bluffs &CAllen Memorial Hospital Waterloo &CCovenant Medical Center Waterloo &CFinley Hospital Dubuque &CGenesis Medical CenterDavenport Davenport &CLakes Regional Healthcare Spirit Lake &C


IoWA continuedMary Greeley Medical Center Ames &CMercy Iowa City Iowa City &CMercy Medical CenterClinton Clinton &CMercy Medical CenterDes Moines Des Moines &CSkiff Medical Center Newton &CSpencer Hospital Spencer &CSt. Luke's Health System, Inc. Sioux City &CSt. Luke's Hospital Cedar Rapids &CTrinity Regional Medical Center Fort Dodge &CUniversity of Iowa Hospitals and Clinics Iowa City &CJennie Edmundson Hospital Council Bluffs &VGreat River Medical Center West Burlington &BIowa Lutheran Hospital Des Moines &BIowa Methodist Medical Center Des Moines &BMercy Medical CenterCedar Rapids Cedar Rapids &BKANSASHeartland Surgical Specialty Hospital Overland Park &ZKansas City orthopaedic Institute Leawood &ZKansas Medical Center Andover &ZKansas Spine Hospital Wichita &ZKansas Surgery and Recovery Center Wichita &ZSaint Luke's South Hospital Overland Park &ZSummit Surgical, LLC Hutchinson &ZGreat Bend Regional Hospital Great Bend &XSalina Surgical Hospital Salina &XShawnee Mission Medical Center Shawnee Mission &XStormont-Vail HealthCare Topeka &XCoffeyville Regional Medical Center Coffeyville &CHutchinson Regional Medical Center Hutchinson &CKansas Heart Hospital Wichita &CLabette Health Parsons &CLawrence Memorial Hospital Lawrence &CMenorah Medical Center Overland Park &CMercy Regional Health Center Manhattan &Colathe Medical Center Olathe &CPratt Regional Medical Center Pratt &CProvidence Medical Center Kansas City &CSalina Regional Health Center Salina &CSt. Francis Health Center Topeka &CThe University of Kansas Hospital Kansas City &CVia Christi Hospital in Pittsburg Pittsburg &CVia Christi Hospital on St. Francis Wichita &CWesley Medical Center Wichita &CWestern Plains Medical Complex Dodge City &CHays Medical Center Hays &Voverland Park Regional Medical Center Overland Park &VNewman Regional Health Emporia &BNewton Medical Center Newton &BSt. Catherine Hospital Garden City &B


KENTUCKYFlaget Memorial Hospital Bardstown &ZSaint Joseph East Lexington &ZMeadowview Regional Medical Center Maysville &XSaint Joseph Hospital Lexington &XSt. Claire Regional Medical Center Morehead &XBaptist Health Corbin Corbin &CBaptist Health Madisonville Madisonville &CBaptist Health Paducah Paducah &CBaptist Health Richmond Richmond &CEphraim McDowell Regional Medical Center Danville &CFrankfort Regional Medical Center Frankfort &CHardin Memorial Hospital Elizabethtown &CHazard ARH Regional Medical Center Hazard &CJackson Purchase Medical Center Mayfield &CJennie Stuart Medical Center Hopkinsville &CJewish HospitalShelbyville Shelbyville &CKing's Daughters Medical Center Ashland &CLourdes Hospital Paducah &Cour Lady of Bellefonte Hospital Ashland &Cowensboro Medical Health System Owensboro &CPikeville Medical Center Pikeville &CSaint JosephLondon London &CSt. Elizabeth Edgewood Edgewood &CSt. Elizabeth Fort Thomas Fort Thomas &CTaylor Regional Hospital Campbellsville &CTriStar Greenview Regional Hospital Bowling Green &CTwin Lakes Regional Medical Center Leitchfield &CBaptist Health Lexington Lexington &VBaptist Health Louisville Louisville &VMedical Center at Bowling Green Bowling Green &VMurray-Calloway County Hospital Murray &VNorton Hospital Louisville &VJewish Hospital Louisville &BLake Cumberland Regional Hospital Somerset &BSaint Joseph Mount Sterling Mount Sterling &BT.J. Samson Community Hospital Glasgow &BUniversity of Kentucky Albert B. Chandler Hospital Lexington &BUniversity of Louisville Hospital Louisville &BLoUISIANAHeart Hospital of Lafayette Lafayette &ZLouisiana Heart Hospital Lacombe &Zochsner Medical Center New Orleans &ZP & S Surgical Hospital Monroe &ZCHRISTUS Schumpert Medical Center Shreveport &XCentral Louisiana Surgical Hospital Alexandria &X




LoUISIANA continuedGreen Clinic Surgical Hospital Ruston &XIberia Medical Center New Iberia &Xochsner Medical CenterBaton Rouge Baton Rouge &XSpecialists HospitalShreveport Shreveport &XAmerican Legion Hospital Crowley &CCHRISTUS St. Frances Cabrini Hospital Alexandria &CCHRISTUS St. Patrick Hospital of Lake Charles Lake Charles &CDauterive Hospital New Iberia &CEast Jefferson General Hospital Metairie &CGlenwood Regional Medical Center West Monroe &CJennings American Legion Hospital Jennings &CLafayette Surgical Specialty Hospital Lafayette &CLake Charles Memorial Hospital Lake Charles &CLane Regional Medical Center Zachary &CMinden Medical Center Minden &Cochsner Baptist Medical Center New Orleans &Cochsner Medical CenterKenner Kenner &Copelousas General Health System Opelousas &Cour Lady of Lourdes Regional Medical Center Lafayette &CSlidell Memorial Hospital Slidell &CSouthern Surgical Hospital Slidell &CSt. Tammany Parish Hospital Covington &CThe NeuroMedical Center Surgical Hospital Baton Rouge &CThibodaux Regional Medical Center Thibodaux &CTouro Infirmary New Orleans &CTulane Medical Center New Orleans &CWK Bossier Health Center Bossier City &CWest Calcasieu Cameron Hospital Sulphur &CWest Jefferson Medical Center Marrero &CWillis-Knighton Medical Center Shreveport &CWoman's Hospital Baton Rouge &CWomen and Children's Hospital Lake Charles &CBaton Rouge General Medical Center Baton Rouge &VLSU Health Sciences Center Shreveport &VLafayette General Medical Center Lafayette &VLakeview Regional Medical Center Covington &VNorthern Louisiana Medical Center Ruston &VRapides Regional Medical Center Alexandria &VNorth oaks Medical Center Hammond &Bour Lady of the Lake Regional Medical Center Baton Rouge &BRegional Medical Center of Acadiana Lafayette &BSt. Francis Medical Center Monroe &BTerrebonne General Medical Center Houma &BMAINESt. Mary's Regional Medical Center Lewiston &X


MAINE continuedAroostook Medical Center Presque Isle &CCentral Maine Medical Center Lewiston &CEastern Maine Medical Center Bangor &CHenrietta D. Goodall Hospital Sanford &CInland Hospital Waterville &CMaine Coast Memorial Hospital Ellsworth &CMaine Medical Center Portland &CMaineGeneral Medical CenterWaterville Campus Waterville &CMayo Regional Hospital Dover-Foxcroft &CMid Coast Hospital Brunswick &CPen Bay Medical Center Rockport &CSouthern Maine Medical Center Biddeford &CSt. Joseph Hospital Bangor &CFranklin Memorial Hospital Farmington &VMiles Memorial Hospital Damariscotta &VYork Hospital York &VMercy Hospital of Portland Portland &BMARYLANDAnne Arundel Medical Center Annapolis &ZCarroll Hospital Center Westminster &ZGreater Baltimore Medical Center Baltimore &ZMedStar Union Memorial Hospital Baltimore &ZMemorial Hospital at Easton Maryland Easton &ZMercy Medical Center Baltimore &ZPeninsula Regional Medical Center Salisbury &ZSuburban Hospital Bethesda &ZWashington Adventist Hospital Takoma Park &ZFrederick Memorial Hospital Frederick &XGarrett County Memorial Hospital Oakland &XHarford Memorial Hospital Havre De Grace &XKernan orthopaedics and Rehabilitation Baltimore &XMedStar Franklin Square Medical Center Baltimore &XMedStar St. Mary's Hospital Leonardtown &XUniversity of Maryland Medical Center Baltimore &XAtlantic General Hospital Berlin &CBaltimore Washington Medical Center Glen Burnie &CCalvert Memorial Hospital Prince Frederick &CDoctors Community Hospital Lanham &CFort Washington Medical Center Fort Washington &CHoly Cross Hospital Silver Spring &CHoward County General Hospital Columbia &CJohns Hopkins Hospital Baltimore &CMedStar Good Samaritan Hospital Baltimore &CMedStar Harbor Hospital Baltimore &C


MARYLAND continuedMedStar Montgomery Medical Center Olney &CMeritus Medical Center Hagerstown &CNorthwest Hospital Randallstown &CPrince George's Hospital Center Cheverly &CSaint Agnes Hospital Baltimore &CShady Grove Adventist Hospital Rockville &CUnion Hospital Elkton &CUpper Chesapeake Medical Center Bel Air &CWestern Maryland Regional Medical Center Cumberland &CCivista Health La Plata &VSinai Hospital of Baltimore Baltimore &VUniversity of Maryland St. Joseph Medical Center Towson &VChester River Health System Chestertown &BJohns Hopkins Bayview Medical Center Baltimore &BMASSACHUSETTSCarney Hospital Boston &ZCooley Dickinson Hospital Northampton &ZBaystate Franklin Medical Center Greenfield &XBaystate Medical Center Springfield &XFalmouth Hospital Falmouth &XHoly Family Hospital and Medical Center Methuen &XMercy Medical Center Springfield &XNewton-Wellesley Hospital Newton Lower Falls &XUMass Memorial Medical Center Worcester &XAnna Jaques Hospital Newburyport &CBeth Israel Deaconess HospitalMilton Milton &CBeth Israel Deaconess Medical Center Boston &CBeverly Hospital Beverly &CBoston Medical Center Boston &CBrigham and Women's Faulkner Hospital Boston &CCape Cod Hospital Hyannis &CEmerson Hospital Concord &CGood Samaritan Medical Center Brockton &CHallmark Health System Melrose &CHealth Alliance Hospitals Leominster &CHeywood Hospital Gardner &CHolyoke Medical Center Holyoke &CJordan Hospital Plymouth &CLowell General Hospital Lowell &CMassachusetts Eye and Ear Infirmary Boston &CMerrimack Valley Hospital Haverhill &CMetroWest Medical Center Framingham &CMilford Regional Medical Center Milford &CMorton Hospital and Medical Center Taunton &CMount Auburn Hospital Cambridge &CNew England Baptist Hospital Boston &CNorth Adams Regional Hospital North Adams &C




MASSACHUSETTS continuedNorth Shore Medical Center Salem &CNorwood Hospital Norwood &CQuincy Medical Center Quincy &CSaint Vincent Hospital Worcester &CSaints Medical Center Lowell &CSignature Healthcare Brockton Hospital Brockton &CSouth Shore Hospital South Weymouth &CSt. Elizabeth's Medical Center Brighton &CSturdy Memorial Hospital Attleboro &CTufts Medical Center Boston &CUMass MemorialMarlborough Hospital Marlborough &CWinchester Hospital Winchester &CBerkshire Medical Center Pittsfield &VLawrence General Hospital Lawrence &VSaint Anne's Hospital Fall River &VBrigham and Women's Hospital Boston &BLahey Hospital & Medical Center, Burlington Burlington &BMassachusetts General Hospital Boston &BSouthcoast Hospitals Group Fall River &BMICHIGANBeaumont HospitalTroy Troy &ZBell Hospital Ishpeming &ZLakeland Regional Medical CenterSt. Joseph Saint Joseph &ZMetro Health Hospital Wyoming &ZProMedica Bixby Hospital Adrian &ZScheurer Hospital Pigeon &ZSt. Joseph Mercy Livingston Hospital Howell &ZDickinson County Healthcare System Iron Mountain &XHillsdale Community Health Center Hillsdale &XHuron Medical Center Bad Axe &Xoaklawn Hospital Marshall &Xotsego Memorial Hospital Gaylord &XPennock Hospital Hastings &XPortage Health Hancock &XProvidence Hospital Southfield &XSaint Mary's Health Care Grand Rapids &XSt. Joseph Mercy Port Huron Port Huron &XAllegan General Hospital Allegan &CAllegiance Health Jackson &CAlpena Regional Medical Center Alpena &CBorgess Medical Center Kalamazoo &CBronson Battle Creek Battle Creek &CBronson Methodist Hospital Kalamazoo &CChelsea Community Hospital Chelsea &CCommunity Health Center of Branch County Coldwater &CCovenant Medical Center Saginaw &CCrittenton Hospital Medical Center Rochester &C


MICHIGAN continuedDetroit Receiving Hospital/University Health Center Detroit &CGarden City Hospital Garden City &CGenesys Regional Medical Center Grand Blanc &CHarper University Hospital/Hutzel Women's Hospital Detroit &CHenry Ford Hospital Detroit &CHenry Ford Macomb Hospitals Clinton Township &CHenry Ford West Bloomfield Hospital West Bloomfield &CHenry Ford Wyandotte Hospital Wyandotte &CHolland Hospital Holland &CKarmanos Cancer Center Detroit &CMarquette General Health System Marquette &CMcLaren Bay Region Bay City &CMcLaren Central Michigan Mount Pleasant &CMcLaren Flint Flint &CMcLaren Greater Lansing Lansing &CMcLaren Lapeer Region Lapeer &CMcLaren Macomb Mount Clemens &CMcLaren Northern Michigan Petoskey &CMcLaren oakland Pontiac &CMecosta County Medical Center Big Rapids &CMemorial Healthcare Owosso &CMemorial Medical Center of West Michigan Ludington &CMercy Health Partners, Hackley Campus Muskegon &CMercy Health Partners, Mercy Campus Muskegon &CMercy Hospital Cadillac Cadillac &CMercy Hospital Grayling Grayling &CMercy Memorial Hospital System Monroe &CMidMichigan Medical CenterGratiot Alma &CMidMichigan Medical CenterMidland Midland &Coakwood Heritage Hospital Taylor &Coakwood Southshore Medical Center Trenton &CPort Huron Hospital Port Huron &CProMedica Herrick Hospital Tecumseh &CSinai-Grace Hospital Detroit &CSpectrum HealthGrand Rapids Grand Rapids &CSpectrum Health Gerber Memorial Fremont &CSt. John Macomb-oakland Hospital Warren &CSt. Joseph Health System Tawas City &CSt. Joseph Mercy Hospital Ypsilanti &CSt. Joseph Mercy oakland Pontiac &CSt. Mary Mercy Hospital Livonia &CSt. Mary's of Michigan Saginaw &C


MICHIGAN continuedUniversity of Michigan Hospitals and Health Centers Ann Arbor &CWar Memorial Hospital Sault Sainte Marie &CWest Branch Regional Medical Center West Branch &CWest Shore Medical Center Manistee &CBotsford Hospital Farmington Hills &VDMC Huron Valley-Sinai Hospital Commerce Township &Voakwood Annapolis Hospital Wayne &VSt. John Hospital and Medical Center Detroit &VBeaumont HospitalRoyal oak Royal Oak &BBeaumont HospitalGrosse Pointe Grosse Pointe &BHurley Medical Center Flint &BMunson Medical Center Traverse City &Boakwood Hospital & Medical CenterDearborn Dearborn &BSparrow Hospital Lansing &BMINNESoTAAbbott Northwestern Hospital Minneapolis &ZDouglas County Hospital Alexandria &ZEssentia Health St. Joseph's Medical Center Brainerd &ZFairview Ridges Hospital Burnsville &ZFairview Southdale Hospital Edina &ZLake Region Healthcare Fergus Falls &ZLakeview Hospital Stillwater &ZMayo Clinic Health System in Albert Lea Albert Lea &ZMercy Hospital Coon Rapids &ZRegions Hospital Saint Paul &ZRice Memorial Hospital Willmar &ZRidgeview Medical Center Waconia &ZSanford Bemidji Medical Center Bemidji &ZSt. Francis Regional Medical Center Shakopee &ZDistrict one Hospital Faribault &XEssentia Health St. Mary's HospitalDetroit Lakes Detroit Lakes &XGrand Itasca Clinic and Hospital Grand Rapids &XMayo Clinic Health System in Red Wing Red Wing &XNew Ulm Medical Center New Ulm &XNorth Memorial Medical Center Robbinsdale &XNorthfield Hospital Northfield &XPark Nicollet Methodist Hospital Saint Louis Park &XRegina Medical Center Hastings &XRochester Methodist Hospital Rochester &XSt. Gabriel's Hospital Little Falls &XSt. John's Hospital Saint Paul &XUnited Hospital Saint Paul &X




MINNESoTA continuedUnity Hospital Fridley &XWinona Health Winona &XWoodwinds Health Campus Woodbury &XBuffalo Hospital Buffalo &CCambridge Medical Center Cambridge &CCuyuna Regional Medical Center Crosby &CEssentia HealthVirginia Virginia &CFairview Lakes Health Services Wyoming &CHennepin County Medical Center Minneapolis &CHutchinson Health Hutchinson &CMayo ClinicSaint Marys Hospital Rochester &CMayo Clinic Health System in Mankato Mankato &CMayo Clinic Health System in New Prague New Prague &Colmsted Medical Center Rochester &Cowatonna Hospital Owatonna &CRiverwood Healthcare Center Aitkin &CSt. Cloud Hospital Saint Cloud &CSt. Joseph's Area Health Services Park Rapids &CSt. Joseph's Hospital Saint Paul &CSt. Luke's Hospital Duluth &CEssentia Health St. Mary's Medical Center Duluth &VMayo Clinic Health System in Fairmont Fairmont &VMayo Clinic Health System in Austin Austin &BSanford Medical Center Thief River Falls Thief River Falls &BUniversity of Minnesota Medical Center, Fairview Minneapolis &B

MISSISSIPPIBaptist Memorial HospitalGolden Triangle Columbus &CBaptist Memorial HospitalNorth Mississippi Oxford &CBaptist Memorial HospitalUnion County New Albany &CCentral Mississippi Medical Center Jackson &CCrossgates River oaks Hospital Brandon &CDelta Regional Medical Center Greenville &CGilmore Memorial Regional Medica

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