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TRANSCRIPT
Form CMS-20107G (08/11)
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES
Form Approved OMB Exempt
RESEARCH REQUEST PACKET
This form shall serve as the research request packet for organizations interested in receiving historical Medicare claims data for use in developing episode definitions for Models 2, 3, and 4 of the Bundled Payments for Care Improvement initiative.
In order to process your request for historical Medicare claims data, you will need to submit the following items:
✓ Completed Research Request Packet ✓ Data Use Agreement ✓ Signature pages for additional data users (if needed)
Please submit these items simultaneously and as soon as possible by email to: [email protected] forms must be submitted in a searchable digital format (e.g., searchable PDF) with attachments encrypted.Encryption must be compliant with AES 256 encryption guidelines. A decryption key must be sent in a separate email from these forms.
All Research Request Packets and Data Use Agreements must be received by 5:00 pm EDT November 4th, 2011. These documents will only be accepted via email.
Any questions regarding data provision for the Bundled Payments for Care Improvement initiative shouldbe submitted by email to: [email protected]. Responses to questions will be shared publiclyto ensure that all applicants have access to clarifying information regarding the initiative and the application process. Questions and answers will be posted on the Bundled Payments for Care Improvement website,http://www.innovations.cms.gov/areas-of-focus/patient-care-models/bundled-payments-for-care-improvement.html.
NATURE of THE DATA PRoviDED In order to facilitate the definition of robust episodes, CMS will provide historical Medicare claims data thatspans care settings. The following Limited Data Set (LDS) files will be provided:
• Inpatient Standard Analytic File (SAF) • Carrier SAF • Outpatient SAF • Durable Medical Equipment • Home Health Agency SAF SAF
• Skilled Nursing Facility SAF • Denominator
It will be necessary for potential applicants to analyze their patient population to determine the counties from which they draw the majority of their patients. CMS has divided the country into Hospital Referral Clusters(HRCs), which are defined by beneficiary county of residence. Applicants will be responsible for identifyingthe HRC(s) most appropriate for their analyses. A list of HRCs appears on page 2, and an appendix defining the exact counties included in each HRC begins on page 11.
1
2
LiST of HoSPiTAL REfERRAL CLUSTERS AvAiLAbLE foR SELECTioN
Portland ME Youngstown OH - Canton OH Manchester NH - Burlington VT Dayton OH - Fort Wayne IN Boston MA Ann Arbor MI Providence RI Detroit MI Hartford - New Haven CT Grand Rapids MI - Saginaw MI Springfield MA - Albany NY South Bend IN - Kalamazoo MI East Long Island, NY Indianapolis IN Danville PA - Binghamton NY Chicago IL Syracuse NY - Rochester NY Rockford IL - Melrose Park IL Bronx NY - Manhattan NY Springfield IL Morristown NJ - Allentown PA Milwaukee WI Philadelphia PA Madison WI Cape May - South NJ Green Bay WI Newark NJ - White Plains NY Minneapolis MN - St. Paul MN Erie PA - Buffalo NY Kansas City MO Salisbury MD - Wilmington DE St. Louis MO Baltimore MD Des Moines IA Harrisburg PA Sioux Falls SD - Sioux City IA Pittsburg PA Fargo ND - Bismarck ND Washington DC Billings MT - Casper WY Roanoake VA - Charleston WV Salt Lake City UT - Boise ID Durham NC - Winston-Salem NC Colorado Springs CO Raleigh NC - Greenville NC Denver CO Norfolk VA - Richmond VA Omaha NE - Wichita KS Charlotte NC - Greenville SC Oklahoma City OK Huntington WV - Columbus OH Fort Worth TX Lexington KY - Knoxville TN Austin TX Charleston SC San Antonio TX Atlanta GA Houston TX Augusta GA - Savannah GA Dallas TX Birmingham AL Albuquerque NM - El Paso TX Miami FL Las Vegas NV - Reno NV Fort Lauderdale FL Tucson AZ Fort Myers FL Phoenix AZ Tampa FL Orange County CA Orlando FL San Diego CA Jacksonville FL - Ocala FL Los Angeles CA Pensacola FL - Montgomery AL Bakersfield CA - Ventura CA New Orleans LA - Shreveport LA San Jose CA - Fresno CA Jackson MS San Francisco CA Mobile AL - Baton Rouge LA Sacramento CA - Medford OR Little Rock AR Portland OR Nashville TN - Memphis TN Spokane WA Cincinatti OH Seattle WA Louisville KY Anchorage AK Cleveland OH Honolulu HI
Form CMS-20107G (08/11)
Date:
Maribel Franey, Division Director Division of Information Security & Privacy Management (DISPM)Centers for Medicare & Medicaid Services (CMS)
To Whom It May Concern:
I am requesting CMS Limited Data Set (LDS) data to conduct research. I will be using this data to completea study entitled Bundled Payments for Care Improvement Episode Development. This study proposes to develop robust definitions for acute, post-acute, or combined acute and post-acute care episodes. The episodedefinitions will include conditions that provide the greatest opportunity for cost savings to Medicare in thecontext of improved care for beneficiaries, providers with whom to partner, and the optimal period of time within which to accept accountability for cost and quality.
The following CMS LDS files are needed for my research:
Years: 2008 and 2009 File Names (Limited Data Set): Inpatient SAF
Outpatient SAFHome Health Agency SAFSkilled Nursing Facility SAF Carrier SAF Durable Medical Equipment SAFDenominator
Geographical Regions: (Enter HRCs from list on page 2)
I have included with this letter a study protocol, request worksheet, and LDS Data Use Agreement.
If you have any questions, my organization’s contact person is as follows:
Contact Name:
Contact information: Telephone: e-mail address:
Sincerely, Signature:
Requestor name:
Requestor address:
Form CMS-20107G (08/11) 3
4 Form CMS-20107G (08/11)
RESEARCH PRoToCoL
1. iNTRoDUCTioN
Title: Bundled Payments for Care Improvement Episode Development
Purpose:
This application is for Limited Data Set (LDS) files to support definition of episodes as part of the Bundled Payments for Care Improvement initiative through the Center for Medicare and MedicaidInnovation (CMMI). Through the use of these LDS files, the User will attempt to develop robust definitions for acute, post-acute, or combined acute and post-acute care episodes. The definitions will include elements such as (1) condition(s) that provide the greatest opportunity for savings to Medicarein the context of improved care for beneficiaries, (2) specific providers with whom to partner, and (3) the optimal period(s) of time within which to accept accountability for cost and quality, and will be more detailed as necessary. The User will additionally estimate expenditures for providing this care.
The episodes developed here will be used to improve the Medicare program through payment reform.By aligning the incentives of hospitals and providers, episode-based payment strategies aim to improvecare coordination, achieving the three-part aim of better care, better health, and lower cost. The episodedefinitions resulting from this research will be generalizable, and Medicare providers will be able to adjust them to meet the needs of their specific patient population. The episodes are expected to alignincentives towards care redesign in a manner that benefits both patients and providers.
2. PRojECT iSSUES AND METHoDS
List the MS-DRGs around which you propose to develop episodes, and describe the type of episodes you wish to explore (acute, post-acute, or combined). Note that in your final application, you will not belimited to the MS-DRGs you list here.
Describe in detail the plan to analyze the data for the project, including the methodology and procedures that will be used.
5 Form CMS-20107G (08/11)
The data generated from this analysis, if promising, will be presented to CMS in the form of an application for participation in the Bundled Payments for Care Improvement initiative. The format presented in the application will be followed as closely as possible in generating episode definitions. If you anticipate generating and usingfurther tabulations, aggregations, or other data presentations beyond the scope of this application, please indicate the forums under which you plan to present these results here.
State whether any of the methodology or tools contain proprietary information (proprietary information is exempt from release requirements under the Freedom of Information Act if it falls within the scope of Exemption4, 5 U.S.C. § 552(b)(4)).
3. DATA MANAgEMENT SAfEgUARDS
Who will have the main responsibility for organizing, storing, and archiving the data? Please provide name(s) and job title(s).
Explain the infrastructure (facilities, hardware, software, other) that will secure the CMS data files.
6 Form CMS-20107G (08/11)
Are additional organizations involved in analyzing the data files provided by CMS? If so, please indicate howthese organizations’ analysts will access the data files:
VPN Connection
Will travel to physical location of data files at requesting organization
Request that a copy of the data files be housed at second location
Other
Describe the procedures that will be used to protect the privacy and identity of an individual. For example, how will the privacy of information of beneficiaries in the files be safeguarded and guaranteed?
Describe safeguards that would be followed for permitted disclosures of data, if applicable.
No disclosures of data to anyone outside CMS will be permitted.
4. KEy PERSoNNEL
List all staff, including consultants, who will have access to the limited data set file(s) and their role inthe project.
5. DiSSEMiNATioN/iMPLEMENTATioN
The findings of this research, if promising, will be used in application for awards under the BundledPayments for Care Improvement initiative of the Centers for Medicare and Medicaid Innovation.Through this mechanism, episodes and payment proposals have the potential to influence thecare received by millions of Medicare beneficiaries towards the three-part aim of improving care,improving health, and reducing cost. The results of this research will not be sold or marketed for commercial purposes.
Data will not be disseminated on the individual or aggregate level.
7 Form CMS-20107G (08/11)
6. PRoPRiETARy iNfoRMATioN
If the Research Application provided by the Requesting Organization contains proprietary information, a statement to that effect must be included in Section 2, above, and submitted to CMS.
Proprietary information is exempt from release under the Freedom of Information Act if it falls within the scope of Exemption 4, 5 U.S.C. § 552(b)(4).
7. fiNANCiAL ARRANgEMENT
The Centers for Medicare and Medicaid Services will cover the cost of providing limited data sets to applicants. These will include the files listed on the Data Use Agreement, within a geographic region to be determined based on the patient population of the applicant organization. Note that this negates Section 10 of the Data Use Agreement, which indicates that the organization applying for data will be responsible for all associated costs. Organizations whose research protocols and Data Use Agreements are approved will be provided the amount of data deemed acceptable to CMS at no cost to them.
8 Form CMS-20107G (08/11)
DATA REQUEST WoRKSHEET
PRojECT iNfoRMATioN
Name:
Project Contact
Title:
Organization:
Address:
City: State: Zip code:
Telephone:
Fax:
Email:
Primary User
Same as Project Contact? Yes No
Name:
Title:
Organization:
Address:
City: State: Zip code:
Telephone:
Fax:
Email:
9 Form CMS-20107G (08/11)
Custodian (Person who signed DUA #15)
Same as User or Project Contact? Yes No
Name:
Title:
Organization:
Address:
City: State: Zip code:
Telephone:
Fax:
Email:
DATA fiLES REQUESTED
Upon successful completion of both this research request packet and the data use agreement, historical Medicare claims data will be provided to you, with the specific files you receive to be based on your geographical location. A list of Hospital Referral Clusters (HRCs) is available on page 2 of this packet, and a comprehensive listing of the counties included in each HRC is located in the appendix.
Please list the files that you are requesting, based on your patient population. If you are requesting more than one HRC, please specify the percent of your patient population that resides in each cluster. Note that the HRCs are divided by county of beneficiary residence.
10 Form CMS-20107G (08/11)
ExTRACT SPECifiCATioNS
Data extracts will be delivered in CSV format with a SAS program.USB hard drives will be used as the output media.
SHiPPiNg iNfoRMATioN
To whom should the data be shipped?
Project contact
User
Custodian
Other
Shipping Address (if other)
Name:
Title:
Organization:
Address:
City: State: Zip code:
Telephone:
Fax:
Email:
1 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
1 Portland ME
Maine Androscoggin
Maine Aroostook
Maine Cumberland
Maine Franklin
Maine Hancock
Maine Kennebec
Maine Knox
Maine Lincoln
Maine Oxford
Maine Penobscot
Maine Piscataquis
Maine Sagadahoc
Maine Somerset
Maine Waldo
Maine Washington
Maine York
New Hampshire Strafford 2 Manchester NH - Burlington VT
New Hampshire Belknap
New Hampshire Carroll
New Hampshire Cheshire
New Hampshire Coos
New Hampshire Grafton
New Hampshire Hillsborough
New Hampshire Merrimack
New Hampshire Rockingham
New Hampshire Sullivan
New York Clinton
New York Essex
New York Franklin
Vermont Addison
Vermont Caledonia
Vermont Chittenden
Vermont Essex
Vermont Franklin
Vermont Grand Isle
Vermont Lamoille
Vermont Orange
Vermont Orleans
Vermont Rutland
Vermont Washington
Vermont Windham
Vermont Windsor 3 Boston MA
Massachusetts Barnstable
Massachusetts Bristol
Massachusetts Dukes
Massachusetts Essex
Massachusetts Middlesex
Massachusetts Nantucket
Massachusetts Norfolk
Massachusetts Plymouth
Massachusetts Suffolk
4 Providence RI
Massachusetts Worcester
Rhode Island Bristol
Rhode Island Kent
Rhode Island Newport
Rhode Island Providence
Rhode Island Washington
5 Hartford - New Haven CT
Connecticut Fairfield
Connecticut Hartford
Connecticut Litchfield
Connecticut Middlesex
Connecticut Tolland
Connecticut Windham
Connecticut New Haven
Connecticut New London 6 Springfield MA - Albany NY
Massachusetts Berkshire
Massachusetts Franklin
Massachusetts Hampden
Massachusetts Hampshire
New York Albany
New York Columbia
New York Delaware
New York Dutchess
New York Fulton
New York Greene
New York Hamilton
New York Montgomery
New York Putnam
2 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
New York Rensselaer New York Saratoga New York Schenectady New York Schoharie New York Sullivan New York Ulster New York Warren New York Washington
Vermont Bennington 7 East Long Island NY
New York Nassau New York Suffolk 8 Danville PA - Binghamton NY
New York Broome New York Chenango New York Otsego New York Tioga Pennsylvania Bradford Pennsylvania Centre Pennsylvania Clinton Pennsylvania Columbia Pennsylvania Lackawanna Pennsylvania Luzerne Pennsylvania Lycoming Pennsylvania Montour Pennsylvania Northumberland Pennsylvania Snyder Pennsylvania Sullivan Pennsylvania Susquehanna Pennsylvania Tioga Pennsylvania Union Pennsylvania Wayne Pennsylvania Wyoming 9 Syracuse NY - Rochester NY
New York Allegany New York Cayuga New York Chemung New York Cortland New York Herkimer New York Jefferson New York Lewis New York Livingston New York Madison
New York Monroe New York Oneida New York Onondaga New York Ontario New York Oswego New York Schuyler New York Seneca New York Steuben New York St. Lawrence New York Tompkins New York Wayne New York Wyoming New York Yates 10 Bronx NY - Manhattan NY
New York Bronx New York Kings New York New York New York1 Queens 11 Morristown NJ - Allentown PA
New Jersey Middlesex New Jersey Morris New Jersey Somerset New Jersey Sussex New Jersey Warren Pennsylvania Carbon Pennsylvania Lehigh Pennsylvania Monroe Pennsylvania Northampton Pennsylvania Pike 12 Philadelphia PA
New Jersey Camden New Jersey Gloucester New Jersey Hunterdon New Jersey Mercer Pennsylvania Bucks Pennsylvania Delaware Pennsylvania Montgomery Pennsylvania Philadelphia 13 Cape May - South NJ
New Jersey Atlantic New Jersey Burlington New Jersey Cape May New Jersey Cumberland New Jersey Monmouth
3 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
New Jersey Ocean 14 Newark NJ - White Plains NY
New Jersey Bergen New Jersey Essex New Jersey Hudson New Jersey Passaic New Jersey Union New York Orange New York Richmond New York Rockland New York Westchester 15 Erie PA - Buffalo NY
New York Cattaraugus New York Chautauqua New York Erie New York Genesee New York Niagara New York Orleans Pennsylvania Cameron Pennsylvania Crawford Pennsylvania Elk Pennsylvania Erie Pennsylvania Forest Pennsylvania McKean Pennsylvania Mercer Pennsylvania Potter Pennsylvania Venango Pennsylvania Warren 16 Salisbury MD - Wilmington DE
Delaware Kent Delaware New Castle Delaware Sussex Maryland Cecil Maryland Dorchester Maryland Somerset Maryland Wicomico Maryland Worcester New Jersey Salem 17 Baltimore MD
Maryland Anne Arundel Maryland Baltimore City Maryland Baltimore Maryland Calvert Maryland Caroline
Maryland Carroll Maryland Harford Maryland Howard Maryland Kent Maryland Queen Anne's Maryland Talbot 18 Harrisburg PA
Pennsylvania Adams Pennsylvania Berks Pennsylvania Chester Pennsylvania Cumberland Pennsylvania Dauphin Pennsylvania Franklin Pennsylvania Fulton Pennsylvania Juniata Pennsylvania Lancaster Pennsylvania Lebanon Pennsylvania Mifflin Pennsylvania Perry Pennsylvania Schuylkill Pennsylvania York 19 Pittsburg PA
Ohio Belmont Ohio Harrison Ohio Jefferson Pennsylvania Allegheny Pennsylvania Armstrong Pennsylvania Beaver Pennsylvania Bedford Pennsylvania Blair Pennsylvania Butler Pennsylvania Cambria Pennsylvania Clarion Pennsylvania Clearfield Pennsylvania Fayette Pennsylvania Huntingdon Pennsylvania Indiana Pennsylvania Jefferson Pennsylvania Somerset Pennsylvania Washington Pennsylvania Westmoreland West Virginia Brooke West Virginia Hancock West Virginia Marshall
4 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
West Virginia Ohio West Virginia Wetzel 20 Washington DC
District of Columbia District of Columbia Maryland Frederick Maryland Montgomery Maryland Prince George's Virginia Fairfax (city) Virginia Manassas Park Virginia Alexandria Virginia Arlington Virginia Fairfax Virginia Falls Church Virginia Fauquier Virginia Loudoun Virginia Manassas Virginia Prince William 21 Roanoke VA - Charleston WV
Maryland Allegany Maryland Garrett Maryland Washington Pennsylvania Greene Virginia Covington (city) Virginia Lexington (city) Virginia Albemarle Virginia Alleghany Virginia Augusta Virginia Bath Virginia Bland Virginia Botetourt Virginia Buckingham Virginia Buena Vista Virginia Charlottesville Virginia Clarke Virginia Craig Virginia Culpeper Virginia Floyd Virginia Fluvanna Virginia Franklin Virginia Frederick Virginia Giles Virginia Greene Virginia Harrisonburg Virginia Highland
Virginia Madison
Virginia Montgomery
Virginia Nelson
Virginia Orange
Virginia Page
Virginia Pulaski
Virginia Radford
Virginia Rappahannock
Virginia Roanoke
Virginia Roanoke
Virginia Rockbridge
Virginia Rockingham
Virginia Salem
Virginia Shenandoah
Virginia Staunton
Virginia Warren
Virginia Waynesboro
Virginia Winchester
Virginia Wythe
West Virginia Barbour
West Virginia Berkeley
West Virginia Boone
West Virginia Braxton
West Virginia Calhoun
West Virginia Clay
West Virginia Doddridge
West Virginia Fayette
West Virginia Gilmer
West Virginia Grant
West Virginia Greenbrier
West Virginia Hampshire
West Virginia Hardy
West Virginia Harrison
West Virginia Jackson
West Virginia Jefferson
West Virginia Kanawha
West Virginia Lewis
West Virginia Logan
West Virginia Marion
West Virginia McDowell
West Virginia Mercer
West Virginia Mineral
West Virginia Mingo
West Virginia Monongalia
22
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
West Virginia
Durham NC - Winston-Salem NC
Monroe
Morgan
Nicholas
Pendleton
Pleasants
Pocahontas
Preston
Putnam
Raleigh
Randolph
Ritchie
Roane
Summers
Taylor
Tucker
Tyler
Upshur
Webster
Wirt
Wood
Wyoming
North Carolina Alamance North Carolina Alexander
North Carolina
North Carolina
Alleghany
Ashe North Carolina Caswell North Carolina Chatham North Carolina Davidson North Carolina Davie North Carolina Durham
North Carolina
North Carolina
Forsyth
Granville North Carolina Guilford North Carolina Hoke North Carolina Iredell North Carolina Lee
North Carolina
North Carolina
Montgomery
Moore
North Carolina
North Carolina
Orange
Person
North Carolina
North Carolina
Randolph
Robeson
North Carolina Rockingham
5 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
North Carolina Scotland North Carolina Stokes
North Carolina
North Carolina
Surry
Vance North Carolina Warren
North Carolina
North Carolina
Watauga
Wilkes North Carolina Yadkin
23
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Raleigh NC - Greenville NC
North Carolina
Bedford (city)
Martinsville
South Boston
Amherst
Appomattox
Bedford
Campbell
Carroll
Charlotte
Danville
Galax
Grayson
Halifax
Henry
Lynchburg
Mecklenburg
Patrick
Pittsylvania
Beaufort North Carolina Bertie North Carolina Bladen North Carolina Brunswick North Carolina Carteret North Carolina Chowan North Carolina Columbus North Carolina Craven North Carolina Cumberland
North Carolina
North Carolina
North Carolina
Duplin
Edgecombe
Franklin North Carolina Greene North Carolina Halifax North Carolina Harnett North Carolina Hertford
North Carolina Hyde
6 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
North Carolina Johnston North Carolina Jones North Carolina Lenoir North Carolina Martin North Carolina Nash North Carolina New Hanover
North Carolina
North Carolina
Northampton
Onslow North Carolina Pamlico North Carolina Pender North Carolina Pitt
North Carolina
North Carolina
North Carolina
Sampson
Tyrrell
Wake
North Carolina
North Carolina
North Carolina
Washington
Wayne
Wilson 24 Norfolk VA - Richmond VA
Maryland
Maryland
North Carolina
Charles
St. Mary’s
Camden North Carolina Currituck North Carolina Dare North Carolina Gates
North Carolina
North Carolina
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Pasquotank
Perquimans
Emporia (city)
Accomack
Amelia
Brunswick
Caroline
Charles City
Chesapeake
Chesterfield
Colonial Heights
Cumberland
Dinwiddie
Essex
Franklin
Fredericksburg
Gloucester
Goochland
Greensville
Hampton
Virginia Hanover Virginia Henrico Virginia Hopewell Virginia Isle of Wight Virginia James City Virginia King and Queen Virginia King George Virginia King William Virginia Lancaster Virginia Louisa Virginia Lunenburg Virginia Mathews Virginia Middlesex Virginia New Kent Virginia Newport News Virginia Norfolk Virginia Northampton Virginia Northumberland Virginia Nottoway Virginia Petersburg Virginia Poquoson Virginia Portsmouth Virginia Powhatan Virginia Prince Edward Virginia Prince George Virginia Richmond Virginia Richmond Virginia Southampton Virginia Spotsylvania Virginia Stafford Virginia Suffolk Virginia Surry Virginia Sussex Virginia Virginia Beach Virginia Westmoreland Virginia Williamsburg Virginia York 25 Charlotte NC - Greenville SC
North Carolina Anson North Carolina Avery North Carolina Buncombe North Carolina Burke North Carolina Cabarrus North Carolina Caldwell
7 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
North Carolina Catawba North Carolina Cherokee North Carolina Cleveland North Carolina Gaston North Carolina Graham
North Carolina
North Carolina
Haywood
Henderson North Carolina Jackson North Carolina Lincoln North Carolina Macon North Carolina Madison North Carolina McDowell
North Carolina
North Carolina
Mecklenburg
Mitchell North Carolina Polk North Carolina Richmond North Carolina Rowan North Carolina Rutherford
North Carolina
North Carolina
Stanly
Swain
North Carolina
North Carolina
Transylvania
Union
North Carolina
South Carolina
Yancey
Anderson South Carolina Cherokee South Carolina Greenville South Carolina Lancaster South Carolina Laurens South Carolina Oconee South Carolina Pickens
South Carolina
South Carolina
Spartanburg
Union South Carolina York 26 Huntington WV - Columbus OH
Ohio Ashland Ohio Athens Ohio Coshocton Ohio Crawford Ohio Delaware Ohio Fairfield
Ohio
Ohio
Fayette
Franklin Ohio Gallia
Ohio Guernsey
Ohio Hardin
Ohio
Ohio
Hocking
Jackson Ohio Knox Ohio Lawrence
Ohio
Ohio
Ohio
Licking
Logan
Madison Ohio Marion
Ohio
Ohio
Meigs
Monroe
Ohio
Ohio
Morgan
Morrow
Ohio
Ohio
Muskingum
Noble
Ohio
Ohio
Ohio
Perry
Pickaway
Pike Ohio Richland Ohio Ross Ohio Scioto Ohio Union Ohio Vinton
27
Ohio
Ohio
West Virginia
West Virginia
West Virginia
West Virginia
Lexington KY - Knoxville TN
Kentucky
Kentucky
Kentucky
Kentucky
Kentucky
Kentucky
Kentucky
Kentucky
Kentucky
Kentucky
Kentucky
Kentucky
Kentucky
Kentucky
Washington
Wyandot
Cabell
Lincoln
Mason
Wayne
Anderson
Bath
Bell
Bourbon
Boyd
Boyle
Bracken
Breathitt
Carter
Casey
Clark
Clay
Elliott
Estill
8 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Kentucky Fayette Kentucky Fleming Kentucky Floyd Kentucky Franklin Kentucky Gallatin Kentucky Garrard Kentucky Greenup Kentucky Harlan Kentucky Harrison Kentucky Jackson Kentucky Jessamine Kentucky Johnson Kentucky Knott Kentucky Knox Kentucky Laurel Kentucky Lawrence Kentucky Lee Kentucky Leslie Kentucky Letcher Kentucky Lawrence Kentucky Lincoln Kentucky Madison Kentucky Magoffin Kentucky Martin Kentucky Mason Kentucky McCreary Kentucky Menifee Kentucky Mercer Kentucky Montgomery Kentucky Morgan Kentucky Nicholas Kentucky Owen Kentucky Owsley Kentucky Perry Kentucky Pike Kentucky Powell Kentucky Pulaski Kentucky Robertson Kentucky Rockcastle Kentucky Rowan Kentucky Scott Kentucky Wayne Kentucky Whitley Kentucky Wolfe
Kentucky
Tennessee
Woodford
Anderson Tennessee Blount
Tennessee
Tennessee
Campbell
Carter Tennessee Claiborne Tennessee Cocke
Tennessee
Tennessee
Grainger
Greene Tennessee Hamblen Tennessee Hancock Tennessee Hawkins Tennessee Jefferson Tennessee Johnson Tennessee Knox Tennessee Loudon Tennessee McMinn
Tennessee
Tennessee
Meigs
Monroe
Tennessee
Tennessee
Morgan
Roane Tennessee Scott Tennessee Sevier Tennessee Sullivan Tennessee Unicoi Tennessee Union
28
Tennessee
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Virginia
Charleston SC
Washington
Bristol
Buchanan
Dickenson
Lee
Norton
Russell
Scott
Smyth
Tazewell
Washington
Wise
South Carolina Abbeville
South Carolina
South Carolina
Bamberg
Barnwell
South Carolina
South Carolina
Berkeley
Calhoun
9 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
South Carolina Charleston South Carolina Chester South Carolina Chesterfield South Carolina Clarendon South Carolina Colleton
South Carolina
South Carolina
Darlington
Dillon South Carolina Dorchester South Carolina Fairfield South Carolina Florence
South Carolina
South Carolina
Georgetown
Greenwood
South Carolina
South Carolina
South Carolina
Hampton
Horry
Kershaw South Carolina Lee
South Carolina
South Carolina
Lexington
Marion South Carolina Marlboro South Carolina McCormick
South Carolina
South Carolina
South Carolina
Newberry
Orangeburg
Richland South Carolina Saluda South Carolina Sumter
29
South Carolina
Atlanta GA
Williamsburg
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Banks
Barrow
Bartow
Butts
Carroll
Cherokee
Clarke
Clayton
Cobb
Coweta
Dawson
DeKalb
Douglas
Elbert
Fannin
Fayette
Forsyth
Georgia Franklin Georgia Fulton Georgia Gilmer Georgia Greene Georgia Gwinnett Georgia Habersham Georgia Hall Georgia Hart Georgia Heard Georgia Henry Georgia Jackson Georgia Jasper Georgia Lumpkin Georgia Madison Georgia Meriwether Georgia Morgan Georgia Murray Georgia Newton Georgia Oconee Georgia Oglethorpe Georgia Paulding Georgia Pickens Georgia Pike Georgia Putnam Georgia Rabun Georgia Rockdale Georgia Spalding Georgia Stephens Georgia Towns Georgia Troup Georgia Union Georgia Walton Georgia White Georgia Whitfield North Carolina Clay 30 Augusta GA - Savannah GA
Georgia Appling Georgia Baker Georgia Baldwin Georgia Ben Hill Georgia Bibb Georgia Bleckley Georgia Bryan Georgia Bulloch
10 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Georgia Burke Georgia Calhoun Georgia Candler Georgia Chatham Georgia Chattahoochee Georgia Columbia Georgia Crawford Georgia Crisp Georgia Dodge Georgia Dooly Georgia Dougherty Georgia Effingham Georgia Emanuel Georgia Evans Georgia Glascock Georgia Hancock Georgia Harris Georgia Houston Georgia Irwin Georgia Jeff Davis Georgia Jefferson Georgia Jenkins Georgia Johnson Georgia Jones Georgia Lamar Georgia Laurens Georgia Lee Georgia Liberty Georgia Lincoln Georgia Long Georgia Macon Georgia Marion Georgia McDuffie Georgia Mitchell Georgia Monroe Georgia Montgomery Georgia Muscogee Georgia Peach Georgia Pulaski Georgia Randolph Georgia Richmond Georgia Schley Georgia Screven Georgia Stewart
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
South Carolina
Sumter
Talbot
Taliaferro
Tattnall
Taylor
Telfair
Terrell
Toombs
Treutlen
Twiggs
Upson
Warren
Washington
Wayne
Webster
Wheeler
Wilcox
Wilkes
Wilkinson
Worth
Aiken South Carolina Allendale South Carolina Beaufort
31
South Carolina
South Carolina
Birmingham AL
Alabama
Edgefield
Jasper
Bibb Alabama Blount Alabama Calhoun Alabama Chambers Alabama Cherokee Alabama Chilton
Alabama
Alabama
Clay
Cleburne Alabama Colbert Alabama Coosa Alabama Cullman Alabama Dallas Alabama DeKalb Alabama Etowah Alabama Franklin Alabama Jackson Alabama Jefferson Alabama Lauderdale
11 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Alabama Lawrence Alabama Lee Alabama Limestone Alabama Macon Alabama Madison
Alabama
Alabama
Marengo
Marion Alabama Marshall
Alabama
Alabama
Alabama
Alabama
Morgan
Perry
Randolph
Russell
Alabama
Alabama
Shelby
St. Clair
Alabama
Alabama
Alabama
Talladega
Tallapoosa
Walker Alabama Wilcox Alabama Winston
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Georgia
Mississippi
Tennessee
Catoosa
Chattooga
Dade
Floyd
Gordon
Haralson
Polk
Walker
Tishomingo
Bledsoe
Tennessee
Tennessee
Bradley
Hamilton Tennessee Lincoln Tennessee Marion Tennessee Polk Tennessee Rhea
32
Tennessee
Miami FL
Sequatchie
Florida Miami-Dade Florida Monroe 33 Fort Lauderdale FL
Florida Broward Florida Martin Florida Palm Beach
34 Fort Myers FL
Florida Charlotte Florida Collier Florida DeSoto Florida Glades
Florida
Florida
Hendry
Lee Florida Manatee Florida Sarasota 35 Tampa FL
Florida Hernando
Florida
Florida
Hillsborough
Pasco Florida Pinellas 36 Orlando FL
Florida Brevard
Florida
Florida
Flagler
Hardee
Florida
Florida
Highlands
Indian River Florida Lake Florida Okeechobee
Florida
Florida
Orange
Osceola Florida Polk Florida Seminole Florida St. Lucie Florida Sumter Florida Volusia 37 Jacksonville FL - Ocala FL
Florida Alachua Florida Baker Florida Bradford Florida Calhoun Florida Citrus
Florida
Florida
Clay
Columbia Florida Dixie Florida Duval Florida Gadsden Florida Gilchrist Florida Hamilton Florida Jefferson
Florida
Florida
Lafayette
Leon
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Florida Levy Florida Liberty Florida Madison Florida Marion Florida Nassau Florida Putnam Florida St. Johns Florida Suwannee Florida Taylor Florida Union Florida Wakulla Georgia Atkinson Georgia Bacon Georgia Berrien Georgia Brantley Georgia Brooks Georgia Camden Georgia Charlton Georgia Clinch Georgia Coffee Georgia Colquitt Georgia Cook Georgia Decatur Georgia Echols Georgia Glynn Georgia Grady Georgia Lanier Georgia Lowndes Georgia McIntosh Georgia Miller Georgia Pierce Georgia Thomas Georgia Tift Georgia Turner Georgia Ware 38 Pensacola FL - Montgomery AL
Alabama Autauga Alabama Barbour Alabama Bullock Alabama Butler Alabama Coffee Alabama Conecuh Alabama Covington Alabama Crenshaw
Alabama Dale Alabama Elmore Alabama Escambia Alabama Geneva
Alabama
Alabama
Henry
Houston Alabama Lowndes
Alabama
Alabama
Montgomery
Pike
Florida
Florida
Bay
Escambia Florida Franklin Florida Gulf Florida Holmes Florida Jackson Florida Okaloosa Florida Santa Rosa Florida Walton
39
Florida
Georgia
Georgia
Georgia
Georgia
New Orleans - Shreveport LA
Louisiana
Washington
Clay
Early
Quitman
Seminole
Acadia Louisiana Allen
Louisiana
Louisiana
Louisiana
Louisiana
Assumption
Avoyelles
Beauregard
Bienville Louisiana Bossier Louisiana Caddo Louisiana Calcasieu Louisiana Caldwell Louisiana Cameron Louisiana Catahoula Louisiana Claiborne Louisiana Concordia Louisiana De Soto Louisiana East Carroll
Louisiana
Louisiana
Evangeline
Franklin Louisiana Grant Louisiana Iberia
13 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Louisiana Jackson Louisiana Jefferson Louisiana Jefferson Davis Louisiana La Salle
Louisiana
Louisiana
Lafayette
Lafourche Louisiana Lincoln Louisiana Morehouse Louisiana Natchitoches Louisiana Orleans Louisiana Ouachita
Louisiana
Louisiana
Louisiana
Plaquemines
Rapides
Red River Louisiana Richland Louisiana Sabine Louisiana St. Bernard Louisiana St. Charles Louisiana St. James
Louisiana
Louisiana
Louisiana
St. John the Baptist
St. Landry
St. Martin
Louisiana
Louisiana
Louisiana
St. Mary
St. Tammany
Tensas Louisiana Terrebonne Louisiana Union Louisiana Vermilion Louisiana Vernon
Louisiana
Louisiana
Washington
Webster Louisiana West Carroll Louisiana Winn Texas Harrison Texas Panola 40 Jackson MS
Alabama
Alabama
Fayette
Greene Alabama Hale Alabama Lamar Alabama Pickens Alabama Tuscaloosa Louisiana Madison
Mississippi Adams
Mississippi Amite Mississippi Attala Mississippi Calhoun Mississippi Carroll Mississippi Chickasaw Mississippi Choctaw Mississippi Claiborne Mississippi Clay Mississippi Copiah Mississippi Franklin Mississippi Grenada Mississippi Hinds Mississippi Holmes Mississippi Humphreys Mississippi Issaquena Mississippi Itawamba Mississippi Jefferson Mississippi Lafayette Mississippi Lawrence Mississippi Leake Mississippi Lee Mississippi Leflore Mississippi Lincoln Mississippi Lowndes Mississippi Madison Mississippi Marion Mississippi Monroe Mississippi Montgomery Mississippi Oktibbeha Mississippi Panola Mississippi Pike Mississippi Pontotoc Mississippi Prentiss Mississippi Rankin Mississippi Scott Mississippi Sharkey Mississippi Simpson Mississippi Smith Mississippi Sunflower Mississippi Tallahatchie Mississippi Union Mississippi Walthall Mississippi Warren Mississippi Webster
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Mississippi Winston Mississippi Yalobusha Mississippi Yazoo 41 Mobile AL - Baton Rouge LA
Alabama Baldwin Alabama Choctaw Alabama Clarke Alabama Mobile Alabama Monroe Alabama Sumter Alabama Washington Louisiana Ascension Louisiana East Baton Rouge Louisiana East Feliciana Louisiana Iberville Louisiana Livingston Louisiana Pointe Coupee Louisiana St. Helena Louisiana Tangipahoa Louisiana West Baton Rouge Louisiana West Feliciana Mississippi Clarke Mississippi Covington Mississippi Forrest Mississippi George Mississippi Greene Mississippi Hancock Mississippi Harrison Mississippi Jackson Mississippi Jasper Mississippi Jefferson Davis Mississippi Jones Mississippi Kemper Mississippi Lamar Mississippi Lauderdale Mississippi Neshoba Mississippi Newton Mississippi Noxubee Mississippi Pearl River Mississippi Perry Mississippi Stone Mississippi Wayne Mississippi Wilkinson 42 Little Rock AR
Arkansas Arkansas
Arkansas
Arkansas
Ashley
Benton Arkansas Boone
Arkansas
Arkansas
Bradley
Calhoun Arkansas Carroll Arkansas Chicot Arkansas Clark
Arkansas
Arkansas
Clay
Cleburne Arkansas Cleveland Arkansas Columbia
Arkansas
Arkansas
Arkansas
Conway
Craighead
Crawford Arkansas Dallas Arkansas Desha Arkansas Drew Arkansas Faulkner Arkansas Franklin Arkansas Fulton Arkansas Garland Arkansas Grant Arkansas Greene
Arkansas
Arkansas
Arkansas
Hempstead
Hot Spring
Howard
Arkansas
Arkansas
Independence
Izard Arkansas Jackson Arkansas Jefferson Arkansas Johnson
Arkansas
Arkansas
Lafayette
Lawrence Arkansas Lincoln Arkansas Little River
Arkansas
Arkansas
Logan
Lonoke Arkansas Madison Arkansas Miller Arkansas Monroe
Arkansas
Arkansas
Montgomery
Nevada
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Arkansas Newton Arkansas Ouachita
Arkansas
Arkansas
Perry
Pike Arkansas Poinsett Arkansas Polk
Arkansas
Arkansas
Pope
Prairie Arkansas Pulaski
Arkansas
Arkansas
Randolph
Saline Arkansas Scott
Arkansas
Arkansas
Searcy
Sebastian Arkansas Sevier
Arkansas
Arkansas
Sharp
Stone Arkansas Union Arkansas Van Buren
Arkansas
Arkansas
Washington
White Arkansas Woodruff Arkansas Yell Missouri Dunklin Oklahoma Adair Oklahoma Haskell Oklahoma Latimer Oklahoma Le Flore Oklahoma McCurtain
Oklahoma
Texas
Sequoyah
Bowie Texas Cass 43 Nashville TN - Memphis TN
Arkansas Crittenden Arkansas Cross Arkansas Lee
Arkansas
Arkansas
Arkansas
Mississippi
Phillips
St. Francis
Kentucky
Kentucky
Kentucky
Kentucky
Kentucky
Allen
Butler
Christian
Edmonson
Fulton
Kentucky
Kentucky
Kentucky
Kentucky
Kentucky
Mississippi
Mississippi
Mississippi
Mississippi
Mississippi
Mississippi
Mississippi
Mississippi
Mississippi
Mississippi
Mississippi
Tennessee
Logan
Muhlenberg
Simpson
Todd
Warren
Alcorn
Benton
Bolivar
Coahoma
DeSoto
Marshall
Quitman
Tate
Tippah
Tunica
Washington
Bedford Tennessee Benton Tennessee Cannon Tennessee Carroll Tennessee Cheatham Tennessee Chester
Tennessee
Tennessee
Clay
Coffee Tennessee Crockett Tennessee Cumberland Tennessee Davidson Tennessee Decatur Tennessee DeKalb Tennessee Dickson
Tennessee
Tennessee
Tennessee
Dyer
Fayette
Fentress Tennessee Franklin Tennessee Gibson Tennessee Giles
Tennessee
Tennessee
Grundy
Hardeman Tennessee Hardin
Tennessee
Tennessee
Haywood
Henderson
Tennessee
Tennessee
Henry
Hickman Tennessee Houston
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Tennessee
Tennessee
Humphreys
Jackson Tennessee Lake Tennessee Lauderdale Tennessee Lawrence Tennessee Lewis Tennessee Macon Tennessee Madison Tennessee Marshall
Tennessee
Tennessee
Tennessee
Tennessee
Maury
McNairy
Montgomery
Moore Tennessee Obion Tennessee Overton
Tennessee
Tennessee
Perry
Pickett Tennessee Putnam Tennessee Robertson Tennessee Rutherford
Tennessee
Tennessee
Shelby
Smith Tennessee Stewart Tennessee Sumner
Tennessee
Tennessee
Tipton
Trousdale Tennessee Van Buren Tennessee Warren
Tennessee
Tennessee
Tennessee
Wayne
Weakley
White Tennessee Williamson Tennessee Wilson 44 Cincinnati OH
Indiana Dearborn Indiana Franklin Indiana Ohio
Kentucky
Kentucky
Kentucky
Kentucky
Kentucky
Ohio
Boone
Campbell
Grant
Kenton
Pendleton
Adams Ohio Brown
Ohio Butler Ohio Clermont Ohio Clinton Ohio Greene Ohio Hamilton
Ohio
Ohio
Highland
Warren 45 Louisville KY
Illinois Crawford Illinois Edwards Illinois Gallatin Illinois Hamilton Illinois Hardin
Illinois
Illinois
Jasper
Johnson Illinois Lawrence Illinois Massac
Illinois
Illinois
Pope
Richland Illinois Saline Illinois Wabash
Illinois
Illinois
Wayne
White Indiana Clark Indiana Crawford Indiana Daviess Indiana Dubois
Indiana
Indiana
Floyd
Gibson Indiana Harrison Indiana Jefferson Indiana Knox Indiana Martin
Indiana
Indiana
Perry
Pike
Indiana
Indiana
Indiana
Posey
Ripley
Scott
Indiana
Indiana
Spencer
Switzerland
Indiana
Indiana
Vanderburgh
Warrick
Indiana
Kentucky
Washington
Adair
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Kentucky Ballard
Kentucky Barren
Kentucky Breckinridge
Kentucky Bullitt
Kentucky Caldwell
Kentucky Calloway
Kentucky Carlisle
Kentucky Carroll
Kentucky Clinton
Kentucky Crittenden
Kentucky Cumberland
Kentucky Daviess
Kentucky Graves
Kentucky Grayson
Kentucky Green
Kentucky Hancock
Kentucky Hardin
Kentucky Hart
Kentucky Henderson
Kentucky Henry
Kentucky Hickman
Kentucky Hopkins
Kentucky Jefferson
Kentucky Larue
Kentucky Livingston
Kentucky Lyon
Kentucky Marion
Kentucky Marshall
Kentucky McCracken
Kentucky McLean
Kentucky Meade
Kentucky Metcalfe
Kentucky Monroe
Kentucky Nelson
Kentucky Ohio
Kentucky Oldham
Kentucky Russell
Kentucky Shelby
Kentucky Spencer
Kentucky Taylor
Kentucky Trigg
Kentucky Trimble
Kentucky Union
Kentucky Washington
46
Kentucky
Cleveland OH
Webster
Ohio Ashtabula
Ohio
Ohio
Cuyahoga
Erie
Ohio
Ohio
Geauga
Huron Ohio Lake Ohio Lorain Ohio Medina 47 Youngstown OH - Canton OH
Ohio Carroll Ohio Columbiana Ohio Holmes
Ohio
Ohio
Ohio
Mahoning
Portage
Stark Ohio Summit Ohio Trumbull Ohio Tuscarawas
48
Ohio
Pennsylvania
Dayton OH - Fort Wayne IN
Indiana
Wayne
Lawrence
Adams Indiana Allen Indiana Blackford Indiana DeKalb Indiana Delaware
Indiana
Indiana
Indiana
Huntington
Jay
Kosciusko
Indiana
Indiana
LaGrange
Noble
Indiana
Indiana
Randolph
Steuben Indiana Wabash Indiana Wells
Indiana
Michigan
Ohio
Whitley
Monroe
Allen
Ohio
Ohio
Ohio
Auglaize
Champaign
Clark Ohio Darke
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Ohio Defiance Ohio Fulton Ohio Hancock
Ohio
Ohio
Henry
Lucas Ohio Mercer Ohio Miami
Ohio
Ohio
Montgomery
Ottawa
Ohio
Ohio
Paulding
Preble Ohio Putnam
Ohio
Ohio
Sandusky
Seneca
Ohio
Ohio
Shelby
Van Wert Ohio Williams Ohio Wood 49 Ann Arbor MI
50
Michigan
Michigan
Michigan
Michigan
Michigan
Detroit MI
Jackson
Lenawee
Livingston
Washtenaw
Wayne
51
Michigan
Michigan
Michigan
Michigan
Michigan
Grand Rapids MI - Saginaw MI
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Genesee
Lapeer
Macomb
Oakland
St. Clair
Alcona
Allegan
Alpena
Antrim
Arenac
Barry
Bay
Benzie
Charlevoix
Cheboygan
Chippewa
Clare
Clinton
Michigan Crawford Michigan Eaton Michigan Emmet Michigan Gladwin Michigan Grand Traverse Michigan Gratiot Michigan Huron Michigan Ingham Michigan Ionia Michigan Iosco Michigan Isabella Michigan Kalkaska Michigan Kent Michigan Lake Michigan Leelanau Michigan Mackinac Michigan Manistee Michigan Mason Michigan Mecosta Michigan Midland Michigan Missaukee Michigan Montcalm Michigan Montmorency Michigan Muskegon Michigan Newaygo Michigan Oceana Michigan Ogemaw Michigan Osceola Michigan Oscoda Michigan Otsego Michigan Ottawa Michigan Presque Isle Michigan Roscommon Michigan Saginaw Michigan Sanilac Michigan Shiawassee Michigan Tuscola Michigan Wexford 52 South Bend IN - Kalamazoo MI
Indiana Elkhart Indiana Fulton Indiana Lake Indiana LaPorte Indiana Marshall
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Indiana Porter
Indiana
Indiana
St. Joseph
Starke
53
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Indianapolis IN
Illinois
Illinois
Berrien
Branch
Calhoun
Cass
Hillsdale
Kalamazoo
St. Joseph
Van Buren
Champaign
Clark Illinois Coles
Illinois
Illinois
Illinois
Douglas
Edgar
Ford
Illinois
Illinois
Iroquois
Piatt Illinois Vermilion Indiana Bartholomew Indiana Benton Indiana Boone Indiana Brown Indiana Carroll Indiana Cass
Indiana
Indiana
Clay
Clinton Indiana Decatur
Indiana
Indiana
Fayette
Fountain Indiana Grant Indiana Greene Indiana Hamilton Indiana Hancock Indiana Hendricks
Indiana
Indiana
Henry
Howard Indiana Jackson
Indiana
Indiana
Indiana
Jasper
Jennings
Johnson Indiana Lawrence
Indiana Madison Indiana Marion Indiana Miami Indiana Monroe
Indiana
Indiana
Indiana
Montgomery
Morgan
Newton
Indiana
Indiana
Orange
Owen Indiana Parke Indiana Pulaski Indiana Putnam Indiana Rush
Indiana
Indiana
Shelby
Sullivan
Indiana
Indiana
Indiana
Tippecanoe
Tipton
Union Indiana Vermillion
Indiana
Indiana
Vigo
Warren
Indiana
Indiana
Wayne
White 54 Chicago IL
Illinois Cook 55 Rockford IL - Melrose Park IL
Illinois Boone Illinois Bureau Illinois Carroll Illinois DeKalb
Illinois
Illinois
Illinois
DuPage
Grundy
Kane Illinois Kankakee Illinois Kendall Illinois Lee
Illinois
Illinois
Illinois
Illinois
McHenry
Ogle
Stephenson
Whiteside Illinois Will
56
Illinois
Springfield IL
Illinois
Winnebago
Adams
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Illinois Brown Illinois Cass Illinois Christian
Illinois
Illinois
Clay
Cumberland Illinois De Witt
Illinois
Illinois
Illinois
Effingham
Fayette
Fulton Illinois Greene Illinois Hancock Illinois Knox Illinois LaSalle
Illinois
Illinois
Illinois
Livingston
Logan
Macon
Illinois
Illinois
Macoupin
Marshall Illinois Mason
Illinois
Illinois
McDonough
McLean Illinois Menard
Illinois
Illinois
Illinois
Montgomery
Morgan
Moultrie Illinois Peoria Illinois Pike Illinois Putnam
Illinois
Illinois
Illinois
Sangamon
Schuyler
Scott
Illinois
Illinois
Shelby
Stark Illinois Tazewell Illinois Warren Illinois Woodford Missouri Lewis Missouri Marion 57 Milwaukee WI
Illinois Lake Wisconsin Fond du Lac Wisconsin Kenosha Wisconsin Milwaukee Wisconsin Ozaukee
Wisconsin Racine
Wisconsin
Wisconsin
Sheboygan
Walworth
Wisconsin
Wisconsin
Washington
Waukesha 58 Madison WI
Iowa Allamakee
Iowa
Iowa
Fayette
Winneshiek Minnesota Houston Minnesota Winona Wisconsin Adams Wisconsin Columbia Wisconsin Crawford Wisconsin Dane
Wisconsin
Wisconsin
Dodge
Grant Wisconsin Green Wisconsin Green Lake Wisconsin Iowa Wisconsin Jefferson Wisconsin Juneau Wisconsin La Crosse
Wisconsin
Wisconsin
Wisconsin
Lafayette
Marquette
Monroe Wisconsin Richland Wisconsin Rock Wisconsin Sauk
Wisconsin
Wisconsin
Trempealeau
Vernon Wisconsin Waushara
59
Wisconsin
Green Bay WI
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Michigan
Winnebago
Alger
Baraga
Delta
Dickinson
Gogebic
Houghton
Iron
Keweenaw
Luce
Marquette
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Michigan
Michigan
Michigan
Minnesota
Menominee
Ontonagon
Schoolcraft
Carlton Minnesota Cook Minnesota Lake Minnesota Pine Minnesota St. Louis Wisconsin Ashland
Wisconsin
Wisconsin
Bayfield
Brown Wisconsin Calumet
Wisconsin
Wisconsin
Chippewa
Clark Wisconsin Door
Wisconsin
Wisconsin
Douglas
Florence Wisconsin Forest Wisconsin Iron Wisconsin Jackson Wisconsin Kewaunee
Wisconsin
Wisconsin
Langlade
Lincoln Wisconsin Manitowoc Wisconsin Marathon Wisconsin Marinette Wisconsin Menominee Wisconsin Oconto Wisconsin Oneida
Wisconsin
Wisconsin
Wisconsin
Outagamie
Portage
Price Wisconsin Rusk
Wisconsin
Wisconsin
Sawyer
Shawano
Wisconsin
Wisconsin
Taylor
Vilas
Wisconsin
Wisconsin
Waupaca
Wood 60 Minneapolis - St. Paul MN
Iowa Chickasaw Iowa Howard Minnesota Aitkin Minnesota Anoka
Minnesota Benton
Minnesota
Minnesota
Big Stone
Blue Earth Minnesota Brown Minnesota Carver Minnesota Cass
Minnesota
Minnesota
Minnesota
Minnesota
Chippewa
Chisago
Crow Wing
Dakota
Minnesota
Minnesota
Minnesota
Dodge
Douglas
Faribault Minnesota Fillmore Minnesota Freeborn Minnesota Goodhue
Minnesota
Minnesota
Hennepin
Isanti Minnesota Itasca Minnesota Kanabec
Minnesota
Minnesota
Minnesota
Kandiyohi
Koochiching
Le Sueur Minnesota Martin Minnesota McLeod Minnesota Meeker Minnesota Mille Lacs Minnesota Morrison Minnesota Mower Minnesota Nicollet Minnesota Olmsted
Minnesota
Minnesota
Minnesota
Pope
Ramsey
Redwood Minnesota Renville Minnesota Rice Minnesota Scott Minnesota Sherburne
Minnesota
Minnesota
Sibley
Stearns Minnesota Steele Minnesota Stevens Minnesota Swift Minnesota Todd
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Minnesota Wabasha
Minnesota Wadena Minnesota Waseca
Minnesota
Minnesota
Washington
Watonwan
Minnesota
Minnesota
Wright
Yellow Medicine Wisconsin Barron Wisconsin Buffalo Wisconsin Burnett Wisconsin Dunn Wisconsin Eau Claire
Wisconsin
Wisconsin
Pepin
Pierce Wisconsin Polk Wisconsin St. Croix Wisconsin Washburn 61 Kansas City MO
Arkansas Baxter Arkansas Marion Kansas Anderson Kansas Atchison Kansas Bourbon Kansas Cherokee Kansas Crawford
Kansas
Kansas
Kansas
Doniphan
Douglas
Franklin Kansas Johnson Kansas Leavenworth Kansas Linn Kansas Miami
Kansas
Missouri
Wyandotte
Adair Missouri Andrew Missouri Audrain
Missouri
Missouri
Barry
Barton Missouri Bates Missouri Benton Missouri Boone Missouri Buchanan Missouri Caldwell
Missouri Callaway
Missouri Camden
Missouri Carroll
Missouri Cass
Missouri Cedar
Missouri Chariton
Missouri Christian
Missouri
Missouri
Clay
Clinton
Missouri Cole
Missouri
Missouri
Cooper
Dade
Missouri Dallas
Missouri Daviess
Missouri DeKalb
Missouri
Missouri
Missouri
Douglas
Gentry
Greene
Missouri
Missouri
Grundy
Harrison
Missouri
Missouri
Missouri
Henry
Hickory
Holt
Missouri Howard
Missouri Howell
Missouri Jackson
Missouri
Missouri
Jasper
Johnson
Missouri Knox
Missouri Laclede
Missouri
Missouri
Lafayette
Lawrence
Missouri Linn
Missouri
Missouri
Livingston
Macon
Missouri Maries
Missouri McDonald
Missouri Mercer
Missouri Miller
Missouri Moniteau
Missouri Monroe
Missouri
Missouri
Missouri
Montgomery
Morgan
Newton
Missouri Nodaway
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Missouri
Missouri
Missouri
Oregon
Osage
Ozark Missouri Pettis Missouri Platte Missouri Polk Missouri Putnam Missouri Ralls
Missouri
Missouri
Missouri
Randolph
Ray
Saline
Missouri
Missouri
Schuyler
Shannon
Missouri
Missouri
Shelby
St. Clair Missouri Stone Missouri Sullivan
Missouri
Missouri
Taney
Texas Missouri Vernon Missouri Webster Missouri Worth
Missouri
Oklahoma
Wright
Delaware Oklahoma Ottawa 62 St. Louis MO
Illinois Alexander Illinois Bond Illinois Calhoun Illinois Clinton Illinois Franklin Illinois Jackson Illinois Jefferson
Illinois
Illinois
Jersey
Madison Illinois Marion Illinois Monroe
Illinois
Illinois
Perry
Pulaski
Illinois
Illinois
Randolph
St. Clair Illinois Union
Illinois
Illinois
Washington
Williamson
Missouri
Missouri
Bollinger
Butler
Missouri
Missouri
Cape Girardeau
Carter Missouri Crawford Missouri Dent Missouri Franklin Missouri Gasconade Missouri Iron Missouri Jefferson Missouri Lincoln Missouri Madison
Missouri
Missouri
Mississippi
New Madrid Missouri Pemiscot
Missouri
Missouri
Missouri
Perry
Phelps
Pike Missouri Pulaski
Missouri
Missouri
Missouri
Reynolds
Ripley
Scott Missouri St. Charles Missouri St. Francois Missouri St. Louis Missouri St. Louis Missouri Ste. Genevieve Missouri Stoddard Missouri Warren
63
Missouri
Missouri
Des Moines IA
Washington
Wayne
Illinois Henderson
Illinois
Illinois
Henry
Jo Daviess Illinois Mercer Illinois Rock Island Iowa Adair Iowa Adams
Iowa
Iowa
Appanoose
Audubon Iowa Benton Iowa Black Hawk Iowa Boone
24 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Iowa Bremer Iowa Buchanan Iowa Butler Iowa Calhoun Iowa Carroll Iowa Cedar Iowa Cerro Gordo Iowa Clarke Iowa Clayton Iowa Clinton Iowa Dallas Iowa Davis Iowa Decatur Iowa Delaware Iowa Des Moines Iowa Dubuque Iowa Floyd Iowa Franklin Iowa Greene Iowa Grundy Iowa Guthrie Iowa Hamilton Iowa Hancock Iowa Hardin Iowa Henry Iowa Humboldt Iowa Iowa Iowa Jackson Iowa Jasper Iowa Jefferson Iowa Johnson Iowa Jones Iowa Keokuk Iowa Kossuth Iowa Lee Iowa Linn Iowa Louisa Iowa Lucas Iowa Madison Iowa Mahaska Iowa Marion Iowa Marshall Iowa Mitchell Iowa Monroe
Iowa Muscatine Iowa Palo Alto Iowa Pocahontas Iowa Polk Iowa Poweshiek
Iowa
Iowa
Ringgold
Scott
Iowa
Iowa
Story
Tama
Iowa
Iowa
Taylor
Union Iowa Van Buren
Iowa
Iowa
Wapello
Warren
Iowa
Iowa
Iowa
Washington
Wayne
Webster
Iowa
Iowa
Winnebago
Worth
Iowa
Missouri
Wright
Clark Missouri Scotland 64 Sioux Falls SD - Sioux City IA
Iowa Buena Vista Iowa Cherokee
Iowa
Iowa
Clay
Dickinson Iowa Emmet Iowa Ida
Iowa
Iowa
Lyon
O'Brien Iowa Osceola
Iowa
Iowa
Plymouth
Sac Iowa Sioux
Iowa
Minnesota
Woodbury
Cottonwood Minnesota Jackson
Minnesota
Minnesota
Lac qui Parle
Lincoln
Minnesota
Minnesota
Minnesota
Lyon
Murray
Nobles
Minnesota Pipestone
25 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Minnesota Rock Montana Carter Nebraska Cedar Nebraska Dakota Nebraska Dawes Nebraska Dixon Nebraska Sheridan Nebraska Thurston
North Dakota
South Dakota
Dickey
Aurora South Dakota Beadle South Dakota Bennett South Dakota Bon Homme
South Dakota
South Dakota
Brookings
Brown South Dakota Brule South Dakota Buffalo South Dakota Butte South Dakota Charles Mix South Dakota Clark
South Dakota
South Dakota
South Dakota
Clay
Codington
Custer South Dakota Davison
South Dakota
South Dakota
Day
Deuel
South Dakota
South Dakota
Douglas
Fall River South Dakota Faulk South Dakota Grant
South Dakota
South Dakota
Gregory
Haakon South Dakota Hamlin South Dakota Hand South Dakota Hanson
South Dakota
South Dakota
South Dakota
Harding
Hughes
Hutchinson
South Dakota
South Dakota
Hyde
Jackson South Dakota Jerauld South Dakota Jones
South Dakota
South Dakota
Kingsbury
Lake
South Dakota Lawrence South Dakota Lincoln
South Dakota
South Dakota
Lyman
McCook South Dakota Meade South Dakota Mellette South Dakota Miner South Dakota Minnehaha
South Dakota
South Dakota
South Dakota
Moody
Pennington
Potter South Dakota Sanborn South Dakota Shannon
South Dakota
South Dakota
South Dakota
South Dakota
Spink
Stanley
Sully
Todd
South Dakota
South Dakota
Tripp
Turner South Dakota Union South Dakota Yankton South Dakota Ziebach 65 Fargo ND - Bismarck ND
Minnesota Becker Minnesota Beltrami
Minnesota
Minnesota
Clay
Clearwater Minnesota Grant Minnesota Hubbard Minnesota Kittson Minnesota Lake of the Woods Minnesota Mahnomen Minnesota Marshall Minnesota Norman Minnesota Otter Tail
Minnesota
Minnesota
Pennington
Polk Minnesota Red Lake Minnesota Roseau Minnesota Traverse Minnesota Wilkin Montana Roosevelt North Dakota Adams North Dakota Barnes
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
North Dakota Benson
North
North
Dakota
Dakota
Billings
Bottineau North Dakota Bowman North Dakota Burke
North
North
Dakota
Dakota
Burleigh
Cass North Dakota Cavalier North Dakota Divide North Dakota Dunn
North
North
Dakota
Dakota
Eddy
Emmons North Dakota Foster
North
North
Dakota
Dakota
Golden Valley
Grand Forks North Dakota Grant
North
North
North
Dakota
Dakota
Dakota
Griggs
Hettinger
Kidder North Dakota LaMoure
North
North
North
Dakota
Dakota
Dakota
Logan
McHenry
McIntosh North Dakota McKenzie North Dakota McLean North Dakota Mercer North Dakota Morton North Dakota Mountrail North Dakota Nelson North Dakota Oliver North Dakota Pembina North Dakota Pierce
North
North
Dakota
Dakota
Ramsey
Ransom North Dakota Renville North Dakota Richland North Dakota Rolette
North
North
Dakota
Dakota
Sargent
Sheridan North Dakota Sioux
North
North
Dakota
Dakota
Slope
Stark North Dakota Steele North Dakota Stutsman
North Dakota Towner North Dakota Traill North Dakota Walsh North Dakota Ward North Dakota Wells North Dakota Williams
South Dakota
South Dakota
Campbell
Corson
South Dakota
South Dakota
Dewey
Edmunds South Dakota Marshall South Dakota McPherson South Dakota Perkins South Dakota Roberts South Dakota Walworth 66 Billings MT - Casper WY
Idaho Lemhi Montana Beaverhead
Montana
Montana
Big Horn
Blaine Montana Broadwater Montana Carbon Montana Cascade Montana Chouteau Montana Custer Montana Daniels Montana Dawson
Montana
Montana
Deer Lodge
Fallon
Montana
Montana
Fergus
Flathead Montana Gallatin Montana Garfield Montana Glacier
Montana
Montana
Golden Valley
Granite Montana Hill Montana Jefferson Montana Judith Basin Montana Lake Montana Lewis and Clark
Montana
Montana
Liberty
Lincoln Montana Madison
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Montana McCone
Montana
Montana
Meagher
Mineral Montana Missoula Montana Musselshell Montana Park Montana Petroleum
Montana
Montana
Phillips
Pondera Montana Powder River Montana Powell Montana Prairie Montana Ravalli Montana Richland Montana Rosebud Montana Sanders Montana Sheridan Montana Silver Bow Montana Stillwater Montana Sweet Grass Montana Teton Montana Toole Montana Treasure
Montana
Montana
Valley
Wheatland Montana Wibaux Montana Yellowstone Montana Yellowstone National Park
Wyoming
Wyoming
Wyoming
Wyoming
Wyoming
Wyoming
Wyoming
Wyoming
Wyoming
Wyoming
Wyoming
Wyoming
Wyoming
Wyoming
Wyoming
Wyoming
Big Horn
Campbell
Carbon
Converse
Crook
Fremont
Goshen
Hot Springs
Johnson
Natrona
Niobrara
Park
Platte
Sheridan
Washakie
Weston
67 Salt Lake City UT - Boise ID
Idaho Ada Idaho Adams Idaho Bannock Idaho Bear Lake
Idaho
Idaho
Bingham
Blaine Idaho Boise Idaho Bonneville Idaho Butte Idaho Camas
Idaho
Idaho
Canyon
Caribou Idaho Cassia Idaho Clark Idaho Custer Idaho Elmore Idaho Franklin Idaho Fremont Idaho Gem
Idaho
Idaho
Gooding
Jefferson Idaho Jerome Idaho Lincoln Idaho Madison Idaho Minidoka Idaho Oneida
Idaho
Idaho
Idaho
Owyhee
Payette
Power Idaho Teton Idaho Twin Falls
Idaho
Idaho
Nevada
Valley
Washington
Elko Nevada Lincoln Nevada White Pine
Oregon
Oregon
Utah
Baker
Malheur
Beaver Utah Box Elder Utah Cache Utah Carbon
Utah Daggett
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Utah Davis Utah Duchesne
Utah
Utah
Emery
Garfield Utah Iron Utah Juab Utah Kane Utah Millard
Utah
Utah
Morgan
Piute Utah Rich Utah Salt Lake Utah San Juan
Utah
Utah
Sanpete
Sevier Utah Summit Utah Tooele Utah Uintah Utah Utah Utah Wasatch
Utah
Utah
Utah
Washington
Wayne
Weber
68
Wyoming
Wyoming
Wyoming
Wyoming
Wyoming
Colorado Springs CO
Colorado
Lincoln
Sublette
Sweetwater
Teton
Uinta
Alamosa Colorado Baca Colorado Bent Colorado Chaffee
Colorado
Colorado
Colorado
Cheyenne
Conejos
Costilla
Colorado
Colorado
Crowley
Custer Colorado Delta
Colorado
Colorado
Eagle
El Paso Colorado Fremont Colorado Garfield Colorado Gunnison
Colorado Hinsdale Colorado Huerfano Colorado Kiowa Colorado Las Animas Colorado Mesa Colorado Mineral Colorado Montrose Colorado Otero
Colorado
Colorado
Ouray
Prowers Colorado Pueblo Colorado Rio Blanco Colorado Rio Grande
Colorado
Colorado
Colorado
Saguache
San Miguel
Teller Utah Grand 69 Denver CO
Colorado Adams
Colorado
Colorado
Arapahoe
Boulder Colorado Broomfield Colorado Clear Creek Colorado Denver
Colorado
Colorado
Douglas
Elbert
Colorado
Colorado
Gilpin
Grand Colorado Jackson Colorado Jefferson Colorado Kit Carson Colorado Lake Colorado Larimer Colorado Lincoln
Colorado
Colorado
Logan
Moffat
Colorado
Colorado
Morgan
Park
Colorado
Colorado
Phillips
Pitkin Colorado Routt
Colorado
Colorado
Sedgwick
Summit
Colorado Washington
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Colorado Weld Colorado Yuma
Kansas
Kansas
Cheyenne
Decatur Kansas Rawlins Kansas Sherman Kansas Thomas Nebraska Arthur Nebraska Banner Nebraska Box Butte Nebraska Chase
Nebraska
Nebraska
Cheyenne
Deuel
Nebraska
Nebraska
Dundy
Garden Nebraska Hitchcock Nebraska Keith Nebraska Kimball Nebraska Morrill Nebraska Perkins Nebraska Red Willow Nebraska Scotts Bluff Nebraska Sioux
70
Wyoming
Wyoming
Omaha NE - Wichita KS
Albany
Laramie
Iowa Cass Iowa Crawford Iowa Fremont Iowa Harrison Iowa Mills Iowa Monona
Iowa
Iowa
Iowa
Montgomery
Page
Pottawattamie
Iowa
Kansas
Shelby
Allen Kansas Barber Kansas Barton Kansas Brown Kansas Butler Kansas Chase Kansas Clark
Kansas Clay
Kansas Cloud
Kansas
Kansas
Coffey
Comanche
Kansas
Kansas
Cowley
Dickinson Kansas Edwards Kansas Elk Kansas Ellis Kansas Ellsworth
Kansas
Kansas
Finney
Ford
Kansas
Kansas
Geary
Gove Kansas Graham Kansas Grant
Kansas
Kansas
Kansas
Gray
Greeley
Greenwood Kansas Hamilton
Kansas
Kansas
Kansas
Harper
Harvey
Haskell
Kansas
Kansas
Hodgeman
Jackson Kansas Jefferson Kansas Jewell
Kansas
Kansas
Kansas
Kearny
Kingman
Kiowa Kansas Labette Kansas Lane Kansas Lincoln
Kansas
Kansas
Kansas
Logan
Lyon
Marion Kansas Marshall Kansas McPherson Kansas Meade Kansas Mitchell Kansas Morris Kansas Nemaha Kansas Neosho Kansas Ness Kansas Norton
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Kansas
Kansas
Osage
Osborne
Kansas Ottawa
Kansas Pawnee
Kansas
Kansas
Phillips
Pottawatomie
Kansas Pratt
Kansas Reno
Kansas
Kansas
Republic
Rice
Kansas
Kansas
Riley
Rooks
Kansas Rush
Kansas Russell
Kansas Saline
Kansas Scott
Kansas
Kansas
Sedgwick
Seward
Kansas Shawnee
Kansas Sheridan
Kansas Smith
Kansas Stafford
Kansas Stanton
Kansas Stevens
Kansas Sumner
Kansas
Kansas
Trego
Wabaunsee
Kansas Wallace
Kansas
Kansas
Washington
Wichita
Kansas Wilson
Kansas Woodson
Missouri Atchison
Nebraska Adams
Nebraska
Nebraska
Antelope
Blaine
Nebraska Boone
Nebraska
Nebraska
Boyd
Brown
Nebraska Buffalo
Nebraska Burt
Nebraska Butler
Nebraska Cass
Nebraska Cherry
Nebraska
Nebraska
Clay
Colfax
Nebraska
Nebraska
Cuming
Custer
Nebraska Dawson
Nebraska
Nebraska
Nebraska
Dodge
Douglas
Fillmore
Nebraska Franklin
Nebraska Frontier
Nebraska Furnas
Nebraska
Nebraska
Gage
Garfield
Nebraska
Nebraska
Gosper
Grant
Nebraska
Nebraska
Greeley
Hall
Nebraska Hamilton
Nebraska Harlan
Nebraska
Nebraska
Hayes
Holt
Nebraska Hooker
Nebraska Howard
Nebraska Jefferson
Nebraska Johnson
Nebraska
Nebraska
Nebraska
Kearney
Keya Paha
Knox
Nebraska Lancaster
Nebraska Lincoln
Nebraska
Nebraska
Nebraska
Logan
Loup
Madison
Nebraska McPherson
Nebraska Merrick
Nebraska Nance
Nebraska Nemaha
Nebraska Nuckolls
Nebraska Otoe
Nebraska Pawnee
Nebraska
Nebraska
Phelps
Pierce
Nebraska Platte
Nebraska Polk
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Nebraska Richardson Nebraska Rock Nebraska Saline
Nebraska
Nebraska
Sarpy
Saunders Nebraska Seward Nebraska Sherman Nebraska Stanton
Nebraska
Nebraska
Thayer
Thomas
Nebraska
Nebraska
Nebraska
Nebraska
Valley
Washington
Wayne
Webster Nebraska Wheeler Nebraska York 71
Oklahoma City OK
Kansas
Kansas
Oklahoma
Chautauqua
Montgomery
Alfalfa Oklahoma Atoka Oklahoma Beaver Oklahoma Beckham Oklahoma Blaine Oklahoma Caddo Oklahoma Canadian Oklahoma Carter Oklahoma Cherokee Oklahoma Cleveland Oklahoma Coal Oklahoma Comanche
Oklahoma
Oklahoma
Craig
Creek Oklahoma Custer
Oklahoma
Oklahoma
Dewey
Ellis Oklahoma Garfield Oklahoma Garvin
Oklahoma
Oklahoma
Grady
Grant Oklahoma Greer Oklahoma Harmon
Oklahoma
Oklahoma
Harper
Hughes
Oklahoma Jackson Oklahoma Jefferson Oklahoma Johnston
Oklahoma
Oklahoma
Oklahoma
Kay
Kingfisher
Kiowa Oklahoma Lincoln
Oklahoma
Oklahoma
Logan
Love
Oklahoma
Oklahoma
Major
Marshall
Oklahoma
Oklahoma
Mayes
McClain Oklahoma McIntosh
Oklahoma
Oklahoma
Oklahoma
Murray
Muskogee
Noble Oklahoma Nowata Oklahoma Okfuskee Oklahoma Oklahoma
Oklahoma
Oklahoma
Oklahoma
Okmulgee
Osage
Pawnee
Oklahoma
Oklahoma
Oklahoma
Payne
Pittsburg
Pontotoc Oklahoma Pottawatomie Oklahoma Pushmataha
Oklahoma
Oklahoma
Oklahoma
Roger Mills
Rogers
Seminole
Oklahoma
Oklahoma
Stephens
Tillman Oklahoma Tulsa
Oklahoma
Oklahoma
Oklahoma
Wagoner
Washington
Washita Oklahoma Woods Oklahoma Woodward
72
Texas
Fort Worth TX
Lipscomb
Kansas Morton
New Mexico
New Mexico
Curry
Eddy
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
New Mexico Lea
New Mexico
New Mexico
Quay
Roosevelt
Oklahoma Cimarron
Oklahoma Cotton
Oklahoma Texas
Texas Andrews
Texas Archer
Texas
Texas
Texas
Texas
Armstrong
Bailey
Baylor
Borden
Texas Brewster
Texas Briscoe
Texas Brown
Texas Callahan
Texas Carson
Texas Castro
Texas Childress
Texas
Texas
Clay
Cochran
Texas Coke
Texas Coleman
Texas
Texas
Collingsworth
Comanche
Texas Concho
Texas Cottle
Texas Crane
Texas Crockett
Texas
Texas
Crosby
Dallam
Texas Dawson
Texas Deaf Smith
Texas Dickens
Texas
Texas
Donley
Eastland
Texas Ector
Texas Erath
Texas Fisher
Texas
Texas
Floyd
Foard
Texas Gaines
Texas Garza
Texas Glasscock
Texas
Texas
Gray
Hale
Texas Hall
Texas Hansford
Texas Hardeman
Texas
Texas
Hartley
Haskell
Texas
Texas
Texas
Hemphill
Hockley
Hood
Texas Howard
Texas Hutchinson
Texas Irion
Texas Jack
Texas Jeff Davis
Texas Johnson
Texas Jones
Texas Kent
Texas
Texas
King
Knox
Texas Lamb
Texas
Texas
Loving
Lubbock
Texas
Texas
Lynn
Martin
Texas McCulloch
Texas Menard
Texas Midland
Texas Mills
Texas Mitchell
Texas Moore
Texas
Texas
Motley
Nolan
Texas Ochiltree
Texas Oldham
Texas Palo Pinto
Texas Parker
Texas Parmer
Texas Pecos
Texas Potter
Texas Presidio
Texas Randall
Texas
Texas
Reagan
Reeves
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Texas Roberts Texas Runnels Texas San Saba Texas Schleicher
Texas
Texas
Scurry
Shackelford Texas Sherman Texas Somervell
Texas
Texas
Texas
Stephens
Sterling
Stonewall Texas Sutton Texas Swisher Texas Tarrant
Texas
Texas
Taylor
Terrell
Texas
Texas
Terry
Throckmorton Texas Tom Green
Texas
Texas
Upton
Ward Texas Wheeler Texas Wichita
Texas
Texas
Wilbarger
Winkler Texas Yoakum
73
Texas
Austin TX
Young
Texas
Texas
Bastrop
Bell
Texas
Texas
Bosque
Brazos Texas Burleson Texas Burnet Texas Caldwell
Texas
Texas
Coryell
Falls Texas Freestone Texas Grimes Texas Hamilton
Texas
Texas
Hays
Hill
Texas
Texas
Lampasas
Lee
Texas Leon Texas Limestone Texas Llano Texas Madison Texas McLennan Texas Milam Texas Robertson Texas Travis Texas Williamson 74 San Antonio TX
Texas Aransas Texas Atascosa Texas Bandera Texas Bee Texas Bexar Texas Blanco Texas Brooks Texas Calhoun Texas Cameron Texas Comal Texas DeWitt Texas Dimmit Texas Duval Texas Edwards Texas Frio
Texas
Texas
Gillespie
Goliad Texas Gonzales
Texas
Texas
Texas
Guadalupe
Hidalgo
Jackson
Texas
Texas
Jim Hogg
Jim Wells Texas Karnes Texas Kendall
Texas
Texas
Kenedy
Kerr Texas Kimble
Texas
Texas
Texas
Kinney
Kleberg
La Salle Texas Live Oak Texas Mason Texas Maverick
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Texas McMullen Texas Medina Texas Nueces Texas Real
Texas
Texas
Refugio
San Patricio Texas Starr Texas Uvalde Texas Val Verde Texas Victoria Texas Webb
Texas
Texas
Willacy
Wilson
Texas
Texas
Zapata
Zavala 75 Houston TX
Texas
Texas
Angelina
Austin Texas Brazoria Texas Chambers Texas Colorado
Texas
Texas
Fayette
Fort Bend Texas Galveston Texas Hardin Texas Harris
Texas
Texas
Jasper
Jefferson Texas Lavaca
Texas
Texas
Texas
Texas
Texas
Liberty
Matagorda
Montgomery
Nacogdoches
Newton
Texas
Texas
Orange
Polk Texas Sabine
Texas
Texas
San Augustine
San Jacinto
Texas
Texas
Texas
Texas
Shelby
Trinity
Tyler
Walker Texas Waller
Texas
Texas
Washington
Wharton 76 Dallas TX
Oklahoma
Oklahoma
Bryan
Choctaw Texas Anderson
Texas
Texas
Camp
Cherokee Texas Collin Texas Cooke Texas Dallas Texas Delta Texas Denton Texas Ellis Texas Fannin Texas Franklin
Texas
Texas
Texas
Grayson
Gregg
Henderson
Texas
Texas
Hopkins
Houston Texas Hunt Texas Kaufman Texas Lamar Texas Marion
Texas
Texas
Montague
Morris Texas Navarro Texas Rains Texas Red River Texas Rockwall Texas Rusk Texas Smith Texas Titus
Texas
Texas
Upshur
Van Zandt Texas Wise Texas Wood 77 Albuquerque NM - El Paso TX
Colorado Archuleta Colorado Dolores Colorado La Plata Colorado Montezuma Colorado San Juan
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
New Mexico Bernalillo New Mexico Catron New Mexico Chaves New Mexico Cibola New Mexico Colfax New Mexico De Baca New Mexico Dona Ana New Mexico Grant
New Mexico
New Mexico
New Mexico
New Mexico
Guadalupe
Harding
Hidalgo
Lincoln New Mexico Los Alamos New Mexico Luna
New Mexico
New Mexico
McKinley
Mora New Mexico Otero New Mexico Rio Arriba New Mexico San Juan
New Mexico
New Mexico
San Miguel
Sandoval New Mexico Santa Fe New Mexico Sierra New Mexico Socorro New Mexico Taos New Mexico Torrance New Mexico Union New Mexico Valencia Texas Culberson Texas El Paso
78
Texas
Las Vegas NV - Reno NV
California
California
California
Hudspeth
Alpine
Inyo
Lassen California Modoc California Mono California Plumas
Nevada
Nevada
Carson City
Churchill Nevada Clark
Nevada
Nevada
Douglas
Esmeralda Nevada Eureka
Nevada Humboldt Nevada Lander
Nevada
Nevada
Lyon
Mineral
Nevada
Nevada
Nevada
Nevada
Nye
Pershing
Storey
Washoe 79 Tucson AZ
Arizona Cochise Arizona Graham Arizona Greenlee Arizona Pima Arizona Pinal Arizona Santa Cruz 80 Phoenix AZ
Arizona
Arizona
Apache
Coconino Arizona Gila Arizona La Paz
Arizona
Arizona
Maricopa
Mohave
Arizona
Arizona
Arizona
Navajo
Yavapai
Yuma 81
Orange County CA
California
California
Orange
Riverside California San Bernardino 82
83
84
San Diego CA
California
California
Los Angeles CA
California
Bakersfield CA - Ventura CA
Imperial
San Diego
Los Angeles
California Kern
California
California
San Luis Obispo
Santa Barbara California Tulare California Ventura 85 San Jose CA - Fresno CA
California Calaveras California Fresno
California Kings
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APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
California Madera
California
California
Mariposa
Merced
California
California
Monterey
San Benito
California
California
San Joaquin
Santa Clara California Santa Cruz California Stanislaus California Tuolumne 86 San Francisco CA
California Alameda California Contra Costa California Lake California Marin California Mendocino
California
California
Napa
San Francisco California San Mateo California Solano California Sonoma 87 Sacramento CA - Medford OR
California Amador California Butte California Colusa California Del Norte California El Dorado California Glenn California Humboldt California Nevada California Placer California Sacramento California Shasta California Sierra
California
California
Siskiyou
Sutter California Tehama
California
California
Trinity
Yolo California Yuba
Oregon
Oregon
Oregon
Oregon
Curry
Jackson
Josephine
Klamath
Oregon Lake 88 Portland OR
Oregon Benton Oregon Clackamas Oregon Clatsop Oregon Columbia Oregon Coos Oregon Crook Oregon Deschutes Oregon Douglas Oregon Gilliam Oregon Grant Oregon Harney Oregon Hood River Oregon Jefferson Oregon Lane Oregon Lincoln Oregon Linn Oregon Marion Oregon Morrow Oregon Multnomah Oregon Polk Oregon Sherman Oregon Tillamook Oregon Umatilla Oregon Union Oregon Wasco Oregon Washington Oregon Wheeler Oregon Yamhill Washington Clark Washington Cowlitz Washington Klickitat Washington Pacific Washington Skamania Washington Wahkiakum 89 Spokane WA
Idaho Benewah Idaho Bonner Idaho Boundary Idaho Clearwater Idaho Idaho Idaho Kootenai Idaho Latah
37 of 37
APPENDIX - List of US Counties by Hospital Referral Cluster (HRC)
Idaho Lewis Idaho Nez Perce Idaho Shoshone Oregon Wallowa Washington Adams Washington Asotin Washington Benton Washington Chelan Washington Columbia Washington Douglas Washington Ferry Washington Franklin Washington Garfield Washington Grant Washington Kittitas Washington Lincoln Washington Okanogan Washington Pend Oreille Washington Spokane Washington Stevens Washington Walla Walla Washington Whitman Washington Yakima 90 Seattle WA
Washington Clallam Washington Grays Harbor Washington Island Washington Jefferson Washington King Washington Kitsap Washington Lewis Washington Mason Washington Pierce Washington San Juan Washington Skagit Washington Snohomish Washington Thurston Washington Whatcom
91 Anchorage AK
Alaska Aleutians East Alaska Aleutians West
Alaska
Alaska
Anchorage
Bethel
Alaska
Alaska
Bristol Bay
Denali
Alaska
Alaska
Dillingham
Fairbanks North Star Alaska Haines
Alaska
Alaska
Hoonah-Angoon
Juneau Alaska Kenai Peninsula
Alaska
Alaska
Ketchikan Gateway
Kodiak Island Alaska Lake and Peninsula Alaska Matanuska-Susitna Alaska Nome
Alaska
Alaska
North Slope
Northwest Arctic
Alaska
Alaska
Alaska
Petersburg
Prince of Wales-Hyder
Sitka
Alaska
Alaska
Skagway
Southeast Fairbanks Alaska Valdez-Cordova
Alaska
Alaska
Alaska
Wade Hampton
Wrangell
Yakutat
92
Alaska
Honolulu HI
Yukon-Koyukuk
Hawaii Hawaii Hawaii Honolulu Hawaii Kalawao Hawaii Kauai Hawaii Maui