Nine area hospitals are being paid less for each Medicare patient they treat in a program that measures patient satisfaction, clinical standards and death rates. The penalties, part of the Affordable Care Act, can mean hundreds of thousands of dollars in reduced reimbursements to the hospitals. Saint Agnes Medical Center in Fresno, Kaweah Delta Medical Center in Visalia, Adventist Medical Center in Hanford, Madera Community Hospital and Clovis Community Medical Center have higher penalties this year, the second year of the program.