Hospital audit

HAC Penalty Risk Auditor

HAC Penalty Risk Auditor

FY2026 · structural fragility of Total HAC Scores

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Hospital audit

BAPTIST MEDICAL CENTER - NASSAU

FL · Facility ID 100140 · FY2026

Total HAC Score

-0.4068

Percentile

25.8th

Displayed status

No reduction

From CMS Payment Reduction column (file).

Score vs threshold (0.3792)

Score distributionThreshold 0.3792Hospital -0.4068

Hospital score -0.4068. Penalty threshold 0.3792. Distribution of 2929 scored hospitals.

Data completeness

Reported on 5 of 6. Missing measures show N/A with the CMS footnote; footnote 18 values are imputed worst-case, not measured performance.

  • PSI-90z 0.603
  • CLABSIN/A
  • CAUTIz -1.319
  • SSIz -0.886
  • CDIz -0.943
  • MRSAz 0.511

Fragility

Each reported measure moves the score by 0.2000 points.

Score swing if each reported measure were at its Z floor versus Z cap, holding other measures fixed
MeasureCurrent ZScore @ floorScore @ capAbs swing
PSI-90controls fate0.6026-0.8240-0.02510.7989
CAUTI-1.3186-0.40680.33420.7410
MRSA0.5114-0.8005-0.06400.7365
CDI-0.9433-0.51060.22050.7311
SSI-0.8860-0.52090.20480.7256

Swing is a mechanics illustration: replace one reported Z with that measure’s observed floor or cap while holding others fixed. Ranked by absolute swing.

Peer context

Percentile within FL (165 scored): 39.7th

Score distributionThreshold 0.3792Hospital -0.4068

Hospital score -0.4068. Penalty threshold 0.3792. Distribution of 165 scored hospitals.

Percentile among hospitals with 5 reported measures (220 scored): 31.1th

Score distributionThreshold 0.3792Hospital -0.4068

Hospital score -0.4068. Penalty threshold 0.3792. Distribution of 220 scored hospitals.

Plain-language verdict

As scored, the CMS file lists no payment reduction (Total HAC Score -0.4068; threshold 0.3792).

Reported on 5 of 6 measures; each reported measure moves the equal-weighted score by 0.2000 points.

Describes scoring mechanics only. Not medical or legal advice. Any “would / would not” language is an illustration against the published threshold, not a CMS prediction.

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