Hospital audit

HAC Penalty Risk Auditor

HAC Penalty Risk Auditor

FY2026 · structural fragility of Total HAC Scores

← All audits

Hospital audit

DECATUR MEMORIAL HOSPITAL

IL · Facility ID 140135 · FY2026

Total HAC Score

-0.2150

Percentile

37.8th

Displayed status

No reduction

From CMS Payment Reduction column (file).

Score vs threshold (0.3792)

Score distributionThreshold 0.3792Hospital -0.2150

Hospital score -0.2150. Penalty threshold 0.3792. Distribution of 2929 scored hospitals.

Data completeness

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

  • PSI-90z 0.618
  • CLABSIz -0.247
  • CAUTIz -1.015
  • SSIz 0.419
  • CDIz -0.587
  • MRSAz -0.479

Fragility

Each reported measure moves the score by 0.1667 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 fate0.6184-0.56530.10040.6657
CAUTI-1.0149-0.26560.35180.6175
MRSA-0.4792-0.37800.23570.6137
CDI-0.5871-0.36090.24830.6092
CLABSI-0.2466-0.40830.19950.6078
SSI0.4193-0.52760.07700.6047

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 IL (112 scored): 34.4th

Score distributionThreshold 0.3792Hospital -0.2150

Hospital score -0.2150. Penalty threshold 0.3792. Distribution of 112 scored hospitals.

Percentile among hospitals with 6 reported measures (1940 scored): 34.3th

Score distributionThreshold 0.3792Hospital -0.2150

Hospital score -0.2150. Penalty threshold 0.3792. Distribution of 1940 scored hospitals.

Plain-language verdict

As scored, the CMS file lists no payment reduction (Total HAC Score -0.2150; threshold 0.3792).

Reported on 6 of 6 measures; each reported measure moves the equal-weighted score by 0.1667 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.

Scan a hospital system →