Hospital audit

HAC Penalty Risk Auditor

HAC Penalty Risk Auditor

FY2026 · structural fragility of Total HAC Scores

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Hospital audit

SHERIDAN MEMORIAL HOSPITAL

WY · Facility ID 530006 · FY2026

Total HAC Score

0.6273

Percentile

84.8th

Displayed status

Payment reduction

From CMS Payment Reduction column (file).

Score vs threshold (0.3792)

Score distributionThreshold 0.3792Hospital 0.6273

Hospital score 0.6273. Penalty threshold 0.3792. Distribution of 2929 scored hospitals.

Data completeness

Reported on 3 of 6. Missing measures show N/A with the CMS footnote; footnote 18 values are imputed worst-case, not measured performance.

  • PSI-90z 0.594
  • CLABSIN/A
  • CAUTIz 2.386
  • SSIN/A
  • CDIz -1.098
  • MRSAN/A

Fragility

Each reported measure moves the score by 0.3333 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 fate0.5938-0.06511.26641.3315
CAUTI2.3863-0.60770.62731.2350
CDI-1.09820.50601.72441.2184

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 WY (8 scored): 68.8th

Score distributionThreshold 0.3792Hospital 0.6273

Hospital score 0.6273. Penalty threshold 0.3792. Distribution of 8 scored hospitals.

Percentile among hospitals with 3 reported measures (196 scored): 79.8th

Score distributionThreshold 0.3792Hospital 0.6273

Hospital score 0.6273. Penalty threshold 0.3792. Distribution of 196 scored hospitals.

Plain-language verdict

As scored, the CMS file lists payment reduction Yes (Total HAC Score 0.6273; threshold 0.3792).

Reported on 3 of 6 measures; each reported measure moves the equal-weighted score by 0.3333 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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