P&P, Paid & Penalized

Public Medicare data, made visible.

Paid & Penalized

Public Medicare data, made visible.

Built by Dalton Haslam, MD, MBA (opens in a new tab)

This site estimates Medicare’s FY2026 inpatient pay to 2,971 hospitals: about $129.1B.

Three quality programs adjust that pay by about $863M, 0.67% of it: the red sliver magnified under the bar. $646M is not paid at all, and $217M moves between hospitals as bonuses.

Scroll to follow the money

Estimated from public CMS files, FY2026

Every hospital starts at $0.

Each dot is one hospital, poured out of that bar. Under them sit the three programs as gates. As each gate rises through the crowd, every hospital it passes shifts by that program’s adjustment.

Readmissions: most hospitals take a small cut.

The readmissions program (HRRP) cuts pay, by up to 3%, when a hospital’s readmissions run above expected. 2,300 hospitals take a cut; the median cut is 0.21% of a hospital’s Medicare inpatient pay. 628 pass through at $0, and 43 are not in the program.

Hospital-acquired conditions: a flat 1% off one quarter.

The HAC program scores infections and other harms; the quarter with the highest scores lose 1% of their Medicare inpatient pay. CMS cut 718 scored hospitals, 709 of them with an estimate here; it also cut one it didn’t score. The tall column: 147 whose only cut is this one.

Value-based purchasing: some move right.

HVBP withholds 2% of each participant’s pay and pays it back by score, so it is budget-neutral by design. 1,257 hospitals come out ahead and 1,190 behind; about $217M moves between them in FY2026, estimated.

Two of every three hospitals take a net cut.

This is where the three programs leave each hospital: its net change as a share of its Medicare inpatient pay. 1,972 take a net cut, 757 a net bonus and 242 come out at $0. Altogether about $646M is not paid in FY2026, estimated.

Cuts reach every state.

The same dots, each now at its hospital’s location. Net cuts outnumber net bonuses almost everywhere, so a map of dots mostly shows where hospitals are. To compare states, add up each state’s hospitals.

The programs take 1.41% of hospital pay in West Virginia and add 0.28% in Minnesota.

Each state is shaded by its hospitals’ combined net change as a share of their Medicare inpatient pay. Only Minnesota, Utah, and Wisconsin come out ahead. Maryland is paid under its own all-payer model, outside these programs.

Find yours among its peers.

An example. Search above for yours.

Upper Valley Medical Center

Troy, OH. 178 beds, non-teaching.

−0.30% −$49K

Estimated FY2026 net cut, share of Medicare inpatient pay

Readmissions
−$69K cut
Hospital-acquired conditions
$0 no change
Value-based purchasing
+$20K bonus

Of 117 Ohio hospitals, 81 take a net cut; the median is −0.47%.

Its hospital page shows every program among its peers, with a what-if.

Open its hospital page
Estimated FY2026 Medicare inpatient pay to 2,971 hospitals, one dot each

$129.1B $863M, 0.67% moved by the programs

$646M not paid

$217M moved to other hospitals as bonuses

Alabama: 74 hospitals, net −0.93% of pay, 78% take a net cutAlaska: 8 hospitals, net −0.56% of pay, 63% take a net cutArizona: 64 hospitals, net −0.63% of pay, 73% take a net cutArkansas: 42 hospitals, net −0.94% of pay, 79% take a net cutCalifornia: 276 hospitals, net −0.41% of pay, 67% take a net cutColorado: 51 hospitals, net −0.16% of pay, 45% take a net cutConnecticut: 25 hospitals, net −0.36% of pay, 72% take a net cutDelaware: 6 hospitals, net −0.52% of pay, 100% take a net cutDistrict of Columbia: 6 hospitals, net −0.24% of pay, 83% take a net cutFlorida: 166 hospitals, net −0.55% of pay, 78% take a net cutGeorgia: 93 hospitals, net −0.75% of pay, 68% take a net cutHawaii: 11 hospitals, net −0.47% of pay, 55% take a net cutIdaho: 15 hospitals, net −0.16% of pay, 47% take a net cutIllinois: 114 hospitals, net −0.49% of pay, 74% take a net cutIndiana: 82 hospitals, net −0.69% of pay, 65% take a net cutIowa: 30 hospitals, net −0.81% of pay, 80% take a net cutKansas: 44 hospitals, net −0.16% of pay, 52% take a net cutKentucky: 59 hospitals, net −1.20% of pay, 68% take a net cutLouisiana: 81 hospitals, net −0.82% of pay, 64% take a net cutMaine: 13 hospitals, net −0.22% of pay, 54% take a net cutMaryland: not in these programs. Its 43 hospitals are paid under the state’s all-payer model.Massachusetts: 54 hospitals, net −0.70% of pay, 78% take a net cutMichigan: 90 hospitals, net −0.57% of pay, 66% take a net cutMinnesota: 46 hospitals, net +0.28% of pay, 37% take a net cutMississippi: 55 hospitals, net −1.08% of pay, 69% take a net cutMissouri: 63 hospitals, net −0.62% of pay, 71% take a net cutMontana: 11 hospitals, net −0.17% of pay, 64% take a net cutNebraska: 25 hospitals, net −0.41% of pay, 64% take a net cutNevada: 20 hospitals, net −0.66% of pay, 85% take a net cutNew Hampshire: 13 hospitals, net −0.71% of pay, 62% take a net cutNew Jersey: 61 hospitals, net −0.70% of pay, 90% take a net cutNew Mexico: 25 hospitals, net −0.64% of pay, 68% take a net cutNew York: 126 hospitals, net −0.40% of pay, 73% take a net cutNorth Carolina: 80 hospitals, net −0.23% of pay, 60% take a net cutNorth Dakota: 7 hospitals, net −0.09% of pay, 57% take a net cutOhio: 117 hospitals, net −0.66% of pay, 69% take a net cutOklahoma: 74 hospitals, net −0.58% of pay, 61% take a net cutOregon: 32 hospitals, net −0.14% of pay, 34% take a net cutPennsylvania: 132 hospitals, net −0.60% of pay, 68% take a net cutRhode Island: 10 hospitals, net −0.39% of pay, 70% take a net cutSouth Carolina: 51 hospitals, net −0.69% of pay, 73% take a net cutSouth Dakota: 17 hospitals, net −0.26% of pay, 59% take a net cutTennessee: 76 hospitals, net −0.76% of pay, 79% take a net cutTexas: 274 hospitals, net −0.36% of pay, 61% take a net cutUtah: 32 hospitals, net +0.10% of pay, 31% take a net cutVermont: 6 hospitals, net −0.75% of pay, 67% take a net cutVirginia: 71 hospitals, net −0.22% of pay, 54% take a net cutWashington: 46 hospitals, net −0.33% of pay, 61% take a net cutWest Virginia: 24 hospitals, net −1.41% of pay, 79% take a net cutWisconsin: 65 hospitals, net +0.07% of pay, 38% take a net cutWyoming: 8 hospitals, net −0.40% of pay, 88% take a net cut

State net change, est. FY2026, % of Medicare inpatient payNet change, est. FY2026, % of pay

−1.5% cut0%+1.5% bonus

Maryland: not in these programs

The programs

Two live, one under construction, six under consideration.

Each card puts its program’s hospitals on one shared scale. Together these three move about $863M of FY2026 Medicare inpatient pay, estimated.

Quality programsEstimated FY2026

Readmissions HRRP

Cuts pay by up to 3% when more patients than expected return to the hospital in the thirty days after leaving.

Most cuts are small; about one hospital in five pays $0.
−3%−2%−1%$0+1%+2%+3% 2,300 cut628 at $0

−$337MEstimate

not paid to hospitals nationally, FY2026

Open HRRP

Hospital-acquired conditions HACRP

Cuts pay by a flat 1% for the quarter of hospitals with the highest infection and patient-safety scores.

One flat step: the quarter with the highest scores take the 1% cut; the rest pay $0.
−3%−2%−1%$0+1%+2%+3% 710 cut2,261 at $0

−$306MEstimate

not paid to hospitals nationally, FY2026

Open HACRP

Value-based purchasing HVBP

Holds back 2% of pay and returns it by quality score, as a bonus or a net cut. Budget-neutral by design.

One pool, two sides: the cuts on the left pay for the bonuses on the right.
−3%−2%−1%$0+1%+2%+3% 1,190 cut1,257 bonus

$217M movedEstimate

net −$3.1M nationally, FY2026

HVBP: under construction

Price adjustments

Wage indexLocal wagesRaises or lowers the labor share of each payment to match local wages.under considerationDSH + UCLow-income patientsAdds payments for hospitals that serve many low-income patients, plus a share of an uncompensated-care pool.under considerationIMETeachingAdds payments for hospitals that train medical residents.under consideration

Reporting rules

IQRQuality reportingHospitals that don’t report required quality data lose a quarter of their yearly payment increase.under considerationPIElectronic health recordsHospitals that miss electronic health record requirements lose three-quarters of their yearly increase.under consideration

Episode payment

TEAMSurgical episodesIn selected areas, hospitals earn or owe money against a spending target for five surgeries.under consideration

Methods, in brief

Every dollar here is an estimate, and is labeled one.

An estimate applies CMS’s published method to CMS’s public data, where an input CMS used is not public. It lands close to CMS’s own figure, not exactly on it. Every build holds its national sums to ranges set from CMS’s published figures, and stops if one falls outside. Tested against 131 cut hospitals’ FY2024 cost reports, the middle estimate of the HAC cut ran 5.2% above what they recorded.

  1. 1Start from each hospital’s estimated Medicare inpatient pay for FY2026.
  2. 2Apply each program’s published factor or rule to the part of pay it covers.
  3. 3Add the programs in dollars, never in percent: each percentage applies to a different base.
Read the methods

Worksheet · FY2026 · An exampleCCN 360174

Worksheet: one hospital’s estimated FY2026 dollars, line by line
1Upper Valley Medical Center, Troy, OH: estimated Medicare inpatient pay$16,171,880
2The part of pay the readmissions and value-based factors apply tobase operating payments, estimated$13,847,566
3Readmissions(factor 0.9950 − 1) × line 2−$69,238
4Hospital-acquired conditionsnot in the 1% cut$0
5Value-based purchasing(factor 1.0014638299 − 1) × line 2+$20,270
6Net, lines 3 + 4 + 5Estimatein whole dollars, each line rounded on its own, so the arithmetic can be off by a dollar; percentages don’t add across programs−$48,968

Find your hospital above and this worksheet fills in for it. Its hospital page

Net cut

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