Hospital record · FY2026CCN 050335

1Hospital

Adventist Health Sonora

2Location

Sonora, CA (California’s hospitals on the map and in the table) 95370

Tuolumne County

3Type

Minor teaching · 75 beds · Nonprofit · Rural · Rural referral center · Sole community hospital

4Care Compare stars

3 of 5 stars

Overall rating, CMS Care Compare data of July 22, 2026
Open on Care Compare (opens in a new tab)

5Total HAC Score

0.6825

As CMS reports it

6Payment reduction

1% cut

CMS’s value: Yes

7Estimated cut

$423K estimate

Likely $303⁠–⁠475K; about $210 per traditional Medicare stay

Cut 1%

$423K

cut from its FY2026 Medicare inpatient payments, this site estimates estimate

For fiscal year 2026, CMS reports a Total HAC Score of 0.6825 for Adventist Health Sonora and a payment reduction decision of Yes.

That is 1% of about $42.3M, this site’s estimate of what traditional Medicare pays it for inpatient stays in a year: about $210 per traditional Medicare stay.

Likely range $303–475K

Its score was above CMS’s line, so CMS cut its Medicare inpatient payments by 1% for the year. The score compares hospitals with each other; it is not a grade of the quality of care.

CMS cut scores of 0.3799 and above.

Each year CMS cuts the hospitals with the highest quarter of scores, those above the 75th percentile, so the line moves with other hospitals’ scores.

Higher than 86% of the other 2,928 scores CMS published (higher is worse).

Its record, fiscal years 2015 to 2026 Cut in 3 of 11 years

15No
16Cut
17No
18No
19No
20No
21No
22No
23—
24Cut
25No
26Cut

Where the score came from

CMS scored this hospital on 5 of the 6 measures. On every measure a lower value is better. Each row puts the hospital among every hospital with a value: the gray columns are those hospitals, the tall tick is the national median, and the hatched ends score the same as CMS’s floor or cap.

Bringing CLABSI down to the national median (0.559) would lower the score the most: by 0.4700, to 0.2125. That change alone would put the score under CMS’s line. Try it in the what-if

Figure 1. Of its 5 measures with a value, this hospital is above the national median on 4; CLABSI added the most to its score.

This hospital
National median
Scores the same as CMS’s floor or cap

PSI 90 (what it counts)
Safety problems such as serious bedsores, falls that break a bone and blood clots after surgery, found by CMS in traditional Medicare claims. A value of 1 matches the national composite value.
Patient safety and adverse events composite
Better than 83% of the other 2,808 hospitals
estimate

This site recomputes this measure’s z‑score from CMS’s published value. The recompute can differ from CMS’s z‑score by up to 0.0021. How this site estimates

CMS value0.8606

Z-score−0.8925

Part of score−0.1785
CLABSI (what it counts)
Bloodstream infections tied to a central line, a tube often placed in a large vein in the neck, chest or groin. Hospitals report them to the CDC’s National Healthcare Safety Network. A value of 1.0 means as many infections as the CDC’s model predicted.
added the most
Central line–associated bloodstream infections
Worse than 98% of the other 2,181 hospitals

CMS value2.044

Z-score2.2402

Part of score+0.4480
CAUTI (what it counts)
Urinary tract infections that start from a urinary catheter, a tube that drains the bladder. Hospitals report them to the CDC’s National Healthcare Safety Network. A value of 1.0 means as many infections as the CDC’s model predicted.
Catheter-associated urinary tract infections
Worse than 68% of the other 2,354 hospitals

CMS value0.670

Z-score0.2964

Part of score+0.0593
SSI (what it counts)
Deep infections at the site of colon surgery or an abdominal hysterectomy, within a month of the operation, pooled into one measure. Hospitals report them to the CDC’s National Healthcare Safety Network. A value of 1.0 means as many infections as the CDC’s model predicted.
Surgical site infections after colon surgery or abdominal hysterectomy
Worse than 91% of the other 2,269 hospitals

CMS value1.814

Z-score1.6509

Part of score+0.3302
CDI (what it counts)
C. diff infections, which cause diarrhea and inflammation of the colon, found by a lab test and starting in the hospital. Hospitals report them to the CDC’s National Healthcare Safety Network. A value of 1.0 means as many infections as the CDC’s model predicted.
Clostridioides difficile (C. diff) infections
Worse than 59% of the other 2,766 hospitals
estimate

This site recomputes this measure’s z‑score from CMS’s published value. The recompute can differ from CMS’s z‑score by up to 0.0071. How this site estimates

CMS value0.408

Z-score0.1176

Part of score+0.0235
MRSA (what it counts)
Bloodstream infections with MRSA, a germ that resists several antibiotics, found by a lab test and starting in the hospital. Hospitals report them to the CDC’s National Healthcare Safety Network. A value of 1.0 means as many infections as the CDC’s model predicted.
MRSA bloodstream infections
Not scored on this measure
CMS footnote 13: Results cannot be calculated for this reporting period.
CMS footnote 5: Results are not available for this reporting period.

CMS valueno value published

Z-scoreno value published

Part of scoreno value published

Source: CMS Provider Data Catalog, HACRP FY2026 (yq43-i98g), released August 13, 2026.

Show table

Measure	CMS value	National median	Z-score	Part of the score	Among hospitals
PSI 90	0.8606	0.9623	−0.8925	−0.1785	Better than 83% of the other 2,808 hospitals
CLABSI	2.044	0.559	2.2402	+0.4480	Worse than 98% of the other 2,181 hospitals
CAUTI	0.670	0.489	0.2964	+0.0593	Worse than 68% of the other 2,354 hospitals
SSI	1.814	0.795	1.6509	+0.3302	Worse than 91% of the other 2,269 hospitals
CDI	0.408	0.346	0.1176	+0.0235	Worse than 59% of the other 2,766 hospitals
MRSA	no value published	0.641	no value published	no value published	Not scored on this measure

How the parts add up

CMS adds the z‑scores and divides by the number of measures scored, so each measure counts the same. Each bar below is one z‑score divided by 5; a bar right of zero raised the score and one left of zero lowered it.

(−0.8925PSI 90+2.2402CLABSI+0.2964CAUTI+1.6509SSI+0.1176CDI)÷5measures=0.6825Total HAC Score

This hospital’s score is 0.3033 above 0.3792, the highest score CMS marked No. (This site recomputes.)

Figure 2. The parts add up to 0.6825, above CMS’s line.

This site recomputes · Source: CMS Provider Data Catalog, HACRP FY2026 (yq43-i98g), released August 13, 2026.

Show table

Measure	Z-score	Part of the score	Running total
PSI 90	−0.8925	−0.1785	−0.1785
CLABSI	2.2402	+0.4480	0.2695
CAUTI	0.2964	+0.0593	0.3288
SSI	1.6509	+0.3302	0.6590
CDI	0.1176	+0.0235	0.6825
Total HAC Score			0.6825
CMS’s line		0.3792	0.3799

The money is a cliff

This program’s cut doesn’t grow with the score. Over CMS’s line, CMS cuts 1% of what traditional Medicare pays a hospital for inpatient stays that year; at or under the line, this program cuts nothing.

The chart draws what the cut would be for this hospital at any Total HAC Score, from this site’s estimate of its payments, with its own score marked.

Figure 3. The cut is a cliff, not a slope: this hospital’s score, 0.3033 over the highest score CMS didn’t cut, costs it about $423K by this site’s estimate, and at CMS’s highest score, 2.3133, the cut would be the same.

Under the axis, every Total HAC Score CMS published: 306 of the 2,929 scored within 0.1 of CMS’s line, on one side or the other.

Estimate · Source: this site’s arithmetic on CMS’s FY2026 IPPS final rule files (the impact file, the rate tables and the value-based factors), its FY2026 HRRP supplemental file and HACRP FY2026 (yq43-i98g), released August 13, 2026.

Show table

Score	Total HAC Score	Estimated HAC cut (whole dollars)
Any score up to 0.3792	0.3792	$0
Any score from 0.3799	0.3799	−$423,365
This hospital	0.6825	−$423,365
CMS’s highest score	2.3133	−$423,365

The money, line by line

This site estimates what traditional Medicare pays the hospital for a year of inpatient stays, from CMS’s FY2026 payment files, then applies Medicare’s three hospital quality programs: the readmissions and value-based adjustments to the base payment, and the HAC cut last, as the law sets.

The readmissions and value-based programs adjust only the base payment: the DRG rates times the hospital’s cases, and a Medicare-dependent hospital’s add-on. The HAC cut comes last and takes 1% of everything left, teaching, low-income-patient, outlier, capital and uncompensated care payments included.

($42,110,138payment+$0readmissions+$226,370value-based)×1%the cut=$423,365HAC cut

$423,365HAC cut÷2,020traditional Medicare stays=$210per traditional Medicare stay

Figure 4. This site estimates the HAC cut at $423K: 1% of the hospital’s whole inpatient payment, taken last. The readmissions and value-based adjustments, on the base alone, came to $0 and +$226K.

Estimated Medicare inpatient payments · FY2026 estimate

What traditional Medicare pays it for inpatient stays
DRG payments at the federal rates the base	$30,901,851
Many low-income patients (disproportionate share)	$1,432,610
Outliers: unusually costly stays	$831,260
Sole community hospital rate difference	$6,548,203
Capital: buildings and equipment	$2,396,214
Total, before the three programs	$42,110,138
The three programs: two on the base, the HAC cut last
Readmissions (HRRP) base × (1.0000 − 1)	$0
Value-based purchasing (HVBP) base × (1.0073 − 1)	+$226,370
After these two	$42,336,508
HAC Reduction Program 1% of everything above; likely $303⁠–⁠475K	−$423,365
Net of the three programs likely −$209K to −$137K	−$196,995

Not paid to this hospital: a Medicare-dependent hospital add-on, teaching payments, a low-volume adjustment, and uncompensated care payments.

Whole dollars, so every line adds up; the estimate is not that precise. Each likely range spans the middle 80% of the misses this site’s estimate made for similar hospitals (or for a wider group, where there were too few) when it was checked against their FY2024 cost reports: one year’s check, not a promise of how often a hospital’s actual figure lands inside.

Show table

Line	Amount (whole dollars)
DRG payments at the federal rates (the base)	$30,901,851
Many low-income patients (disproportionate share)	$1,432,610
Outliers: unusually costly stays	$831,260
Sole community hospital rate difference	$6,548,203
Capital: buildings and equipment	$2,396,214
Total, before the three programs	$42,110,138
Readmissions (HRRP) (base × (1.0000 − 1))	$0
Value-based purchasing (HVBP) (base × (1.0073 − 1))	+$226,370
After these two	$42,336,508
HAC Reduction Program (1% of everything above; likely $303–475K)	−$423,365
Net of the three programs (likely −$209K to −$137K)	−$196,995

What if a measure were different?

Change a measure’s value to see how this site recomputes the Total HAC Score, the payment reduction decision and, by its estimate, the money, starting from CMS’s values. The money doesn’t slide with the score: it drops off a cliff at CMS’s line.

The what-if needs JavaScript. Without it, the values below stay as they are.

Show table

	CMS reports	Hypothetical
Total HAC Score	0.6825	same
Payment reduction decision	Yes	same
Payment cut	1%	same
Estimated HAC cut estimate	$423K	same

CMS’s line: between 0.3792 and 0.3799

The faint ticks are CMS’s line in earlier years under the same formula, from about 0.300 (FY2022) to about 0.375 (FY2024). The line moves every year, so a hospital can cross it without changing anything.

CMS reports a Total HAC Score of 0.6825 and a payment reduction decision of Yes.

A what-if shows the formula’s arithmetic, not what a hospital could realistically change or how. CMS’s real result also depends on other hospitals.

What would it take?

Getting under CMS’s line would keep about $423K, this site estimates: the whole cut, however far under the score lands.

From CMS’s values, one measure at a time, with every other measure held at CMS’s value.

Measure	Value that would read No
PSI 90	not possible with this measure alone
CLABSI	0.918 or lower
CAUTI	0.040 or lower
SSI	0.928 or lower
CDI	0.016 or lower

Each measure weighs 1 ÷ 5 of the score.

Measure values

SIR 1.0 = as many infections as predicted · Lower is better

On each track the tick is the national median; shaded values score the same as the floor or cap, as this site fits them to CMS’s values.

Patient safety and adverse events composite PSI 90

PSI 90 value

CMS 0.8606 · median 0.9623 · floor 0.7760 · cap 1.3482 · each 0.1 = 0.1396

Central line–associated bloodstream infections CLABSI

CLABSI value

CMS 2.044 · median 0.559 · cap 1.572 · each 0.1 = 0.0464

Catheter-associated urinary tract infections CAUTI

CAUTI value

CMS 0.670 · median 0.489 · cap 1.537 · each 0.1 = 0.0482

Surgical site infections after colon surgery or abdominal hysterectomy SSI

SSI value

CMS 1.814 · median 0.795 · cap 2.118 · each 0.1 = 0.0343

Clostridioides difficile (C. diff) infections CDI

CDI value

CMS 0.408 · median 0.346 · cap 0.944 · each 0.1 = 0.0774

Have your NHSN predicted counts? (optional, stays in your browser)

Stays in your browser; never sent.

Optional: your NHSN predicted infections for CLABSI, January 1, 2023 to December 31, 2024

Optional: your NHSN predicted infections for CAUTI, January 1, 2023 to December 31, 2024

Optional: your NHSN predicted infections for SSI, January 1, 2023 to December 31, 2024

Optional: your NHSN predicted infections for CDI, January 1, 2023 to December 31, 2024

Figure 5. CLABSI added the most to this hospital’s Total HAC Score of 0.6825 among its measured results: +0.4480.

PSI 90 −0.1785
CLABSI +0.4480
CAUTI +0.0593
SSI +0.3302
CDI +0.0235

A measure adds its z‑score divided by 5, the number of measures scored. Bars right of the center line raise the score. Hatched: assigned by CMS.

This site recomputes · Source: CMS Provider Data Catalog, HACRP FY2026 (yq43-i98g), released August 13, 2026.

Show table

Measure	Z-score	Part of the score	Hypothetical
PSI 90	−0.8925	−0.1785	same
CLABSI	2.2402	+0.4480	same
CAUTI	0.2964	+0.0593	same
SSI	1.6509	+0.3302	same
CDI	0.1176	+0.0235	same

Interactive what-if at https://paidandpenalized.org/hacrp/hospital/050335/

Among hospitals with a Yes or No payment decision, CMS cut those with a published Total HAC Score of 0.3799 or higher and none at 0.3792 or lower. Maryland’s hospitals are scored but not subject to the reduction.

Held fixed: every other hospital’s results, CMS’s line, and each measure’s mean, spread, floor and cap as this site fits them to CMS’s published values.

Year by year

Where this hospital’s score fell among every hospital’s, each year CMS published one. A score near the top is among the highest; the shaded band is where CMS cut. Places compare across years even where CMS changed how it builds the score.

Figure 6. CMS cut this hospital in 3 of the 11 years it made a decision.

● Red: a year CMS cut it ○ Hollow: a year it didn’t

This site recomputes · Source: CMS, HACRP hospital files for fiscal years 2015 to 2026 (Provider Data Catalog, its archives and, for the oldest years, the Internet Archive’s copies), and CMS’s cut lists for FY2015 and FY2016.

Show table

Fiscal year	Total HAC Score	Higher than this share of scores	Payment reduction
FY2015	6.7000	69.1%	not cut
FY2016	7.5000	83.9%	cut
FY2017	5.6000	54.2%	not cut
FY2018	0.0536	57.1%	not cut
FY2019	0.1926	66.1%	not cut
FY2020	0.1080	61.5%	not cut
FY2021	0.0005	52.4%	not cut
FY2022	−0.4582	22.0%	not cut
FY2023			no decision
FY2024	0.3954	76.0%	cut
FY2025	0.0827	58.5%	not cut
FY2026	0.6825	86.8%	cut

Its infections, year by year

This hospital’s infection rate against prediction for each calendar year Care Compare published one, on each measure with at least two years of results (black), over the nation’s middle hospital (gray). Below the dashed line at one, fewer infections than predicted. Each year is measured against the same fixed baseline, not against other hospitals, so unlike the score they can all improve at once.

Figure 7. 2 of its 3 infection measures ended lower than they started.

Source: CMS Care Compare, healthcare-associated infections by hospital, calendar years 2017 to 2024 (Provider Data Catalog archives; the oldest year through the Internet Archive’s copy).

Show table

Calendar year	CAUTI	SSI, colon	C. diff
2017	0.670	2.492	1.371
2018	0.722	2.820	0.434
2019	0.000	0.805	0.407
2021	0.713	0.797	0.000
2022	0.776	2.361	0.791
2023	0.000	2.705	0.209
2024	1.226	1.787	0.599

Among hospitals like it

Each row is a group this hospital belongs to, drawn from every hospital in it with a payment decision. Red columns are hospitals past CMS’s line, the ones CMS cut; the short tick is the group’s middle score.

In California, its score is higher than 88% of the other 276 scored there.

Figure 8. Its score is above the middle in all 7 groups it belongs to; the share cut runs from 21% (Minor teaching) to 32% (Rural).

Source: CMS Provider Data Catalog, HACRP FY2026 (yq43-i98g), released August 13, 2026.

Show table

Group	With a decision	Hospitals cut	Share cut	Middle score	Hospital higher than
All hospitals	2,886	718	25%	−0.0453	86%
West region	593	157	26%	−0.0302	87%
California	277	76	27%	−0.0217	88%
Minor teaching	873	181	21%	−0.0567	91%
Fewer than 100 beds	805	225	28%	−0.1154	79%
Nonprofit	1,830	478	26%	−0.0134	86%
Rural	619	196	32%	0.0229	79%
This hospital				0.6825
CMS’s line				0.3792	0.3799

The nearest hospitals

The 8 closest hospitals with a Total HAC Score, in a straight line. The squares are each hospital’s measures in order: filled, above the national median; open, at or below it; hatched, assigned by CMS; blank, not scored.

Figure 9. CMS cut 2 of the 8 nearest hospitals; the closest is 31 miles away.

Source: CMS Provider Data Catalog, HACRP FY2026 (yq43-i98g), released August 13, 2026.

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Hospital	Miles	Score	Decision
Oak Valley Hospital District, Oakdale, CA	31	1.0591	cut
Sutter Amador Hospital, Jackson, CA	34	−0.4794	not cut
Stanislaus Surgical Hospital, Modesto, CA	39	−0.1162	not cut
Memorial Medical Center, Modesto, CA	39	−0.1466	not cut
Doctors Medical Center, Modesto, CA	40	0.2392	not cut
Emanuel Medical Center, Turlock, CA	41	−0.4847	not cut
Adventist Health Lodi Memorial, Lodi, CA	44	0.4289	cut
Mercy Medical Center, Merced, CA	44	−0.5643	not cut

#	Hospital	Miles	Score	Decision	Est. cut ($, modeled)	Measures
1	Oak Valley Hospital DistrictOakdale, CA	31	1.0591	1% cut	$23K	Above the national median on 2 of 2 measures
2	Sutter Amador HospitalJackson, CA	34	−0.4794	No cut	$0	Above the national median on 1 of 3 measures
3	Stanislaus Surgical HospitalModesto, CA	39	−0.1162	No cut	$0	Above the national median on 1 of 1 measures
4	Memorial Medical CenterModesto, CA	39	−0.1466	No cut	$0	Above the national median on 2 of 6 measures
5	Doctors Medical CenterModesto, CA	40	0.2392	No cut	$0	Above the national median on 3 of 6 measures
6	Emanuel Medical CenterTurlock, CA	41	−0.4847	No cut	$0	Above the national median on 2 of 6 measures
7	Adventist Health Lodi MemorialLodi, CA	44	0.4289	1% cut	$349K	Above the national median on 4 of 6 measures
8	Mercy Medical CenterMerced, CA	44	−0.5643	No cut	$0	Above the national median on 1 of 6 measures

Download all hospitals’ data (CSV) · Data dictionary · CMS’s dataset page

CMS’s footnotes on this page

13: Results cannot be calculated for this reporting period.
5: Results are not available for this reporting period.

How the program works, and how to find another hospital

A penalty reflects how CMS’s formula scored relative performance; it is not a verdict on the quality of care.

Cite this page

Paid & Penalized. Adventist Health Sonora, Sonora, CA: Hospital-Acquired Conditions, FY2026. https://paidandpenalized.org/hacrp/hospital/050335/. Source: CMS Provider Data Catalog, HACRP FY2026 (yq43-i98g), released August 13, 2026.