Hospital record · FY2026CCN 160112

1Hospital

Spencer Municipal Hospital

2Location

Spencer, IA (Iowa’s hospitals on the map and in the table) 51301

Clay County

3Type

Not a teaching hospital · 93 beds · Government · Rural · Medicare-dependent hospital

4Care Compare stars

4 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

0.7954

As CMS reports it

6Payment reduction

1% cut

CMS’s value: Yes

7Estimated cut

$101K estimate

Likely $72⁠–⁠113K; about $140 per traditional Medicare stay

Cut 1%

$101K

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

For fiscal year 2026, CMS reports a Total HAC Score of 0.7954 for Spencer Municipal Hospital and a payment reduction decision of Yes.

That is 1% of about $10.1M, this site’s estimate of what traditional Medicare pays it for inpatient stays in a year: about $140 per traditional Medicare stay.

Likely range $72–113K

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 89% of the other 2,928 scores CMS published (higher is worse).

Its record, fiscal years 2015 to 2026 Cut in 5 of 11 years

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

Where the score came from

CMS scored this hospital on 4 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 CAUTI down to the national median (0.489) would lower the score the most: by 0.3507, to 0.4447. Try it in the what-if

Figure 1. Of its 4 measures with a value, this hospital is above the national median on 4; CAUTI 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
Worse than 84% 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 value1.1344

Z-score1.0187

Part of score+0.2547
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.
Central line–associated 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
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.
added the most
Catheter-associated urinary tract infections
Worse than 87% of the other 2,354 hospitals

CMS value1.071

Z-score1.2630

Part of score+0.3158
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 80% of the other 2,269 hospitals

CMS value1.343

Z-score0.8441

Part of score+0.2110
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 57% 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 value0.392

Z-score0.0557

Part of score+0.0139
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	1.1344	0.9623	1.0187	+0.2547	Worse than 84% of the other 2,808 hospitals
CLABSI	no value published	0.559	no value published	no value published	Not scored on this measure
CAUTI	1.071	0.489	1.2630	+0.3158	Worse than 87% of the other 2,354 hospitals
SSI	1.343	0.795	0.8441	+0.2110	Worse than 80% of the other 2,269 hospitals
CDI	0.392	0.346	0.0557	+0.0139	Worse than 57% 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 4; a bar right of zero raised the score and one left of zero lowered it.

(1.0187PSI 90+1.2630CAUTI+0.8441SSI+0.0557CDI)÷4measures=0.7954Total HAC Score

This hospital’s score is 0.4162 above 0.3792, the highest score CMS marked No. (This site recomputes.)

Figure 2. The parts add up to 0.7954, 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	1.0187	+0.2547	0.2547
CAUTI	1.2630	+0.3158	0.5705
SSI	0.8441	+0.2110	0.7815
CDI	0.0557	+0.0139	0.7954
Total HAC Score			0.7954
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, 0.4162 over the highest score CMS didn’t cut, costs it about $101K 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	−$100,595
This hospital	0.7954	−$100,595
CMS’s highest score	2.3133	−$100,595

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.

($9,934,917payment−$30,329readmissions+$154,888value-based)×1%the cut=$100,595HAC cut

$100,595HAC cut÷721traditional Medicare stays=$140per traditional Medicare stay

Figure 4. This site estimates the HAC cut at $101K: 1% of the hospital’s whole inpatient payment, taken last. The readmissions and value-based adjustments, on the base alone, came to −$30K and +$155K.

Estimated Medicare inpatient payments · FY2026 estimate

What traditional Medicare pays it for inpatient stays
DRG payments at the federal rates	$7,220,152
Medicare-dependent hospital add-on	$362,047
Base payment the base	$7,582,199
Many low-income patients (disproportionate share)	$58,989
Outliers: unusually costly stays	$32,274
Low-volume adjustment	$1,503,585
Capital: buildings and equipment	$557,329
Uncompensated care	$200,541
Total, before the three programs	$9,934,917
The three programs: two on the base, the HAC cut last
Readmissions (HRRP) base × (0.9960 − 1)	−$30,329
Value-based purchasing (HVBP) base × (1.0204 − 1)	+$154,888
After these two	$10,059,476
HAC Reduction Program 1% of everything above; likely $72⁠–⁠113K	−$100,595
Net of the three programs likely $17⁠–⁠25K	+$23,964

Not paid to this hospital: teaching payments and a sole community hospital rate difference.

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	$7,220,152
Medicare-dependent hospital add-on	$362,047
Base payment (the base)	$7,582,199
Many low-income patients (disproportionate share)	$58,989
Outliers: unusually costly stays	$32,274
Low-volume adjustment	$1,503,585
Capital: buildings and equipment	$557,329
Uncompensated care	$200,541
Total, before the three programs	$9,934,917
Readmissions (HRRP) (base × (0.9960 − 1))	−$30,329
Value-based purchasing (HVBP) (base × (1.0204 − 1))	+$154,888
After these two	$10,059,476
HAC Reduction Program (1% of everything above; likely $72–113K)	−$100,595
Net of the three programs (likely $17–25K)	+$23,964

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	0.7954	same
Payment reduction decision	Yes	same
Payment cut	1%	same
Estimated HAC cut estimate	$101K	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 0.7954 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 $101K, 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	0.8958 or lower
CAUTI	0.380 or lower
SSI	0.371 or lower
CDI	not possible with this measure alone

Each measure weighs 1 ÷ 4 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 1.1344 · median 0.9623 · floor 0.7760 · cap 1.3482 · each 0.1 = 0.1745

Catheter-associated urinary tract infections CAUTI

CAUTI value

CMS 1.071 · median 0.489 · cap 1.537 · each 0.1 = 0.0603

Surgical site infections after colon surgery or abdominal hysterectomy SSI

SSI value

CMS 1.343 · median 0.795 · cap 2.118 · each 0.1 = 0.0428

Clostridioides difficile (C. diff) infections CDI

CDI value

CMS 0.392 · median 0.346 · cap 0.944 · each 0.1 = 0.0968

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

Stays in your browser; never sent.

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. CAUTI added the most to this hospital’s Total HAC Score of 0.7954 among its measured results: +0.3158.

PSI 90 +0.2547
CAUTI +0.3158
SSI +0.2110
CDI +0.0139

A measure adds its z‑score divided by 4, 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	1.0187	+0.2547	same
CAUTI	1.2630	+0.3158	same
SSI	0.8441	+0.2110	same
CDI	0.0557	+0.0139	same

Interactive what-if at https://paidandpenalized.org/hacrp/hospital/160112/

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.

Its longest run: cut 3 years in a row.

Figure 6. CMS cut this hospital in 5 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	2.0000	4.7%	not cut
FY2016	6.2500	64.4%	not cut
FY2017	5.4000	49.8%	not cut
FY2018	0.2189	67.9%	not cut
FY2019	0.5398	82.8%	cut
FY2020	0.3704	77.1%	cut
FY2021	0.1623	65.3%	not cut
FY2022	−0.6223	14.9%	not cut
FY2023			no decision
FY2024	0.6429	84.5%	cut
FY2025	0.7577	89.5%	cut
FY2026	0.7954	89.8%	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. 1 of its 2 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	SSI, hysterectomy	C. diff
2017	0.000	1.376
2018	0.000	0.983
2019	0.000	0.621
2021		0.750
2022		1.240
2023		0.343
2024		0.456

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 Iowa, its score is higher than 68% of the other 29 scored there.

Figure 8. Its score is above the middle in all 7 groups it belongs to; the share cut runs from 25% (All hospitals) to 53% (Iowa).

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	89%
Midwest region	683	174	25%	−0.0268	90%
Iowa	30	16	53%	0.3970	68%
Not teaching	1,563	389	25%	−0.1053	87%
Fewer than 100 beds	805	225	28%	−0.1154	82%
Government	401	140	35%	0.1602	81%
Rural	619	196	32%	0.0229	82%
This hospital				0.7954
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 5 of the 8 nearest hospitals; the closest is 19 miles away.

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

Show table

Hospital	Miles	Score	Decision
Lakes Regional Healthcare, Spirit Lake, IA	19	0.4133	cut
Sanford Worthington Medical Center, Worthington, MN	40	1.1398	cut
Mayo Clinic Health System - Fairmont, Fairmont, MN	48	−0.2527	not cut
Trinity Regional Medical Center, Fort Dodge, IA	66	0.8681	cut
St Lukes Regional Medical Center, Sioux City, IA	77	0.6377	cut
MercyOne Siouxland Medical Center, Sioux City, IA	78	0.8012	cut
Dunes Surgical Hospital, Dakota Dunes, SD	82	−0.6357	not cut
Avera McKennan Hospital & University Health Center, Sioux Falls, SD	83	0.3618	not cut

#	Hospital	Miles	Score	Decision	Est. cut ($, modeled)	Measures
1	Lakes Regional HealthcareSpirit Lake, IA	19	0.4133	1% cut	$48K	Above the national median on 2 of 3 measures
2	Sanford Worthington Medical CenterWorthington, MN	40	1.1398	1% cut	$34K	Above the national median on 2 of 2 measures
3	Mayo Clinic Health System - FairmontFairmont, MN	48	−0.2527	No cut	$0	Above the national median on 0 of 2 measures
4	Trinity Regional Medical CenterFort Dodge, IA	66	0.8681	1% cut	$155K	Above the national median on 4 of 6 measures
5	St Lukes Regional Medical CenterSioux City, IA	77	0.6377	1% cut	$291K	Above the national median on 5 of 6 measures
6	MercyOne Siouxland Medical CenterSioux City, IA	78	0.8012	1% cut	$303K	Above the national median on 4 of 6 measures
7	Dunes Surgical HospitalDakota Dunes, SD	82	−0.6357	No cut	$0	Above the national median on 0 of 1 measures
8	Avera McKennan Hospital & University Health CenterSioux Falls, SD	83	0.3618	No cut	$0	Above the national median on 4 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. Spencer Municipal Hospital, Spencer, IA: Hospital-Acquired Conditions, FY2026. https://paidandpenalized.org/hacrp/hospital/160112/. Source: CMS Provider Data Catalog, HACRP FY2026 (yq43-i98g), released August 13, 2026.