Hospital record · FY2026CCN 440018

1Hospital

Sycamore Shoals Hospital

2Location

Elizabethton, TN (Tennessee’s hospitals on the map and in the table) 37643

Carter County

3Type

Not a teaching hospital · 121 beds · Nonprofit · Urban

4Care Compare stars

2 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

0.9218

As CMS reports it

6Payment reduction

1% cut

CMS’s value: Yes

7Estimated cut

$56K estimate

Likely $41⁠–⁠70K; about $102 per traditional Medicare stay

Cut 1%

$56K

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

For fiscal year 2026, CMS reports a Total HAC Score of 0.9218 for Sycamore Shoals Hospital and a payment reduction decision of Yes.

That is 1% of about $5.6M, this site’s estimate of what traditional Medicare pays it for inpatient stays in a year: about $102 per traditional Medicare stay.

Likely range $41–70K

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 92% 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
16No
17No
18No
19Cut
20Cut
21No
22No
23—
24No
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 SSI down to the national median (0.795) would lower the score the most: by 0.4533, to 0.4685. Try it in the what-if

Figure 1. Of its 5 measures with a value, this hospital is above the national median on 4; SSI 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 66% 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 value0.9208

Z-score−0.4724

Part of score−0.0945
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
Worse than 74% of the other 2,181 hospitals

CMS value0.858

Z-score0.5839

Part of score+0.1168
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 73% of the other 2,354 hospitals

CMS value0.745

Z-score0.4772

Part of score+0.0954
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.
added the most
Surgical site infections after colon surgery or abdominal hysterectomy
Worse than 99% of the other 2,269 hospitals

CMS value4.118

Z-score2.1717

Part of score+0.4343
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 92% 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 value0.855

Z-score1.8484

Part of score+0.3697
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	0.9208	0.9623	−0.4724	−0.0945	Better than 66% of the other 2,808 hospitals
CLABSI	0.858	0.559	0.5839	+0.1168	Worse than 74% of the other 2,181 hospitals
CAUTI	0.745	0.489	0.4772	+0.0954	Worse than 73% of the other 2,354 hospitals
SSI	4.118	0.795	2.1717	+0.4343	Worse than 99% of the other 2,269 hospitals
CDI	0.855	0.346	1.8484	+0.3697	Worse than 92% 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.

(−0.4724PSI 90+0.5839CLABSI+0.4772CAUTI+2.1717SSI+1.8484CDI)÷5measures=0.9218Total HAC Score

This hospital’s score is 0.5426 above 0.3792, the highest score CMS marked No. (This site recomputes.)

Figure 2. The parts add up to 0.9218, 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	−0.4724	−0.0945	−0.0945
CLABSI	0.5839	+0.1168	0.0223
CAUTI	0.4772	+0.0954	0.1177
SSI	2.1717	+0.4343	0.5520
CDI	1.8484	+0.3697	0.9217
Total HAC Score			0.9218
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, 0.5426 over the highest score CMS didn’t cut, costs it about $56K 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	−$55,963
This hospital	0.9218	−$55,963
CMS’s highest score	2.3133	−$55,963

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.

($5,741,517payment−$103,891readmissions−$41,280value-based)×1%the cut=$55,963HAC cut

$55,963HAC cut÷547traditional Medicare stays=$102per traditional Medicare stay

Figure 4. This site estimates the HAC cut at $56K: 1% of the hospital’s whole inpatient payment, taken last. The readmissions and value-based adjustments, on the base alone, came to −$104K and −$41K.

Estimated Medicare inpatient payments · FY2026 estimate

What traditional Medicare pays it for inpatient stays
DRG payments at the federal rates the base	$4,517,001
Many low-income patients (disproportionate share)	$116,719
Capital: buildings and equipment	$344,197
Uncompensated care	$763,600
Total, before the three programs	$5,741,517
The three programs: two on the base, the HAC cut last
Readmissions (HRRP) base × (0.9770 − 1)	−$103,891
Value-based purchasing (HVBP) base × (0.9909 − 1)	−$41,280
After these two	$5,596,346
HAC Reduction Program 1% of everything above; likely $41⁠–⁠70K	−$55,963
Net of the three programs likely −$257K to −$146K	−$201,134

Not paid to this hospital: a Medicare-dependent hospital add-on, teaching payments, outlier payments, a sole community hospital rate difference, and a low-volume adjustment.

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)	$4,517,001
Many low-income patients (disproportionate share)	$116,719
Capital: buildings and equipment	$344,197
Uncompensated care	$763,600
Total, before the three programs	$5,741,517
Readmissions (HRRP) (base × (0.9770 − 1))	−$103,891
Value-based purchasing (HVBP) (base × (0.9909 − 1))	−$41,280
After these two	$5,596,346
HAC Reduction Program (1% of everything above; likely $41–70K)	−$55,963
Net of the three programs (likely −$257K to −$146K)	−$201,134

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	0.9218	same
Payment reduction decision	Yes	same
Payment cut	1%	same
Estimated HAC cut estimate	$56K	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 0.9218 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 $56K, 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	not possible with this measure alone
CAUTI	not possible with this measure alone
SSI	0.534 or lower
CDI	0.154 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 0.9208 · median 0.9623 · floor 0.7760 · cap 1.3482 · each 0.1 = 0.1396

Central line–associated bloodstream infections CLABSI

CLABSI value

CMS 0.858 · median 0.559 · cap 1.572 · each 0.1 = 0.0464

Catheter-associated urinary tract infections CAUTI

CAUTI value

CMS 0.745 · median 0.489 · cap 1.537 · each 0.1 = 0.0482

Surgical site infections after colon surgery or abdominal hysterectomy SSI

SSI value

CMS 4.118 · median 0.795 · cap 2.118 · each 0.1 = 0.0343

Clostridioides difficile (C. diff) infections CDI

CDI value

CMS 0.855 · 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. SSI added the most to this hospital’s Total HAC Score of 0.9218 among its measured results: +0.4343.

PSI 90 −0.0945
CLABSI +0.1168
CAUTI +0.0954
SSI +0.4343
CDI +0.3697

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	−0.4724	−0.0945	same
CLABSI	0.5839	+0.1168	same
CAUTI	0.4772	+0.0954	same
SSI	2.1717	+0.4343	same
CDI	1.8484	+0.3697	same

Interactive what-if at https://paidandpenalized.org/hacrp/hospital/440018/

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 2 years in a row.

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	1.3500	1.6%	not cut
FY2016	2.2500	6.2%	not cut
FY2017	3.1300	15.8%	not cut
FY2018	0.1271	62.1%	not cut
FY2019	0.3618	75.8%	cut
FY2020	0.6470	87.6%	cut
FY2021	−0.0678	46.5%	not cut
FY2022	−0.5843	16.5%	not cut
FY2023			no decision
FY2024	−0.6463	13.1%	not cut
FY2025	−0.2370	35.6%	not cut
FY2026	0.9218	92.4%	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 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).

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Calendar year	CAUTI	C. diff
2017	0.643	1.355
2018	0.000	0.668
2019	0.000	0.596
2021	0.000	0.391
2022	0.590	0.371
2023		0.840
2024		0.879

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 Tennessee, its score is higher than 95% of the other 72 scored there.

Figure 8. Its score is above the middle in all 7 groups it belongs to; the share cut runs from 19% (Tennessee) to 26% (Nonprofit).

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

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Group	With a decision	Hospitals cut	Share cut	Middle score	Hospital higher than
All hospitals	2,886	718	25%	−0.0453	92%
South region	1,174	263	22%	−0.1056	92%
Tennessee	73	14	19%	−0.2186	95%
Not teaching	1,563	389	25%	−0.1053	90%
100 to 299 beds	1,193	275	23%	−0.0732	94%
Nonprofit	1,830	478	26%	−0.0134	93%
Urban	2,241	510	23%	−0.0574	94%
This hospital				0.9218
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 8 miles away.

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

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Hospital	Miles	Score	Decision
Johnson City Medical Center, Johnson City, TN	8	0.7814	cut
Franklin Woods Community Hospital, Johnson City, TN	9	−0.2186	not cut
Wellmont Bristol Regional Medical Center, Bristol, TN	17	−0.1675	not cut
Indian Path Community Hospital, Kingsport, TN	21	−1.0670	not cut
Wellmont Holston Valley Medical Center, Kingsport, TN	22	0.7462	cut
Johnston Memorial Hospital, Abingdon, VA	27	−0.0320	not cut
Greeneville Community Hospital, Greeneville, TN	33	0.1925	not cut
Watauga Medical Center, Boone, NC	35	0.2806	not cut

#	Hospital	Miles	Score	Decision	Est. cut ($, modeled)	Measures
1	Johnson City Medical CenterJohnson City, TN	8	0.7814	1% cut	$764K	Above the national median on 4 of 6 measures
2	Franklin Woods Community HospitalJohnson City, TN	9	−0.2186	No cut	$0	Above the national median on 3 of 6 measures
3	Wellmont Bristol Regional Medical CenterBristol, TN	17	−0.1675	No cut	$0	Above the national median on 4 of 6 measures
4	Indian Path Community HospitalKingsport, TN	21	−1.0670	No cut	$0	Above the national median on 0 of 3 measures
5	Wellmont Holston Valley Medical CenterKingsport, TN	22	0.7462	1% cut	$504K	Above the national median on 6 of 6 measures
6	Johnston Memorial HospitalAbingdon, VA	27	−0.0320	No cut	$0	Above the national median on 1 of 6 measures
7	Greeneville Community HospitalGreeneville, TN	33	0.1925	No cut	$0	Above the national median on 3 of 6 measures
8	Watauga Medical CenterBoone, NC	35	0.2806	No cut	$0	Above the national median on 5 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. Sycamore Shoals Hospital, Elizabethton, TN: Hospital-Acquired Conditions, FY2026. https://paidandpenalized.org/hacrp/hospital/440018/. Source: CMS Provider Data Catalog, HACRP FY2026 (yq43-i98g), released August 13, 2026.