Which factors are used to determine payout based on efficiency?

• A. Spending per beneficiary, 3 days prior to admission to 30 days post discharge.
• B. Mortality
• C. Resource utilization
• D. Length of stay

Answer: (A)

Efficiency-based payout looks at how resources are used to deliver care within a defined episode. The key measure is total spending per beneficiary over that episode window, capturing all related services from a short period before admission through a period after discharge. This approach directly ties payment to cost efficiency for each patient, rewarding lower but appropriate spending while maintaining value.

The option that matches this idea describes spending per beneficiary over a window that starts a few days before admission and extends after discharge. That window is designed to encompass the full episode of care and the associated costs, which is exactly what determines an efficiency-based payout.

Mortality is an important outcome, but it reflects quality and safety more than cost efficiency. Resource utilization and length of stay relate to how intensively care is used, but the specific payout model for efficiency centers on total spending per beneficiary in the episode window rather than these factors alone.