National Efficiency Ratio. A national baseline efficiency ratio will be calculated for each entitlement category. The national efficiency ratio is a measure of the ACO’s efficiency relative to the entire reference population. The national efficiency ratio will be the ratio of.
1. The NGACO’s risk- and GAF-adjusted baseline expenditure PBPM; and,
2. The national risk- and GAF-adjusted baseline expenditure PBPM.11 As noted in section 3.7.2, IME and DSH will be excluded from all expenditures when calculating the national efficiency ratio. IME and DSH are not related to an ACO’s national efficiency, and inclusion of IME and DSH in the national expenditure ratio could create bias in the NGACO Model. The NGACO’s risk- and GAF-adjusted baseline expenditure PBPM for an entitlement category is discussed in section 7.2.1. 11 The national risk- and GAF-adjusted baseline expenditure PBPM will, because of the steps taken to ensure that the standardization process neither increases nor decreases total expenditures, will equal the incurred expenditure PBPM of the reference population. NGACO Benchmarking Methods Rev. 1.02.01
8.1 NGACO Financial Settlement 22
