will result in a value based outcome adjustment factor determined under subparagraph (A) for an applicable prospective period that reduces the total payments under subsection (d) across all applicable hospitals and all potentially-avoidable outcomes for such period by an amount equal to the reduction in payments under such subsection for such period that would have resulted from the application of subsections (d)(4)(D), (o), (p), and (q) if the amendments made by the Healthcare Outcomes Act of 2017 had not applied. (4) Process for determining financial impacts For purposes of paragraph (3), the Secretary shall, for each performance category described in paragraph (5) and each data collection period that is with respect to an applicable prospective period beginning on or after October 1, 2018, determine each of the following: (A) Nationwide-average rates With respect to each risk category specified under paragraph (6)(B), the ratio of— (i) the number of discharges occurring among (or, in the case of the performance category described in paragraph (5)(D), the total amount of standardized post acute care episode expenditures made with respect to) all applicable hospitals during such applicable data collection period that are with respect to such risk category and that involve the potentially-avoidable outcomes in such performance category