Ceiling Effect with Keet Outcomes QCDR Measures

MCID unable to be met due to high/low initial score

Keet Outcomes QCDR calculates a “Failure to Progress” (FTP) performance rate for each Keet Outcomes quality measure that is reported to CMS for participation in the MIPS program. An FTP rate is the percent of eligible patients failing to show progression deemed by a score-change between their initial and last Patient Reported Outcome (PRO) that does not meet or exceed the Minimum Clinically Important Difference (MCID), or the smallest change in a treatment outcome that a patient would identify as important based on clinical research. 

Occasionally when a patient starts care, their initial score on a PRO is recorded at the more “positive health state” end of the scale and does not allow for a score-change equal to or greater than the MCID. In this case, the patient may make possible improvements in health, however, the variance in the score change from the beginning to the end of treatment is not significant enough to hit the established MCID threshold for the given outcome measure tool. For example, an initial NPRS pain score of 1 with a final NPRS score of “0” --or no pain-- illustrates a positive outcome, but because the patient's initial score was at the upper limit of the scale the degree of possible improvement is limited to a change score of 1, which is below the MCID of 2 points for the NPRS outcome measure. These scenarios are often referred to as the “Ceiling” effect.

Large population registries like Keet's QCDR are intentionally designed to reflect a "real world" population which includes patients who may be subject to the ceiling effect. Therefore, under the CMS-approved measure specifications for the Keet Outcomes Measures, the inability to meet or exceed the MCID due to the ceiling effect is not a cause for automatic disqualification.

If the patient meets any additional criteria for removal from the MIPS registry, they may be excluded based on that judgment.

Learn More:

To review the Keet Outcomes Measure Specifications click here

To review the disqualification criteria for Keet Outcomes Measures click here

For more information on qualification/disqualification of an Episode of Care click here