Top 25 Physician Groups by MIPS and Medicare Payments

The Merit-based Incentive Payment System (MIPS) program was first implemented in 2017 to help identify where physicians are struggling and may require assistance. The program was designed by CMS to update and consolidate previous programs such as Physician Quality Reporting System (PQRS,) Value-Based Payment Modifier (VBM,) and the Medicare Electronic Health Records (EHR) Incentive Program for Eligible Clinicians. As the only publicly available Physician Quality Dataset, MIPS provides performance-based adjustments (positive or negative) to participating clinicians.

Over the course of 2018 and 2019, MIPS reporting requirements, eligibility, and participation guidelines have continued to evolve. Currently performance in the program is measured in four areas—quality, improvement activities, promoting interoperability (formerly ACI – Advancing Care Information) and cost. These four areas make up a final score which determines a clinician’s payment adjustment.

The following list includes the top Physician Groups that received a perfect MIPS score ranked by highest Medicare payment. Of the groups appearing on the list, California has the highest frequency with four groups in the top 25. The specialty with the highest frequency of appearance was family practice with 11 occurrences followed by internal medicine with nine occurrences.

Top 25 Physician Groups by MIPS Score and Medicare Payments:

Fig 1. Program Year 2017 MIPS Performance Data was released as part of the July 2019 Physician Compare Update. The anticipated release date for MIPS Program Year 2018 data has not yet been released. Medicare data is from the Centers for Medicare and Medicaid Services (CMS) Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (PUF). Calendar Year data is projected to be released each July by the CMS. The most recent data is from calendar year 2017; 2018 data is scheduled to be released in July 2020.