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Healthcare Insights

Top 25 physician groups by MIPS and Medicare payments

The Merit-based Incentive Payment System (MIPS) program was implemented in 2017 as an initiative to improve the quality of care delivered in the U.S. while simultaneously reducing costs and eliminating wasteful actions.  

According to CMS, the creators of the program, MIPS rewards Medicare clinicians who provide high-quality care with payment increases. At the same time, clinicians who fail to meet performance standards receive reduced payments. The program is the product of consolidating and streamlining several legacy reporting methods for Medicare.  

The table below lists the top active physician groups that received a perfect MIPS score in 2020, ranked by total Medicare payments.  

Top performing physician groups that participated in MIPS in 2020

RankHospital nameDefinitive IDMIPS ScoreTotal Medicare paymentsExplore dataset
1Texas Health Physicians Group550635100%$330,813,272Explore
2Northside Hospital Physicians (FKA Northside Network Providers)749148100%$328,201,581Explore
3Piedmont Healthcare Physicians1007685100%$300,917,740Explore
4Fyzical Therapy & Balance Centers955510100%$247,611,211Explore
5Cleveland Clinic618513100%$239,639,010Explore
6John Muir Health Physician Network550477100%$224,550,009Explore
7Washington University Physicians957039100%$168,728,840Explore
8Summit Health (FKA Summit Medical Group)955383100%$168,498,109Explore
9Saint Lukes Health System Physicians1034935100%$153,187,551Explore
10University of Maryland Physicians1027744100%$126,379,973Explore
11Sanford Health Physicians (FKA Sanford Health Medical Group)550880100%$119,670,471Explore
12Prisma Health Medical Group (FKA Prisma Health Physicians)735848100%$117,961,161Explore
13Santa Clara County IPA (AKA SCCIPA)550734100%$115,163,861Explore
14Millennium Physician Group955530100%$106,247,261Explore
15Cooper University Health Care Physicians1032511100%$105,112,184Explore
16Our Lady of the Lake Physicians (FKA Our Lady of the Lake Physician Group)550741100%$100,693,938Explore
17Sutter Medical Foundation550623100%$96,562,676Explore
18Cedars-Sinai Physicians (FKA Cedars-Sinai Medical Group)552127100%$94,386,476Explore
19WillsEye Physicians Mid Atlantic Retina638563100%$93,228,219Explore
20Sentara Physicians (FKA Sentara Medical Group)550585100%$84,041,628Explore
21NJ Retina638735100%$83,475,452Explore
22Apogee Physicians955099100%$81,838,120Explore
23Christiana Care Health System Physicians585187100%$80,240,603Explore
24Temple Health Physicians (FKA Temple Physicians Inc)550888100%$70,280,006Explore
25Southern California Oncology Associates (AKA Oncology Physicians Network)956475100%$69,317,527Explore

Fig 1. CMS MIPS Performance Data covers Performance Year 2020, released in August 2022. Next Performance Year data is scheduled to be released in March 2023. Medicare data sourced from the Medicare Cost Report.  

Which physician groups had the highest total Medicare payments? 

The top three physician groups on our list are also the only three to have more than $300 million in total Medicare payments. Texas Health Physician’s Group ranks first on our list with more than $330 million in total Medicare payments. In second is Northside Hospital Physicians with about $328 million, and Piedmont Healthcare Physicians comes in third.  

California has the highest frequency with five physician groups in the top 25. Georgia, New Jersey, and Pennsylvania are all tied with two physician groups each on our list.  

Do physicians have to participate in MIPS? 

A provider’s eligibility status for MIPS is determined by a wide range of criteria and may change each performance year to reflect new policies. CMS’ participation status tool can help organizations check if they are eligible.   

However, a healthcare provider must participate in MIPS (unless otherwise exempt) if: 

  • They see more than 200 Medicare Part B patients 

  • They provide more than 200 covered professional services to Medicare Part B patients, and; 

  • They bill more than $90,000 for those services 

What are the four MIPS performance categories? 

Currently performance in the program is measured in four areas—quality, improvement activities, promoting interoperability, and cost. These four areas make up a final score which determines a clinician’s payment bonus or penalty, or whether they receive no payment adjustment at all.  

What are the 2022 MIPS quality measures? 

Healthcare providers and organizations participating in MIPS must collect and submit data to the CMS for review. Each performance category is comprised of several measures to report and provide data on.   

Under the ‘Quality’ section, there are six categories of data that are measured: 

  1. MIPS Clinical Quality Measures (CQMs) 

  1. Electronic Clinical Quality Measures (eCQMs) 

  1. Qualified Clinical Data Registry (QCDR) measures 

  1. Medicare Part B claims measures 

  1. CMS web interface measures 

  1. Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS survey 

Check out the Quality Payment Program tool made by the CMS for more information on these measures and how to properly submit data. 

Learn more 

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