Healthcare Insights

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:

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  Physician Group Name Definitive ID MIPS Score Total Medicare Payments Number of Medicare Procedures Explore This Dataset
1. NYC University Physicians Network 577713 100% $203,431,664 5,055,819 Explore This Profile
2. Aurora Health Care Medical Group Inc 550238 100% $186,348,909 5,076,502 Explore This Profile
3. John Muir Health Physician Network 550477 100% $169,846,307 5,439,559 Explore This Profile
4. Beaumont Medical Group 752078 100% $153,365,926 4,453,224 Explore This Profile
5. Palo Alto Medical Foundation 550513 100% $147,569,905 4,729,815 Explore This Profile
6. Atrium Health Medical Group 550275 100% $146,544,440 4,252,642 Explore This Profile
7. Geisinger Clinic Physician Group 550339 100% $135,424,816 3,005,014 Explore This Profile
8. Northern Light Health Physicians 622159 100% $118,648,319 3,308,725 Explore This Profile
9. Santa Clara County IPA 550734 100% $116,908,313 2,692,611 Explore This Profile
10. Our Lady of the Lake Physician Group 550741 100% $111,984,196 3,084,917 Explore This Profile
11. Northwestern Medical Group 552709 100% $104,271,677 2,690,496 Explore This Profile
12. Sentara Medical Group 550585 100% $102,232,898 1,940,907 Explore This Profile
13. St Lukes Physician Group 550612 100% $100,714,628 1,968,248 Explore This Profile
14. Centra Medical Group 550281 100% $95,583,966 3,005,491 Explore This Profile
15. Sutter Medical Foundation 550623 100% $90,165,252 2,769,055 Explore This Profile
16. University of Washington Physicians 551153 100% $82,532,563 1,451,514 Explore This Profile
17. WillsEyePhysicians Mid Atlantic Retina 638563 100% $81,610,179 364,827 Explore This Profile
18. Deaconess Clinic 645915 100% $76,832,391 1,941,662 Explore This Profile
19. Intermountain Healthcare Medical Group 618527 100% $74,536,394 2,664,754 Explore This Profile
20. Prisma Health Physicians 735848 100% $72,793,296 1,757,955 Explore This Profile
21. University of Colorado Medicine 550933 100% $72,646,479 1,348,385 Explore This Profile
22. Valley Physician Enterprise 763733 100% $70,402,545 1,865,333 Explore This Profile
23. SSM Health Dean Medical Group 550314 100% $69,111,955 2,668,782 Explore This Profile
24. Baptist Medical Group 550246 100% $65,295,380 2,742,496 Explore This Profile
25. Sanford Health Medical Group 550880 100% $62,297,886 1,594,713 Explore This Profile

 

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.

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