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.
| Rank | Hospital name | Definitive ID | MIPS Score | Total Medicare payments | Explore dataset |
|---|---|---|---|---|---|
| 1 | Texas Health Physicians Group | 550635 | 100% | $330,813,272 | Explore |
| 2 | Northside Hospital Physicians (FKA Northside Network Providers) | 749148 | 100% | $328,201,581 | Explore |
| 3 | Piedmont Healthcare Physicians | 1007685 | 100% | $300,917,740 | Explore |
| 4 | Fyzical Therapy & Balance Centers | 955510 | 100% | $247,611,211 | Explore |
| 5 | Cleveland Clinic | 618513 | 100% | $239,639,010 | Explore |
| 6 | John Muir Health Physician Network | 550477 | 100% | $224,550,009 | Explore |
| 7 | Washington University Physicians | 957039 | 100% | $168,728,840 | Explore |
| 8 | Summit Health (FKA Summit Medical Group) | 955383 | 100% | $168,498,109 | Explore |
| 9 | Saint Lukes Health System Physicians | 1034935 | 100% | $153,187,551 | Explore |
| 10 | University of Maryland Physicians | 1027744 | 100% | $126,379,973 | Explore |
| 11 | Sanford Health Physicians (FKA Sanford Health Medical Group) | 550880 | 100% | $119,670,471 | Explore |
| 12 | Prisma Health Medical Group (FKA Prisma Health Physicians) | 735848 | 100% | $117,961,161 | Explore |
| 13 | Santa Clara County IPA (AKA SCCIPA) | 550734 | 100% | $115,163,861 | Explore |
| 14 | Millennium Physician Group | 955530 | 100% | $106,247,261 | Explore |
| 15 | Cooper University Health Care Physicians | 1032511 | 100% | $105,112,184 | Explore |
| 16 | Our Lady of the Lake Physicians (FKA Our Lady of the Lake Physician Group) | 550741 | 100% | $100,693,938 | Explore |
| 17 | Sutter Medical Foundation | 550623 | 100% | $96,562,676 | Explore |
| 18 | Cedars-Sinai Physicians (FKA Cedars-Sinai Medical Group) | 552127 | 100% | $94,386,476 | Explore |
| 19 | WillsEye Physicians Mid Atlantic Retina | 638563 | 100% | $93,228,219 | Explore |
| 20 | Sentara Physicians (FKA Sentara Medical Group) | 550585 | 100% | $84,041,628 | Explore |
| 21 | NJ Retina | 638735 | 100% | $83,475,452 | Explore |
| 22 | Apogee Physicians | 955099 | 100% | $81,838,120 | Explore |
| 23 | Christiana Care Health System Physicians | 585187 | 100% | $80,240,603 | Explore |
| 24 | Temple Health Physicians (FKA Temple Physicians Inc) | 550888 | 100% | $70,280,006 | Explore |
| 25 | Southern California Oncology Associates (AKA Oncology Physicians Network) | 956475 | 100% | $69,317,527 | Explore |
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:
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They see more than 200 Medicare Part B patients
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They provide more than 200 covered professional services to Medicare Part B patients, and;
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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:
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Medicare Part B claims measures
Check out the Quality Payment Program tool made by the CMS for more information on these measures and how to properly submit data.
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