2022 Cross-Sectional Study Links Multisetting Generalist Groups to Lower Medicare MIPS Scores

Generalist physician groups whose doctors work across hospitals, emergency departments, offices and nursing homes were associated with lower performance in Medicare’s Merit-Based Incentive Payment System in a cross-sectional analysis of 2022 data. Among 4,145 groups made up of general internal medicine, geriatric medicine and family medicine physicians, each 10-percentage-point increase in the study’s generalist setting specialization measure was associated with an overall MIPS score that was 0.23 points lower. The analysis also found that these groups had 4% higher odds of falling below the program’s 75-point performance threshold.

The reported association was evident in urban groups but was not statistically significant in rural groups. The principal outcome was the continuous overall MIPS score. Secondary analyses examined scores for individual MIPS components and classified groups according to whether their total score was below the 75-point threshold.

The approach allowed the investigators to test whether groups with a greater concentration of multisetting generalists differed systematically in measured Medicare incentive performance. Multivariable linear and logistic regression estimates showed a consistent association between greater multisetting specialization and weaker overall performance. For each 10-percentage-point increase in the specialization measure, the adjusted overall MIPS score was estimated to decline by 0.23 points, with a 95% confidence interval of −0.35 to −0.11 and p<0.001.

The fully adjusted logistic model estimated 4% higher odds of scoring below 75 points for each 10-percentage-point increase, with an odds ratio of 1.04, a 95% confidence interval of 1.01–1.07 and p<0.01. Adjustment incorporated practice characteristics, patients’ clinical complexity, insurance case mix and socioeconomic vulnerability, reducing the likelihood that the reported relationships were explained solely by those measured differences between groups. The component analysis pointed to the MIPS Quality domain as the main part of the pattern.

Each 10-percentage-point increase in generalist setting specialization was associated with a 0.46-point lower Quality score, with a 95% confidence interval of −0.71 to −0.22 and p<0.001. No statistically significant association was found between the specialization measure and the other component scores examined. Because the result concerns scoring under a specific Medicare performance system in a cross-sectional dataset, it does not by itself establish that multisetting work caused lower scores or demonstrate worse patient outcomes.

The analysis also does not show how the measured Quality score translates into any specific aspect of clinical care. Stratified results differed between urban and rural groups. In urban physician groups, each 10-percentage-point increase in the specialization measure was associated with a 0.30-point lower overall MIPS score, with a 95% confidence interval of −0.43 to −0.17 and p<0.001.

The corresponding estimate for rural groups was a 0.08-point higher score, but its 95% confidence interval ranged from −0.23 to 0.40, indicating that the rural association was not statistically significant. The supplied findings therefore show a negative association among urban groups and an uncertain estimate among rural groups, without establishing that urbanicity formally modified the relationship. The authors said future research should examine whether setting-based specialization within generalist groups affects patient outcomes and costs, questions that the present study was not designed to answer.

Subject of Research: Association between multisetting generalist physician groups and 2022 Medicare MIPS performance

Article Title: Composition of generalist physician groups and their performance on medicare’s Merit-based Incentive Payment System (MIPS)

Article References: Ni, V., & Ryskina, K. L. (2026). Composition of generalist physician groups and their performance on medicare’s Merit-based Incentive Payment System (MIPS). BMC Health Services Research. https://doi.org/10.1186/s12913-026-15866-4

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15866-4

Keywords: Medicare, MIPS, physician groups, general medicine, care settings, quality scores, cross-sectional study, urban-rural differences, health services research, Composition, generalist, physician