Despite the transition to value-based care in the healthcare industry using the Merit-Based Incentive Payment Systems (MIPS), small and rural physician practices still score in the poor category annually. These poor performances negatively impact funding for staffing and service availability; further, little research has focused on the factors behind these poor performance scores. The purpose of this study was to examine the relationship between practice size and organization geographical location on annual MIPS scores among dermatologists in the South-Central United States. The Donabedian model was used as the theoretical framework for this study that focused on the three qualities of care: structure, process, and outcome. The research design included an independent samples t test, which evaluated the relationship between the variables. The findings of the parametric test demonstrated statistical significance (p-value \u3c.001) for practice size. Geographical location was not statistically significant (p-value 0.23). Further analysis was conducted using the same parametric test for the South-Central United States and the relationship of the variables. Practice size in the region demonstrated statistical significance (p-value \u3c.001) while geographical location in the region was not statistically significant. Texas was the only state to be significant within the region (p-value \u3c.001). The most important implication of this study’s findings for positive social change could be the direct support healthcare administrators will have to actively improve their organization’s MIPS scores and the potential incentives and additional funding they may receive by CMS