On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released a final rule with comment period (Final Rule) implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Final Rule overhauls the methodology by which most physicians and certain other clinicians participating in Medicare will be reimbursed and marks a significant shift away from fee-for-service payments and toward value-based reimbursement. It also repeals the Medicare Sustainable Growth Rate and provides for winding down, by the end of 2018, the Physician Quality Reporting System (PQRS), the Medicare Electronic Health Record Incentive Program for Eligible Professionals (commonly known as Meaningful Use), and the Physician Value-Based Payment Modifier (VM). In their place, CMS created the Quality Payment Program (QPP), which incorporates components of these programs and creates positive and negative payment adjustments based on reporting and performance metrics. The QPP is effective January 1, 2017, with the first payment adjustments becoming effective in 2019.