The document summarizes the Quality Payment Program (QPP) established by the Medicare Access and CHIP Reauthorization Act (MACRA). It outlines two tracks for physician payment under MACRA - the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). MIPS consolidates existing quality programs and adds a cost component, with payment adjustments starting at -4% to +12% in 2019. Advanced APMs offer higher payment updates and bonuses for bearing more than nominal risk. The document provides details on participation requirements, payment adjustments, and strategic considerations for physicians to succeed under the new program.