“This is the biggest change in our lifetimes since Medicare to physician practice” is what MACRA, also known as the Medicare Access and CHIP Reauthorization Act, including its MIPS (Merit-based Incentive Payment System) and APM (advanced payment model) tracks, has been called by health leaders such as Katherine Schneider, CEO of the Delaware Valley Accountable Care Organization. The law, which was passed by Congress in 2015, is aimed at shifting the United States healthcare system from a fee-for-service volume based system to a system that pays for quality care. Notably for health IT watchers, the MIPS component has subsumed the Meaningful Use electronic health record certification program. MACRA calls for a range of quality reporting demands to be met by physician practices. And, it is structured as a losers-pay-winners system, as practices are paid based on where they perform relative to their peers. A 4% bonus is supported by a 4% penalty, which translates into real financial impact. At the recent August 2017 Philadelphia Health IT Summit, a lively debate was held about what MACRA will mean for physician practices and health policy. Participating in the debate along with Ms. Schneider were industry leaders including Anne Docimo, M.D., CMO of Jefferson Health System (Philadelphia), and Sriram (Sri) Bharadwaj, chief information security officer and director, UC Irvine Health (Irvine, Calif.), with debate moderator Mark Stevens of ARRAHealth Consulting, Inc. (Philadelphia). The full debate analysis by Healthcare Informatics writer Mark Hagland can be found here.