It is unlikely that a total repeal of the Affordable Care Act will happen, and almost certain that the provisions of MACRA will survive to impact the manner in which you practice medicine. Since the MACRA documentation requirements began January 1, 2017, special attention should be given to the proper ways to avoid a Medicare payment reduction in 2019. In addition, other payers are monitoring your coding patterns, your cost of care and the quality of your outcomes. The surveillance of commercial payers may become a greater item of concern than the MACRA implementation. This session will explain what Medicare and commercial payers are trying to accomplish, how they are watching your practice, the penalties or rewards that may come to your practice, and what you can currently do so that your practice is on the winning side of the budget neutral changes.