Discuss the difficulty of weaning physicians off fee-for-service payment models. Although it seems inevitable that we are gradually embracing value payment models, most physicians do not appreciate the reasons why and they are still supportive of traditional payment models. Dr. Bottles will discuss MACRA, MIPS, patient satisfaction surveys, Physician Compare, the ProPublica Surgeon Scorecard, and much more. Value based payments are changing from abstract theory to concrete pilots that will have winners who will receive more Medicare payments and losers who will receive less Medicare payments.