Under both the Obama and Trump administrations, CMS has been steadily pushing hospitals and physicians toward pay for performance and shared risk reimbursement models. Matt Stevens will discuss the major tool aimed at physicians, the Medicare Access and CHIP Reauthorization Act (MACRA), and the strategic implications of the 2018 final rule. In addition, the complexity and pace of change in health care is causing a growing physician burnout problem, as between 2011 and 2014 the percentage of physicians who reported feeling burnt out increased by almost 10 percent. Matt will discuss the consequences of burnout on physicians and organizations, and provide insights on better understanding and mitigating burnout.