"What Congress wants to do differently this time around is, by 2021, put as much as nine percent of doctors' reimbursements at stake if providers can't hit certain quality standards. It would also include a bonus pool of $500 million for the doctors who do provide really great care. The idea is to use metrics, such as whether they're adopting electronic medical records and hitting certain medical quality targets, to adjust upward or downward what doctors' earn. That's quite different from the current, largely fee-for-service system, where doctors get a flat fee regardless of whether their patients get any better."