1 Repeals the flawed Medicare sustainable growth rate (SGR) formula that calculated payment cuts for physicians. 2  2016 through 2019: MACRA establishes a 0.5 percent physician fee schedule update each year.  January 2019: Based on qualification and eligibility, physicians may enter the APM track or the MIPS track.
In sociolinguistics, an accent is a manner of pronunciation peculiar to a particular individual, location, or nation. An accent may identify the locality in which its speakers reside, the socio-economic status of its speakers, their ethnicity, their caste or social class, their first language, and so on.
An accent is a way of pronouncing a language. It is therefore impossible to speak without an accent. Some people may think they do not have an accent. Or you may think that there are other people who do not have an accent. Everyone has an accent. The term 'accentless' is sometimes used (by non-linguists) about people who speak one of the high prestige 'reference' accents (such as 'General American' or, less commonly, 'RP'), which are associated with people from a fairly wide region and with people of high social class.