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 may be identified with the locality in which its speakers reside (a regional or geographical accent), the socio-economic status of its speakers, their ethnicity, their caste or social class (a social accent), or influence from their first language (a foreign accent).rom Wikipedia, the free encyclopedia. Accent serves as the first point of gate keeping because we are forbidden, by law and social custom, and perhaps by a prevailing sense of what is morally and ethically right, from using race, ethnicity, homeland or economics more directly.