The Patient Protection and Accountable Care Act (PPACA), signed into law by President Obama on March 23, 2010, contains provisions designed to materially change the manner in which hospitals and physicians deliver care to Medicare and Medicaid patients and the way they are compensated for such care. The purpose is to vastly improve the quality of healthcare, while at the same time lowering healthcare costs. This quality/cost initiative is a concept that will spell the future for healthcare reform. This article broadly describes the provisions of PPACA, along with the demonstration and pilot programs created as a result of PPACA, which are all designed to further the quality/cost initiative. It also provides some of the author's predictions as to what the future holds for physicians and hospitals given the government’s focus on the quality/cost initiative.