“Under the Patient Protection and Affordable Care Act (PPACA), Congress has enacted record-breaking Medicare payment reductions. Most of these are reductions in Medicare payment updates to non-physician providers. To a lesser degree, these reductions are attributable to certain health care delivery reforms. The Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS), the agency that administers the Medicare and Medicaid programs, estimates an initial 10-year savings from the total set of Medicare changes amounting to $575 billion.”