The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, shifts Medicare payments from volume to value. This landmark legislation aims to move Medicare from fee-for-service to a system that rewards quality and low cost. Most of you have heard of MACRA, and many are participating. On June 20, 2017, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule to govern 2018 MACRA participation. The rule is