Early Nephrologist Performance in the Merit-Based Incentive Payment System: Both Reassurance and Reason for Concern

In an effort to control increasing health care costs, lawmakers passed the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA) with bipartisan support in 2015. MACRA coincided with repeal of the Sustainable Growth Rate (SGR) formula, which imposed strict caps on physician payments but had been ineffective due to annual postponements.1 While replacing the SGR with MACRA eliminated the looming threat of large SGR payment cuts to physicians, it represented a shift in physician reimbursement toward value-based payment.