When physicians and health-policy mavens are asked to name the federal legislation with the greatest impact on domestic retinal practice, most would suggest the passage of Medicare in 1964. Although Medicare greatly expanded access for the elderly and the disabled, increased physician revenues, and stimulated investment in new technology, it produced little disruption in day-to-day practice. In reality the 2015 passage of the Medicare Payment and CHIP Reauthorization Act (MACRA) has far more impact.