Public reporting on quality performance has become widespread, and financial rewards for demonstrating higher quality are now common. National organizations, such as the Centers for Medicare & Medicaid Services (CMS), the National Committee for Quality Assurance (NCQA), and The Joint Commission, as well as some employers, large health care systems, and multistakeholder collations, operate programs that track, and sometimes pay for, quality using a defined set of measures. Although there is evidence that measurement and reporting have contributed to improved quality, there also is evidence that current quality monitoring systems have had unintended consequences and sometimes limited returns.1,2