When national professional organizations, such as the American Medical Association convened Physician Consortium for Performance Improvement and the American College of Cardiology and American Heart Association Task Force on Performance Measurement, first began developing nationally standardized physician performance measures more than 10 years ago, the objective was fairly simple: provide physicians with tools to assist them in improving the quality of care.1 The direction of measures development quickly changed to support the exponential growth in both the number and complexity of physician incentive and public reporting programs that has occurred in the last decade. Until recently, these programs and their concomitant measures were focused on reports that American patients were not receiving required services as exemplified by the oft-quoted study by McGlynn et al,2 which concluded that 54.9% of patients were not receiving “recommended care.” Measures addressing guideline-recommended care (eg, lipid and hypertension management) were created to help in improving this performance.