Is there too much focus on measuring and reporting quality rather than on the conditions needed for improving it? The Centers for Medicare & Medicaid Services (CMS) and other organizations require physicians and hospitals to publicly report performance on quality measures, and the CMS and private payers are tying reimbursement partly to data from such measures in pay-for-performance programs. However, as the director of an intensive care unit performance improvement program, I know that it is difficult—and sometimes counterproductive—to try to improve a complex system simply by rewarding or penalizing the results.