The US federal government is interested in approaches to improving health care cost-effectiveness. Procedural care, which refers primarily to surgical procedures, should be an important target for innovation, since these interventions account for more than 50% of national health care expenses.1-3 Curiously, little focus on procedural care has been evident so far. The Centers for Medicare and Medicaid Services (CMS) has initiated efforts to improve surgical quality, for example, through the Hospital Acquired Conditions program. However, these efforts are limited in scope, have a punitive component, and are unpopular with physicians.