The complex, at times confusing landscape of quality measurement programs in which practices and providers are required to participate, are the culmination of over a century of evolving quality measurement and improvement efforts in the American health care system.1 The Institute of Medicine (IOM) defined quality as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge".2 Contemporary quality measures fall under four broad categories:3 Structure Process