The US Centers for Medicare and Medicaid Services (CMS) defines quality measures as “tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or relate to one or more quality goals for health care [which] include: effective, safe, efficient, patient-centered, equitable and timely care.”1 The End Stage Renal Disease (ESRD) Quality Improvement Program (QIP) was the first pay-for-performance (PFP) quality program in Medicare fee-for-service, tying payment penalties to performance on quality measures.