In December 2023, the Centers for Medicare and Medicaid Services (CMS) asked for public comments regarding the ESRD Patient Life Goals Survey (PaLS) as a potential quality metric in the ESRD Quality Incentive Program (QIP), a federal program that reduces payment to dialysis facilities for failure to meet quality metric targets .1 The PaLS contains four questions for patients receiving dialysis about their life goals (Figure 1). According to the Partnership for Quality Measurement (Battelle), a quality measurement development entity, PaLS data will generate a “patient-level t-score that reflects patient-reported satisfaction with how well the dialysis care team is doing in discussing life goals as part of the treatment planning process.”2,3