Unless you are spending your working time under the protection of and within the shelter of the proverbial rock you should be aware of the advancing impress of the concept, methods and policy demands of quality as it impinges on the practice of Medicine in the U.S. in general and the practice of radiology in your facility in particular. The facts and the folklore relating to quality are no longer recondite matters. Whatever your views on the Affordable Care Act, you know that measurements of quality are going to be matters for which you must become knowledgeable. For example, in a recent issue of JACR there is an article entitled “Medicare’s Physician Quality Reporting System: Early National Radiologists Experience and Near-Future Performance Projections”, which is a report on the utilization of Medicare’s Pay for Performance program known under the acronym PQRS. The program enables bonuses to be paid by those who comply with reporting and documentation obligations which are detailed and specific. The earliest bonuses to those who comply, that is those issued from 2007 to the present, will then reduce in amount through 2014. Then the “stick” of penalties will replace the “carrot” of financial awards by 2015. In the following year it will amount to 2 % of Medicare payments to individual physicians. It is clear that this program has “teeth” and that all of us, current participants and non-participants alike, should be aware of them for their financial implications for one thing and for the maintenance of our professional qualifications including MOC satisfaction for another. But while this particular initiative will garner our attention, more and more, I wish to alert you to another one, a program for which I suspect most of you have not heard about when unless you actively (1) practice in an academic environment and (2) are intimately involved in resident education and their accreditation obligations.