Change is inevitable, but participation is optional. An array of quality measures is being used by various government entities, health care purchasers and payers, and other groups. Many of the quality-measurement initiatives have not only gained the attention of large employers, but are also beginning to pique the public's interest. Novel approaches to measuring and rewarding quality are also emerging, such as pay-for-performance schemes and the use of APR-DRGs. Health care organizations that participate in the quality-measurement process and provide input will benefit by the type of measures that are ultimately created. It is much better to be part of the development process than to have insurer- or employer-designed quality measures imposed on your institution. At the very least, health care organizations would be wise to serve as watchdogs to ensure that currently proposed quality measures truly measure high-quality care.