Since the early 1990s, Veterans Affairs (VA) has been at the vanguard of national efforts to measure hospital-level performance and ensure quality care for veterans. In response to a congressional mandate that 鈥渢he VA should report its surgical outcomes in comparison to the national average鈥ith risk adjustment,鈥� the initial VA National Surgical Quality Improvement Program (NSQIP) was created to accurately collect clinical data using standardized methodology and incorporating robust risk adjustment.1 Renamed the VA Surgical Quality Improvement Program (VASQIP) after merging the cardiac and noncardiac surgery components of NSQIP, this mandatory, VA-wide program has remained a model for national quality improvement (QI) efforts and was the template used to develop the private sector American College of Surgeons鈥揘SQIP.