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�with 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.