Pay for performance is one component of a growing movement in this country to better align incentives so as to increase the quality of medical care and reduce unnecessary costs. The Physician Consortium for Quality Improvement is a national multistakeholder organization that is developing performance measures. Concerns regarding performance measures include technical concerns (eg, validity, risk adjustment, sample size, and accuracy considerations), concerns regarding the cost of implementation, and concerns regarding unintended consequences. Some data support the effectiveness of pay-for-performance programs, but more and better-designed studies are needed to rigorously assess the effectiveness of pay-for-performance programs. The Institute of Medicine 2006 report supports pay for performance "as a stimulus to foster comprehensive and system-wide improvements in the quality of healthcare." This report also recommends that implementation of pay-for-performance programs should be carefully monitored to be sure that the stated goals are being achieved and that unintended consequences are recognized as early as possible. It is important for the allergist-immunologist to be an active participant in the evolving paradigm of pay for performance, advocating for the best interests of patients and providers alike.