Today's environment is causing hospitals and health systems to rethink performance measurement. First, organizations are facing revenue pressures. The health care reform law calls for a decline in provider reimbursements and the redesign of the health care delivery system. Other political imperatives, including deficit reduction, are likely to put more strain on providers through additional payment cuts. Second, quality and patient satisfaction are being emphasized, as a wide range of performance indicators are publicly disclosed and reimbursements are tied to outcomes. Finally, the economic recovery has been slow in many areas of the country, so some health care organizations will continue to serve communities with high unemployment and face the prospects of uncompensated care.