Performance standards are not new in contractual arrangements, but they are not often discussed in the scientific literature. There are a number of possible reasons. First, to clinicians these contractual standards are often seen only as an exchange between financial officers of the contracting organizations. Second, it appears that despite the vast changes in health care in the last few decades, talk about money remains unseemly, even unprofessional to clinicians. Third, clinicians are likely to see themselves as working in an entirely different world from the "suits"—in the clinicians' world, altruistic motives underlie every action. Admittedly, describing the clinicians' world view as a rather naive conception of human behavior is perhaps unfair. Certainly, we can all appreciate the slippery slope that begins with incentives to improve care through the implementation of certain acknowledged best practices and descends to financial rewards that only come when clinically sound treatment is compromised. One person's definition of justified financial rewards is another person's definition of greed, and the line between the two is not always clear. In addition, discussions about financial incentives to change clinician and organizational behavior may reinforce the belief that the health care system is driven by money and is undermining professional altruistic values.