My current practice setting is primarily based out of the hospital and quality care measures as well as cost analyses are certainly the biggest concern this day and time. I am constantly making sure that all "quality indicators" are present on each and every cardiac consult that we encounter and making sure that I document the reason why a certain "quality indicator" is not indicated on that individual patient. What I find thought provoking is that although I may discharge a chronic systolic heart failure patient on all the core measure medications and they demonstrated improvement while in the hospital for the 3 to 4 days that they are allowed for that admission, they still bounce right back into the hospital for "congestive heart failure".