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ACP does not support QPP measure 324: "Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Testing in Asymptomatic, Low-Risk Patients" because the numerator is not specified for individual clinician use and the measure does not specify a standardized approach to risk assessment. As written, the numerator relies on the individual clinician’s ability to appropriately document level of risk. Measure developers recognize the reliability of certain assessment tools (e.g., Framingham Risk Calculation) to accurately assess level of risk in asymptomatic patients; however, developers also recognize the significant clinician burden associated with these data collection tools, and therefore, suggest clinicians attest to the accuracy of their estimation by submission. A stronger measure may specify a more systematic approach to risk assessment. Furthermore, the developers should consider revising the numerator specifications to include “healthy, low-risk patients.” While a performance gap exists to form the basis of the measure and implementation will likely promote appropriate use of cardiac stress imaging in low- risk patients, the measure is currently designed evaluate performance at the cardiac lab level, not at the level of the individual clinician.