When Erne Garcia was ASNC President in 2003, the theme of his presidency was “Quality Counts.” More than a decade has passed since then, but his message resonates more loudly and clearly than ever. ASNC initiatives and guidelines, and federal and third-party regulatory requirements implemented since that time have emphasized the relevance of Dr. Garcia’s vision. However, as our specialty has matured the importance of quality has increased even further, and in some ways, has become more difficult to assure.