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ACP supports MIPS measure ID# 204: “Vascular Disease: Use of Aspirin or Another Antiplatelet Therapy” because implementation will likely lead to meaningful and measurable improvements in clinical outcomes and also promote the appropriate use of antiplatelet therapy in patients who are diagnosed with ischemic vascular disease (IVD). Furthermore, developers cite clinical recommendations of the American College of Cardiology and the American Heart Association for the “Management of Patients who are Diagnosed with IVD” to form the basis of the measure. Additionally, the numerator and denominator specifications are well defined and the denominator includes clinically appropriate exceptions to eligibility for the measure (i.e., patients who have a history of gastrointestinal bleeding, intracranial bleeding, bleeding disorder, allergy to aspirin or antiplatelet, or patients who are prescribed non-steroidal anti-inflammatory agent therapy). While we support this measure, we note that it may be difficult for clinicians who report this measure to capture over-the-counter aspirin therapy.