Sooner is probably better than later for the curative treatment of diseases that can rapidly be fatal. Pneumonia in older people is one such disease, accounting annually for > 750,000 hospitalizations of Americans ≥ 65 years old,1– with a mortality rate of about 7% in hospital and 12% within 30 days.2– Since 1998, the National Pneumonia Project (NPP) of the Centers for Medicare and Medicaid Services (CMS) has promoted hospital practices that are associated with improved outcomes.3 These include timely antibiotic administration following arrival at the hospital. While it was initially 8 h, the current NPP performance measure is 4 h. It was originally applied to persons in the age group ≥ 65 years, from which it was derived. The NPP sought an increased proportion of care to meet the measure, not 100% compliance. State-level performance rates were reported publicly, and no financial incentive was involved.