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The goal of assessing health care quality is to recognize gaps in performance and identify opportunities for improvement that will increase the health of individuals and society. The complexity inherent in health care systems, health care delivery and humans themselves, requires the development of complex measurement systems. However, greater complexity in measurement comes at a cost. In this work, the impact of data quality and limitations in the resources necessary to ensure accurate and reliable measurement through risk adjustment are explored. A new metric for ranking risk adjustment methods, managerial efficiency, is proposed and a novel approach of cost-conscious risk adjustment is demonstrated and compared with more traditional methods. This work will bring new insight to researchers involved in quality of care measurement and methods and health care managers faced with the increasing demands of health care quality reporting.