In this original research article, Bertolet et al take a look at how the VASCADE® Vascular Closure System (VCS) lowers rates of access site complications through a novel performance guarantee risk-sharing agreement between participating institutions and Cardiva Medical. With an estimated cost of $5,440 per bleeding complication, VASCADE® lowers vascular complications relative to national registries thereby reducing length of stay and complication costs, all while sharing financial risk.