In 2007, the Flex Monitoring Team conducted a national telephone survey of 381 CAH administrators inquiring about their organizations’ most important quality improvement activities and their participation in quality reporting and benchmarking initiatives. Respondents indicated that they were actively involved in a wide range of quality improvement initiatives, with a particular focus on patient safety and medication safety. For CAHs that do not report data to Hospital Compare, respondents listed reasons including: an insufficient volume of patients; the fact their hospital is not required to report; and insufficient staff time for chart review. However, among those CAHs that do not report, 30% planned to submit data in the next year, and two-thirds of CAHs participated in a national, state, or local initiative other than Hospital Compare. This briefing paper highlights the importance of exploring alternative ways of presenting and analyzing quality data for low volume hospitals, and it underscores how the high rate of CAH participation in reporting initiatives other than Hospital Compare may support expanded national reporting of quality measures.