Healthcare reform has focused increased attention on potential ways to identify and reward high performing healthcare providers. Rural Prospective Payment System (PPS) hospitals publicly report quality measures through the Centers for Medicare and Medicaid Services Inpatient and Outpatient Quality Reporting Programs and the Hospital Compare website. Seventy-four percent of Critical Access Hospitals (CAHs) also voluntarily submit data to Hospital Compare. Many of these quality measures address conditions commonly treated by rural hospitals, but CAHs and small rural PPS hospitals do not have a sufficient number of patients on an annual basis to reliably calculate a number of the measures. Composite measures can increase sample size for smaller hospitals.