How do quality reporting requirements affect hospitals? What strategies do hospitals and quality reporting organizations use to minimize burden? What forces facilitate or impede these efforts? Using a case study approach and building on the HSC’s ongoing tracking of local health care markets across the country, the researchers focused on four communities (Boston, Indianapolis, Seattle, and Orange County, CA) with a high level of reporting and performance measurement activity. In these communities, the researchers: (1) confirmed the programs that hospitals reported participating in during the Round 5 site visits; (2) confirmed what the reporting requirements are for each program based on background work for the project; and (3) indicated the ways in which hospitals believe reporting requirements of the programs differ enough to meaningfully increase burden. The objective of this study was to explore the burden on hospitals of quality reporting in four communities, extrapolate lessons learned for other communities with similar attributes, and draw implications for policymakers and private sector decision makers seeking to reduce administrative burdens associated with this type of reporting.