Reporting outcomes research from giant datasets is like using a megaphone: Volume grabs attention whether the message is clear and important, or just white noise. Vassileva and colleagues have substantial experience working with one of the biggest megaphones in outcomes research the Medicare patient database used in their most recent report to determine whether older patients undergoing mitral surgery at low-volume centers achieve the same outcomes as patients at high-volume centers. Wide variations in mitral repair rates have been documented in the United States and elsewhere, despite the established benefits of mitral repair over replacement in terms of early and late mortality, morbidity, and quality of life. How does this latest analysis clarify optimal surgical referral?