To that end, ACC and SCAI leaders have been meeting with Maryland policymakers in an ongoing, candid, and productive dialogue. These leaders have presented a program in partnership with state officials and other stakeholders to allow for accountability, transparency, and accurate data collection. During this process we found that the state agency charged with data collection and investigation regarding institutional and operator overuse, the Health Service Cost Review Commission (HSCRC), was wedded to using claims-based administrative data (billing data) to assess appropriateness and evaluate quality of care. This approach raises major concerns, given that administrative data have proven in many analyses to be frequently unreliable, incomplete, and inaccurate. Further, administrative data does not allow for benchmarking of outcomes, assessment of the appropriateness of PCI, or importantly, risk stratification or risk adjustment (3).