INTRODUCTION The hospital is a 350-bed acute care hospital that is part of a payer-owned integrated delivery network (IDN) located in a large metropolitan area. The hospital has a comprehensive musculoskeletal service line and conducted 1,350 inpatient and 1,620 outpatient procedures in the past year . Although a significant share of elective orthopedic patients has historically gone to the better known city-based facilities, the major compe

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