title: Understanding how orthopaedic surgery practices generate value for healthcare systems.
abstract: BACKGROUND
  Orthopaedic surgery practices can provide substantial value to healthcare systems. Increasingly, healthcare administrators are speaking of the need for alignment between physicians and healthcare systems. However, physicians often do not understand what healthcare administrators value and therefore have difficulty articulating the value they create in discussions with their hospital or healthcare organization. Many health systems and hospitals use service lines as an organizational structure to track the relevant data and manage the resources associated with a particular type of care, such as musculoskeletal care. Understanding service lines and their management can be useful for orthopaedic surgeons interested in interacting with their hospital systems.
  
  
  OBJECTIVE
  We provide an overview of two basic types of value orthopaedic surgeons create for healthcare systems: financial or volume-driven benefits and nonfinancial quality or value-driven patient care benefits.
  
  
  METHODS
  We performed a search of PubMed from 1965 to 2012 using the term "service line." Of the 351 citations identified, 18 citations specifically involved the use of service lines to improve patient care in both nursing and medical journals.
  
  
  RESULTS
  A service line is a structure used in healthcare organizations to enable management of a subset of activities or resources in a focused area of patient care delivery. There is not a consistent definition of what resources are managed within a service line from hospital to hospital. Physicians can positively impact patient care through engaging in service line management.
  
  
  CONCLUSIONS
  There is increasing pressure for healthcare systems and hospitals to partner with orthopaedic surgeons. The peer-reviewed literature demonstrates there are limited resources for physicians to understand the value they create when attempting to negotiate with their hospital or healthcare organization. To effectively negotiate for resources to provide the best care for patients, orthopaedic surgeons need to claim and demonstrate the value they create in healthcare organizations.
authors.affiliation: Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3389, Durham, NC 27710, USA. Olson016@dm.duke.edu
authors.forename: Steven A
authors.initials: SA
authors.lastname: Olson
authors.forename: Richard C
authors.initials: RC
authors.lastname: Mather
mesh_terms: D003142:Communication; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000458:organization & administration; D015276:Health Care Rationing / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D015279:Organizational Culture; D009985:Orthopedics / Q000191:economics*; D011357:Product Line Management; D012945:Social Values