Orthopedic and spine service lines represent great opportunities and challenges for facilities, both acute and ambulatory. They require strong leadership, savvy negotiation with surgeons and payors and clearly defined, evidence-based quality protocols. As facilities move toward treating patients through the continuum of care, the key to a successful orthopedic and spine service line will be integrating the critical elements to create a coordinated delivery system. Walter Spires, an orthopedic thought leader and CEO of ANOVA Orthopaedic Solutions, summarizes below the "5 P Model" of an integrated orthopedic network.