A paper presented by Dr. Bozic, at the 19th annual meeting of the Association of Hip and Knee Surgeons, pointed out the importance of hospital and surgeon volumes and process standardization with regard to the results of total joint replacement. The author has analyzed 182,146 consecutive primary total joint replacements performed by 3,421 physicians over a two year period using Medicare claims data. What they found was higher surgeon volume was associated with lower risk of complications, readmissions, reoperation, and a shorter length of stay. They found that higher hospital volume was associated with lower risk of mortality and readmission and the likelihood of being discharged home. The impact of process standardization was substantial and led to improved clinical outcomes and shorter length of stay. The author’s concluded that although surgeon hospital procedure volumes are correlated with patient outcomes in total joint replacement, process standardization is also strongly associated with improved quality and efficiency of care. At Valley Medical Center we have standardized the pre and postoperative process that patients go through in an effort to decrease variance. In this fashion we are able to maximize efficiency, improve patient satisfaction, and give patients the best possible opportunity for improvement.