What caveats must be observed when trying to isolate ROI for program components? Southwest Regional Medical Center (SRMC) believed it could boost its orthopedic presence by establishing an orthopedics service line (the Orthopedics Center of Excellence). To support the center, SRMC recruited three new physicians, bought state-of-the-art equipment, renovated a nursing unit, added nurses and technicians, developed and linked a dedicated Web page to its enterprise website, conducted educational programs for referring physicians, made sales calls to primary care physicians, placed articles in local publications, and advertised on radio and television and in print media. The total investment in the first year for programmatic changes and marketing was $1.6 million.