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available at http://www.ncbi.nlm.nih.gov/pubmed/30027289 Editorial Comment: While surgeons seek to provide patients with satisfactory perioperative pain control, there is increasing evidence that overprescription of perioperative opioids contributes substantively to opioid diversion and abuse. However, there remain key knowledge gaps surrounding what constitutes an appropriate perioperative opioid prescription and, moreover, how we operationalize what is deemed appropriate into clinical practice. This pre and post study characterized the effect of decreasing the default number of opioid pills in the electronic medical record enabled postoperative order set from 30 to 12 in a cohort of patients undergoing outpatient surgery. Investigators found the intervention to be associated with a reduction in the median number of opioid pills from 30 to 20 (p <0.001). Significant decreases in number of pills prescribed were observed in nearly all outpatient procedures with the notable exception of total knee arthroplasty. Importantly there was no reciprocal increase in refill rates after intervention. There remains considerable unexplained variation in perioperative opioid prescribing behaviors, with marked rates of overprescription. This study found that a simple change to the postoperative order set resulted in significant reductions in opioid prescribing without any observed increase in refills. There is ample evidence in the economics literature supporting the significant effect of defaults on human behavior. This study is an example of how defaults in health care might be engineered to nudge providers toward more desirable behaviors. Matthew J. Resnick, MD, MPH, MMHC Re: Hospital-Physician Consolidation Accelerated in the Past Decade in Cardiology, Oncology S. S. Nikpay, M. R. Richards and D. Penson Department of Health Policy, Vanderbilt University School of Medicine, and Vanderbilt-Ingram Cancer Center and Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Health Aff (Millwood) 2018; 37: 1123e1127. doi: 10.1377/hlthaff.2017.1520 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/29985694available at http://www.ncbi.nlm.nih.gov/pubmed/29985694 Editorial Comment: In the last decade hospital-physician consolidation, or vertical integration, has emerged as a critically important topic in care delivery owing to ongoing uncertainty surrounding implications of vertical integration with respect to quality, access and cost. Using physician survey data, this study evaluated the landscape of vertical integration across medical and surgical specialties from 2007 to 2017. The investigators found considerable heterogeneity in observed rates of vertical integration by specialty, with cardiology and oncology practices most likely to integrate with a health system during the study period. More than 50% of cardiology practices that were independent in 2007 had consolidated with a hospital or health system by 2017. This finding is in comparison to urology, where nearly 30% of independent practices had consolidated by 2017. Interestingly observed rates of vertical integration for primary care practices lagged SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS 219 Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.