Simulation as a guide for systems redesign in gastrointestinal endoscopy: Appointment template redesign

In this era of health care value-based purchasing, health care systems are increasingly focused on maximizing the utilization of their most expensive resources. This trend is evident in gastrointestinal endoscopy which makes up the largest percentage of ambulatory surgical center claims in Medicare. In response to these pressures, the Duke University Health System plans to shift a majority of low-risk, endoscopic procedures to a lower-cost Ambulatory Surgical Center within the next year. In this paper, we describe our efforts partnering with Duke University Health System to develop a discrete event simulation model of this ambulatory surgical center and use the model to predict the impact of this case-shift. Furthermore, we use modeling to help guide systems redesign efforts by focusing on appointment template design. Through modeling, we uncover a number of operationally meaningful findings that are currently under consideration within the health system.