Scheduling the hospital-wide flow of elective patients

In this paper, we address the problem of planning the patient flow in hospitals subject to scarce medical resources with the objective of maximizing the contribution margin. We assume that we can classify a large enough percentage of elective patients according to their diagnosis-related group (DRG) and clinical pathway. The clinical pathway defines the procedures (such as different types of diagnostic activities and surgery) as well as the sequence in which they have to be applied to the patient. The decision is then on which day each procedure of each patient's clinical pathway should be done, taking into account the sequence of procedures as well as scarce clinical resources, such that the contribution margin of all patients is maximized. We develop two mixed-integer programs (MIP) for this problem which are embedded in a static and a rolling horizon planning approach. Computational results on real-world data show that employing the MIPs leads to a significant improvement of the contribution margin compared to the contribution margin obtained by employing the planning approach currently practiced. Furthermore , we show that the time between admission and surgery is significantly reduced by applying our models. For many years, cost reimbursement has been the standard payment scheme for hospitals. In this scheme, a hospital receives the total cost for treating the patient which is calculated by multiplying the patient's length of stay with a (ward specific) daily rate and adding the costs for clinical procedures applied, such as diagnosis and surgery. Cost reimbursement does not provide an incentive for hospitals to operate efficiently. As a consequence, hospital costs as the largest part of total health care costs (approximately 31% in the US, see Lim, Mobasher, Kardar, & Cote (2011, chap. 3)), have increased sharply. In an effort to limit hospital costs and to create an incentive for hospitals to operate more efficiently, many countries have introduced payment schemes that are based on diagnosis-related groups (DRGs). In these schemes, patients are classified into DRGs with homogeneous clinical characteristics and resources required during treatment within each group, while between groups, the patients' clinical characteristics and therefore costs are different. Hospitals receive payments based on the DRG instead of the applied procedures and the length of stay. The reimbursement the hospital receives for treating a patient with a specific DRG equals the average cost which accrued in a representative sample of hospitals in the year before last. For each …