Healthcare Simulation and Obamacare

What you need to know about the Affordable Care Act.

On October 1, 2012, a new form of the Inpatient Prospective Payment System went into effect, launching the government’s effort to reduce Medicare expenses by more than $155 billion dollars. Familiar terms like fee-for-service and capitation will give way to government-sponsored controls such as Value-based Purchasing and Clinical Process of Care Measures. The healthcare landscape has changed.

So what should you know about the Patient Protection and Affordable Care Act (PPACA or, more popularly, Obamacare)? Here are five important details about PPACA and how healthcare simulation software provides solutions to working within this new system:


1)

Hospitals will have to reduce their costs by at least 2.4% in order to continue operating under the reduced amount of reimbursement given.

With the right strategies, any facility can make the necessary cost savings without sacrificing patient outcomes, and FlexSim Healthcare is the perfect tool for the job. FlexSim Healthcare allows you to evaluate costs using activity-based costing, so each and every process across all patient types can be analyzed, optimized, and streamlined.

2)

New “Value-based Purchasing” scores will award reimbursement based on how quickly, efficiently, and effectively hospitals implement and meet government-established standards.

The goal has and always will be to make the patient better, but the advent of “Value-based Purchasing” and its accompanying performance scores will usher in a new way of delivering healthcare: doing what it takes to get the patient better at the lowest possible price. Simulation allows healthcare facilities to consider these new standards as they model their day-to-day operations.

Hospital Design and Layout

3)

Centers for Medicare and Medicaid (CMS) will have to make adjustments in payment rates and DRG coding, revising the included care in each DRG profile and its reimbursement.

New reimbursement policies will mean changes to staffing policies and patient priorities, while improper care protocols and readmission could have even more costly and far-reaching effects. FlexSim Healthcare will allow you to review the impact of each change, and determine if it’s the right course of action for your organization.

4)

Under PPACA, 70% of a hospital’s Total Performance Score (TPS) will be based on how effectively and efficiently hospitals do their job…

For example, hospitals and other care facilities could lose a large portion of the already dwindling insurance reimbursement if patients are readmitted within 30 days. FlexSim Healthcare is the only product on the market that has been built from the ground up specifically to model healthcare-related processes. Regardless of the complexity of new regulations that will have a profound effect on a facility’s TPS, FlexSim Healthcare is ready to consider all of the intricate facets of the new healthcare landscape.

FlexSim Healthcare Analytics Dashboards

5)

…and the other 30% of the TPS will be based on patient satisfaction, which includes how quickly a patient receives care, how comprehensive the care was, and how happy the patient is with the experience.

Simulating a healthcare process can provide insights that are difficult to observe, especially since so many areas of a facility are interconnected. Determine average wait times, figure out and plan for the busiest times of the day/week/year, and determine how to best allocate resources to improve the patient experience. FlexSim Healthcare’s powerful experimentation engine will let you consider endless scenarios to find the perfect balance for your healthcare facility.


The new healthcare regulations are carrying with them uncertainty, but also opportunity. Choose healthcare simulation, validate your strategy, and guide your organization into many years of prosperity in the healthcare industry.

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