Skip to main content
Log in

Improving Financial Performance by Modeling and Analysis of Radiology Procedure Scheduling at a Large Community Hospital

  • Original Paper
  • Published:
Journal of Medical Systems Aims and scope Submit manuscript


Radiology tests, such as MRI, CT-scan, X-ray and ultrasound, are cost intensive and insurance pre-approvals are necessary to get reimbursement. In some cases, tests may be denied for payments by insurance companies due to lack of pre-approvals, inaccurate or missing necessary information. This can lead to substantial revenue losses for the hospital. In this paper, we present a simulation study of a centralized scheduling process for outpatient radiology tests at a large community hospital (Central Baptist Hospital in Lexington, Kentucky). Based on analysis of the central scheduling process, a simulation model of information flow in the process has been developed. Using such a model, the root causes of financial losses associated with errors and omissions in this process were identified and analyzed, and their impacts were quantified. In addition, “what-if” analysis was conducted to identify potential process improvement strategies in the form of recommendations to the hospital leadership. Such a model provides a quantitative tool for continuous improvement and process control in radiology outpatient test scheduling process to reduce financial losses associated with process error. This method of analysis is also applicable to other departments in the hospital.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others


  1. Banks, J., Carson II, J. S., Nelson, B. L., and Nicol, D. M., Discrete-event system simulation, 4th Edn. Englewood Cliffs, NJ: Prentice Hall, 2004.

    Google Scholar 

  2. Breaner, S., Zeng, Z., Liu, Y., Wang, J., Li, J., and Howard, P. K., Modeling and analysis of Emergency Department at University of Kentucky Chandler Hospital using simulations. Under review, J. Emerg. Nurs., 2009, in press.

  3. Carter, D., Optimizing revenue by reducing medical necessity claims denials. Healthc. Financ. Manage. 56:88–96, 2002.

    Google Scholar 

  4. Everett, J. E., A decision support simulation model for the management of an elective surgery waiting system. Health Care Manage. Sci. 5:89–95, 2002.

    Article  Google Scholar 

  5. Fahey, P., Cruz-Huffmaster, D., Blincoe, T., Welter, C. and Welker, M. J., Analysis of downstream revenue to an academic medical center from a primary care network. Acad. Med. 81:702–707, 2006.

    Article  Google Scholar 

  6. Hauge, J. W. and Paige, K. N., Learning SIMUL8: the complete guide. Bellingham, WA: Plain Vu Publishers, 2002.

    Google Scholar 

  7. Hoot, N. R., LeBlanc, L. J., Jones, I., Levin, S. R., Zhou, C., Gadd, D. S. and Aronsky, D., Forecasting emergency department crowding: a discrete event simulation. Ann. Emerg. Med. 52:116–125, 2008.

    Article  Google Scholar 

  8. Hung, G. R., Whitehouse, S. R., O’Neill, C., Gray, A. P. and Kissoon, N., Computer modeling of patient flow in a pediatric emergency department using discrete event simulation. Pediatr. Emerg. Care 23:5–10, 2007.

    Article  Google Scholar 

  9. Jacobson, S. H., Hall, S. N., and Swisher, J. R., Discrete-event simulation of health care systems. Chapter 8 in Patent flow: reducing delay in healthcare delivery, In: Hall, R.W. (Ed.), International Series in Operations Research & Management Science, vol. 91, pp. 211–252. New York: Springer, 2006.

    Chapter  Google Scholar 

  10. Khorasani, R., Computerized physician order entry and decision support: improving the quality of care. RadioGraphics 21:1015–1018, 2001.

    Google Scholar 

  11. Kobayashi, L., Shapiro, M. J., Gutman, D. C. and Jay, G., Multiple encounter simulation for high-acuity multipatient environment training. Acad. Emerg. Med. 14:1141–1148, 2007.

    Article  Google Scholar 

  12. Komashie, A., and Mousavi, A., Modeling emergency departments using discrete event simulation techniques. In: Proceedings of the 2005 Winter Simulation Conferences, pp. 2661–2665, 2005

  13. Mozumda, B. C., Hornsby, D. N., Gogate, A. S., Intriere, L. A., Hanson, R., McGreal, K., Kelly, P. and Ros, P., Radiology scheduling: preferences of users of radiologic services and impact on referral base and extension. Acad. Radiol. 10:908–913, 2003.

    Article  Google Scholar 

  14. Reynold, J., Zeng, Z., Li, J., and Chiang, S.-Y., Design and analysis of a health care clinic for homeless people using simulations. Int. J. Health Care Qual. Assur., 2009, in press.

  15. Sinreich, D., and Jabali, O., Staggered work shifts: a way to downsize and restructure an emergency department workforce yet maintain current operational performance. Health Care Manage. Sci. 10:293–308, 2007.

    Article  Google Scholar 

  16. Swisher, J .R. and Jacobson, S. H., Evaluating the design of a family practice healthcare clinic using discrete-event simulation. Health Care Manage. Sci. 5:88, 2002.

    Article  Google Scholar 

  17. Tayfur, E. and Taaffe, K., Allocation of resources for hospital evacuations via simulation. In: Proceedings of the 2007 Winter Simulation Conferences, pp. 1148-1154, 2007.

  18. Waller Lansden, Outpatient Imaging - 2009 Outlook., 2008.

Download references


The authors are grateful to K. Qian and Y. Du of University of Kentucky, and Tracy McLaughlin of Central Baptist Hospital for their help in this project.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Jingshan Li.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lu, L., Li, J. & Gisler, P. Improving Financial Performance by Modeling and Analysis of Radiology Procedure Scheduling at a Large Community Hospital. J Med Syst 35, 299–307 (2011).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: