Simulation analysis of hospital intensive care unit reimbursement policies from the triple bottom line perspective

We consider how alternative intensive care unit (ICU) cost reimbursement policies impact an ICU’s ability to satisfy the triple bottom line (TBL) of sustainability. Towards this end, we develop a discrete event simulation model of an ICU and use simulation optimization to identify ‘near‐optimal’ ICU cost reimbursement policies, staffing levels, and sizes (number of beds) that allow investors to reap profits while still respecting the TBL of sustainability. The studied ICU is reimbursed based on either (1) the total time patients spend in the ICU or (2) the total time medical doctors spend treating patients. Results show that reimbursement Policy 1 generates higher profits but is associated with socially and environmentally unsustainable outcomes including high numbers of early patient discharges and readmissions and a large ICU size. Reimbursement Policy 2, on the other hand, respects the TBL of sustainability to a much greater degree while still yielding a healthy profit.