Robert B. Fetter's research while affiliated with Yale-New Haven Hospital and other places

Publications (24)

Article
Diagnosis-related groups have been revised through more refined uses of secondary diagnoses. Under the refined diagnosis-related groups, patients are distinguished with respect to classes of secondary diagnoses that are disease- and procedure-specific. Each class represents a different level of utilization for a given principal diagnosis or surgica...
Article
The results are reported of a first round of costing by DRG in seven major teaching hospital sites in Sydney using the Yale cost model. These results, when compared between the hospitals and with values of relative costs by DRG from the United States, indicate that the cost modelling procedure has produced credible and potentially useful estimates...
Article
Proposals to make complexity-of-illness adjustments to the diagnosis-related group system have relied on secondary diagnosis codes and additional clinical information obtained from the hospital record. Another potential mechanism for modifying diagnosis-related groups involves the use of non-operating room procedure codes. The use of these codes ha...
Article
Medicare's diagnosis related groups (DRGs) payment system has been criticized for not making adequate allowances for severity of illness differences within DRGs. The respiratory diseases major diagnostic category (MDC) has been a particular target; therefore, ability of several procedure codes that identify patients with assisted respiration (tempo...
Article
Medicare's diagnosis related groups (DRGs) payment system has been criticized for not making adequate allowances for severity of illness differences within DRGs. The respiratory diseases major diagnostic category (MDC) has been a particular target; therefore, ability of several procedure codes that identify patients with assisted respiration (tempo...
Article
Most public funding methods for long-term care do not adequately match payment rates with patient need for services. Case-mix payment systems are designed to encourage a more efficient and equitable allocation of limited health care resources. Even nursing home case-mix payment systems, however, do not currently provide the proper incentives to mat...
Article
In October 1983, a new hospital payment system was introduced in the United States which was a radical departure from traditional methods of reimbursement. Concern over continuing increases in expenditures for hospital care caused Medicare to replace its ‘cost based’ reimbursement system, in which hospital payments were based on the actual costs in...
Article
Concern over the rising cost of medical care has caused many countries to investigate and implement different methods of cost containment, particularly for hospital services. In the United States, Medicare replaced its ‘cost-based’ reimbursement system, in which hospital payments were based on the actual costs incurred in treating patients, with a...
Article
The hospital is viewed as a human service enterprise whose primary function is the provision of diagnostic and therapeutic medical services. Its products are the specific sets of services provided to individual patients. A system for defining hospital products based on the characteristics of patients receiving similar sets of services has been deve...
Article
If hospitals are to succeed in their efforts in cost control, they must segregate the influence of efficiency and effectiveness and integrate the medical staff into the management structure. One management model that facilitates such integration is Clinical Matrix Management. Using such a model, the distinct responsibilities in patient care can be...
Article
Medicare uses Diagnosis-related Groups for prospective hospital payments nationwide, but the groups were not originally intended as such. The authors trace the development of this landmark program and explore the concept of product line management. Dr. Fetter, a leading authority in health care resource allocation, developed the entire framework fo...
Article
This article describes Ambulatory Visit Groups (AVGs) and the process by which they were defined. An approach to the analysis of physician productivity in the ambulatory setting is then demonstrated, with data derived from the National Ambulatory Medical Care Survey [1]. Finally, recommendations for future work are presented to make this approach m...
Chapter
To improve hospital productivity the French Ministere des Affaires Sociales et de la Solidarité Nationale has embarked on a project named PMSI (Projet de médicalisation du système d’information)whose main objective is to understand the cost of hospital care and to compare the productivity among hospitals according to groupes homogenes de malades (G...
Chapter
The rising costs of health care and factors influencing their growth are concerns shared by many countries besides the United States. For France in particular, a recent study (Sandier 1983), found its per capita medical expenditures from 1950 to 1978 grew at a greater average yearly rate than those in the United States. Adjusting for inflation, the...
Article
By relating the demographic, diagnostic, and therapeutic characteristics of patients to the hospital outputs they utilize, a patient classification scheme can be developed which provides the framework for both the specification of hospital case mix and the measurement of the impact of case mix on hospital utilization and performance. The Diagnosis-...
Article
This paper outlines the system for cost accounting and managerial control which is an extension of the usually accepted departmental costing systems and takes as its units the 383 Diagnosis Related Groups (DRGs) considered to be the hospital's products. It is held that such an approach offers hospital managers a more powerful, analytic, budgeting,...
Article
A system has been developed to generate hospital budgets based on the types of patients served. Several hundred classes of patients are defined according to clinical attributes such as diagnoses and surgical procedures, and for each class a profile of resources consumed is determined. The class definitions are based both on homogeneity of patient c...
Article
AUTOGRP is an interactive computer system designed to facilitate rapid analysis of complex medical information. AUTOGRP allows the clinical or administrative expertise of the user to be combined with sophisticated computer techniques to permit rapid information retrieval, hypothesis testing, development of norms, and identification of deviant cases...
Article
This paper approaches the design of a regional or statewide hospital rate-setting system as the underpinning of a larger system which permits a regulatory agency to satisfy the requirements of various public laws now on the books or in process. It aims to generate valid interinstitutional monitoring on the three parameters of cost, utilization, and...
Article
This study deals with two specific aspects of hospital performance: the effect of an institution's diagnostic mix on its use of resources; and the application of diagnostic specific case groups as the preferable units of output (products) upon which selected aspects of hospital performance and costs could be analyzed and monitored, and for which th...

Citations

... When we observe the construction of data-irrespective what kind of data-the construction is choreographed by technical and technological solutions, "tools" for efficient and valid data collection-at least defined as efficient and valid by system designers and end product users. One such tool is Diagnosis Related Groups (DRG), a classification system which groups in-hospitalized patients on ehe basis of primary diagnoses, secondary diagnoses, and complications, surgical procedures, age, and discharge routines (Aas et al. 1989). k is a management-oriented case mix system which aggregates upwards (away from rhe details of medi cal practice; Bloomfield 1991). ...
... When more than one unit in the system is under consideration for changes in capacity, or an entire new system is being designed, it may be necessary to use a simulation model, such as Fetter and Mills (1975) Observe that the system is Markovian for the state space given by v, since the holding time and arrival distributions are negative exponential. Note that Pt+At(v) is dependent only upon v and At because of the memoryless property of the exponential distributions governing the service times and external interarrival times. ...
... A price was set for each DRG episode of care based on the average amount charged by all hospitals for the treatment concerned, with hospitals generally using financial accounting models to determine their charges. These models, the best known being the Yale Cost Model (Freeman et al 1986), allocate costs on the basis of DRG-specific service weights rather than by reference to actual patterns of resource use of patients within a DRG. ...
... 2 The assignment of a patient to a DRG depends on principal diagnosis, secondary diagnosis, surgical procedures performed, comorbidities and complications, patient age and sex and discharge status. 3 The purposes of using the DRG system are cost containment, improving the efficiency, transparency and fairness of funding and quality, and supporting the management of hospitals. 4 Hospitals in most developed countries have introduced DRG as a tool for assessing reimbursement over the past 30 years. ...
... (ibid.: 148) Ever since, this view has been gradually discredited especially with scientists from various fields trying to design elements necessary for the setting up of a market for health care services that would account for a certification of quality of treatment and efficiency of operations by means of logical abstraction and statistical calculation. This evolution can roughly be summarized as a threefold process (see Vera 2009). 1 The first step saw the construction of medical activities as products classified within so called "diagnose-related groups" (DRG) developed by industrial engineer and professor of industrial management Robert b. Fetter and colleagues at Yale University throughout the 1970ies and 1980ies (see for example Thompson et al. 1975;Fetter et al. 1980;Fetter/Freeman 1986). This grouping process would allow for classifying and thereby comparing diseases in relation to their consumption of resources during medical procedures necessary for cure in order to set up standardized linear product lines. ...
... Chinese government is embarking on the health care system reform, including the expansion of social health insurance, reform of public hospitals, and strengthening of primary care [36]. As a public hospital, the Second Hospital of Tianjin Medical University [37], which is encouraged as the mainstream payment method in public hospitals. At the same time, our hospital has cooperated with primary care institutions to screen the population for stroke risk factors including chronic diseases and guiding disease management. ...
... Sono state oggetto di studio durante il Progetto le metodologie di analisi statistica utilizzate per la definizione dei gruppi finali iso-risorse, basate sostanzialmente su algoritmi di ricerca della maggiore eterogeneità statistica tra gruppi. Tali tecniche -i metodi di partizione ricorsiva -sono in linea con il processo di sviluppo dei primi prototipi dei DRG (Fetter et al., 1980;Mills et al., 1976), pur prevedendo l'utilizzo di metodologie statistiche maggiormente avanzate e di più recente introduzione (Grubinger et al., 2010;Mason et al., 2011). ...
... Moreover, these measures rely on diagnostic information that is typically available in hospital administrative databases, such as those used for prospective payment systems based upon Diagnosis Related Groups (DRGs). Since the introduction of DRG hospital reimbursement in 1983 in the United States (US), several countries have gradually introduced this system as their main hospital provider payment mechanism [12][13][14][15], and several modifications and DRG versions have been developed since then [16]. Any DRG-based hospital payment system, however, includes an exhaustive patient classification algorithm, where the hospital episode is assigned to a clinically and economically homogeneous group (DRG) based upon the diagnoses, procedures and demographic characteristics, such as age and sex. ...
... It only works if it is built properly so that the groups are homogeneous both economically and medically. Otherwise cream-skimming might occur [50,51]. The problem will intensify if the same DRG can be reported for cases which costs differ significantly. ...
... However, the present study represents a first attempt employing an entire State's resident popu lation to examine the effect of payment methods. Past studies that included resi dent level data have either used small resi dent samples from many different facilities and States (Cohen and Spector, 1996), sin gle nursing home chains (Murtaugh et al., 1988), or statewide results for single States (Coburn et al., 1993;Davis, Freeman, and Kirby, 1998). This analysis exemplifies both the power and hazards of populationbased nursing home research. ...