February 2021 Newsletter

WWW.MHCE.US Monthly Newsletter | 3
As a result, the services are seeking to shed nearly 18,000 frontline health
care workers and the DoD has targeted 50 military medical facilities for
downsizing or closure.
At the same time, the DoD is introducing a new electronic health record
system, MHS Genesis, to select installations.
But these efforts came to a stop March 24 because of the pandemic.
McCaffery said Tuesday the initiatives have now resumed.
"We're in the midst of implementing a collection of reforms that, taken
together, represented the most dramatic change to the system in over
three decades," he said.
McCaffery explained that the DoD has launched its electronic health
record system at 21 sites and plans to roll out five additional "waves" in
2021.
The establishment of administrative markets also has resumed, and the
DHA is helping the services determine their requirements for military
medical personnel, defense officials said.
But one aspect of military health reform -- the restructuring of 50 MTFs,
based on community assessments of available medical care through
private providers -- will have to be reassessed, Defense Health Agency
Director Lt. Gen. Ronald Place said.
The DoD announced in February the list of facilities slated for
restructuring based on community assessments of available medical care
by private physicians through the Tricarenetwork. Under the plan, 37
outpatient clinics would begin serving only active-duty personnel, and
three were slated to close.
But those recommendations will need to be tweaked, since many
physician offices and even hospitals cut services or closed permanently
during the pandemic, Place said.
"Hundreds, if not thousands, of physician offices have either downsized
or closed, and so the assumptions that went into the data ... the data that
went into the initial validation of what might be available outside of the
gates ... weren't true any more," he said.
The DoD is reassessing the communities and will have new data compiled
later this month. Depending on the outcome, the DHA will proceed with
realignment and closures in locations where the community can support
new patients at private practices, Place said.
The secretaries of the Army, Navy and Air Force, along with the branch
chiefs of the Army, Navy, Air Force, Marine Corps and Space Force, sent
a memo to then-Defense Secretary Mark Esper on Aug. 5 calling for the
return of all military hospitals and clinics already transferred to the DHA
and suspension of any planned moves of personnel or resources.
They said the COVID-19 outbreak has demonstrated that the reform
effort introduced "barriers, creates unnecessary complexity and increases
inefficiency and cost."
In early March, the Air Force and Army surgeons general told the House
Appropriations defense subcommittee that the reorganization is an
"extremely difficult [and] complicated merger of four cultures." They
suggested that the Defense Health Agency isn't ready for some of the
coming changes.
As the pandemic took hold, tensions that had been bubbling since the
initial facility transfer erupted. At one facility, commanders and DHA
leadership argued over who was responsible for the COVID-19 screening
tents in the parking lot.
"There are definitely turf battles going on," said the source, a DoD
civilian employee. "[The services] are making it very hard."
If friction continues between the branches and the Defense Health
Agency, it was not apparent during a forum at AMSUS that brought
together Place and the surgeons general or deputy surgeons general of
the military branches.
Navy Surgeon General Rear Adm. Bruce Gillingham said the Navy
Bureau of Medicine is committed to training medical professionals to
perform in combat and support operational requirements.
Air Force Deputy Surgeon General Maj. Gen. Sean Murphy said the
Air Force Medical Service is "really about our operational forces," and
Army Surgeon General Lt. Gen. Scott Dingle said his service is honing
its forces to ensure that soldiers receive "world-class care."
"We fully understand we must reform. It is the law," Dingle said. "As we
go through reorganization, [soldiers] will still get care, the world-class
medical response, the world-class engagements they need to ensure that
they're ready to go out the door to deploy, fight and win when called
upon."
"Those areas where it seems as though the capabilities that exist ... [and]
really can do that function, we'll set forth a plan for the process of descoping
capabilities at those installations and the personal handoff of
care requirements for individual patients to practitioners outside the
gates," he said.
Roughly 200,000 Tricare beneficiaries, including 80,000 active-duty
family members, are expected to be affected by the changes.
Critics have called the effort to shift non-uniformed beneficiaries to
Tricare simply a form of privatization -- an effort to save taxpayer dollars
that undermines the department's obligation to provide care for military
personnel and their families.
But McCaffery said the reforms are designed to make sure that the
military services have medical personnel trained for warfighting and to
improve patient care for all.
"Having both our private-sector care system and our direct care system
under one joint entity will allow us to have more standardized health care
delivery policies and business practices across the entire military health
system. And that will go a long way to reducing undesirable variation for
both our providers and our patients," McCaffery said.
In August, the military branches called for a halt to the transfer of medical
facilities to the DHA,saying the plan is not viable.