Here’s a link to this recent and controversial article:
This is a really good article by the Principal Deputy Assistant Secretary of Defense for Health Affairs that summarizes all the changes we are experiencing. If you feel like you could benefit from a good summary of what is going on, read this article:
BACKGROUND: All prescribing providers caring for TRICARE beneficiaries in military treatment facilities (MTFs) are required to complete the initial opioid prescriber safety training program (OPST) upon starting work in the MTF and every 3 years (or as otherwise directed) afterwards. This on line training had been located at https://opstp.cds.pesgce.com/hub.php as published in Defense Health Agency Procedural Instruction, Number 6025.04, dated, 8 June 2018. The web address was changed in November 2018 to:
Although a message was distributed at that time, the DHA Chief Medical Officer has learned that some MTFs may be referring to the DHAPI in search of this training module. The DHAPI will be updated with the correct web address. However, DHA requests you make widest dissemination of the new web address so that prescribing providers are not impeded in their effort to certify in this required training.
- The web address for the DoD Opioid Prescriber Safety Training Program published in the Defense Health Agency Procedural Instruction, Number 6025.04, dated, 8 June 2018 has changed. The new url is:
- All prescribing providers caring for TRICARE beneficiaries in MTFs are required to complete initial OPST upon starting work in the MTF and every 3 years (or as otherwise directed) afterwards.
- The web address to OPST changed after DHAPI 6025.04 was published. A message was distributed alerting users to the new web address in November 2018, however the DHA Chief Medical Officer has learned that the new web address may not have reached across the entire MHS.
- An update to DHAPI 6025.04 is pending. Until then, please make widest dissemination possible of the new web address for the DoD Opioid Prescriber Safety Training Program.
Last week was the Specialty Leader Business Meeting, which is always held in conjunction with the GME Selection Board. If you want to see the following Powerpoint decks, they are available on the Medical Corps Sharepoint Site (pick your e-mail CAC certificate or it won’t open for you):
- DHA Organizational Update
- Finding Joy in Work
- GME Interdependency Brief
- GME Overview
- Military Unique Curriculum
- PERS Pearls
I would post them, but the one about DHA is labelled “for internal use only” and there are too many authors of the other ones to get permission to post them on the blog. Because of all the change going on, I wanted to call attention to their availability.
There was a recent Government Accountability Office (GAO) report released that talks about the structure and deployment of military medicine. Here are the 1 page summary and full report, but a summary of its findings is:
The military departments each have their own processes to determine their operational medical personnel requirements; however, their planning processes to meet those requirements do not consider the use of all medical personnel or the full cost of military personnel. Specifically:
- The Department of Defense (DOD) has not assessed the suitability of federal civilians and contractors to meet operational medical personnel requirements. Federal civilians and contractors play key roles in supporting essential missions, i.e. providing operational assistance via combat support. Military department officials expressed a preference for using military personnel and cited possible difficulties in securing federal civilian and contractor interest in such positions. An assessment of the suitability of federal civilians and contractors could provide options for meeting operational medical personnel requirements.
- When determining the balance of active and reserve component medical personnel, the military departments’ processes generally do not consider full personnel costs, including education and benefits. Specifically, officials stated that the Army and the Navy do not consider personnel costs in their assessment of the appropriate balance between active and reserve personnel, and the Air Force’s analysis had some limitations. DOD policy states that workforce decisions must be made with an awareness of the full costs. Further, in a 2013 report, DOD identified the cost of unit manning, training, and equipping as one of five factors that play a key role in decisions concerning the mix of active and reserve component forces. By developing full cost information for active and reserve component medical personnel, DOD can better ensure an appropriate and cost-effective mix of personnel.
The military departments have taken actions, such as establishing policies and procedures, to assess the appropriate workforce mix for beneficiary care within Military Treatment Facilities (MTFs), but challenges remain. The military departments distribute military personnel across the MTFs and then use policies and procedures to consider risks, costs, and benefits to determine how to fill the remaining positions with federal civilians and contractors. However, a number of challenges, including lengthy hiring and contracting processes and federal civilian hiring freezes affect DOD’s ability to use federal civilians and contractors. For example, senior officials at each of the six MTFs that GAO spoke with cited challenges with the federal civilian hiring process, and five of six MTFs cited challenges with the contracting process. As a result, senior officials from five of six MTFs reported discontinuing some services and referring patients to DOD’s TRICARE network of private sector providers or Veterans Affairs facilities. The Military Health System (MHS) is also preparing for the phased transfer of administrative responsibility for MTFs to the Defense Health Agency (DHA), including management of the MTF workforce. According to GAO’s report on agency reform efforts, strategic workforce planning should precede any staff realignments or downsizing. However, according to a senior official, the DHA has not developed a strategic workforce plan. Without developing such a plan, the DHA may continue to face the same challenges experienced by the military departments in executing an appropriate and efficient workforce mix at its MTFs.
This is a O6-level leadership opportunity with the Defense Health Agency. The candidate should be a senior leader with extensive experience in healthcare delivery and a Masters (or higher) of Public Health or other healthcare discipline that required a thesis/dissertation.
Applications are due to the Corps Chief’s Office NLT 1 OCT 2018 via your Specialty Leader.
Here is a document with all the details of the position:
Here is the Senate’s version of the FY 2019 defense authorization bill (S. 2987). If you’re curious like me, you take a document like this and search for key words that might affect your life. Take the word “medicine” for instance…
On page 304 of the document you find this:
(1) IN GENERAL.—Not later than the date on which the Secretary of Defense establishes an operational medical force readiness organization within a military department pursuant to subsection (f), the Secretary of Defense shall, acting through the Secretary of such military department concerned, disestablish the following:
(A) In the case of the Army, the Army Medical Command, and any associated subordinate command or organization.
(B) In the case of the Navy, the Bureau of Medicine and Surgery of the Navy, and any associated subordinate command or organization.
(C) In the case of the Air Force, the Air Force Medical Service, and any associated subordinate command or organization.
Disestablish BUMED, the Army Medical Command, and Air Force Medical Service? Now that’s interesting.
This would occur:
Not later than the date on which the Secretary of Defense establishes an operational medical force readiness organization within a military department
What would happen to us?
(2) TRANSFER OF PERSONNEL AUTHORIZATIONS.—Any personnel authorization of a command or organization disestablished pursuant to paragraph (1) as of the date of disestablishment may be transferred by the Secretary to the Defense Health Agency or any other organization of the Department of Defense considered appropriate by the Secretary, including an operational medical force readiness organization under subsection (f).
This is simply the Senate version and has to be reconciled with the House version. What’s the likelihood that something like this actually becomes law and happens? I have no idea, but the fact that they are thinking about it is certainly something of interest to all of us.
Here’s another article that discusses the medical impacts of the Senate’s proposal: