NDAA

Special Pays Update – Senate Proposal to Increase Pays and BUMED Pays Update

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FY21 NDAA – SASC Bill Released

Please note the good news below, including a PROPOSED increase in special pays, in the legislative summary from the BUMED Legislative Liaison. While it is just a proposal at this point, at least it is a sign that they read the GAO report that concluded that military physicians are grossly underpaid and that they appreciate the extra efforts everyone has been giving due to COVID:

The SASC has released their version of the FY21 NDAA. Please note the bill still needs to be voted on by the Senate, which will include amendments being proposed. I have attached two modified documents: One includes sections 602 and 612 (described below), the other includes all of Title VII – Health Care Provisions. The full bill can be found here.

Below is a brief summary of notable legislative provisions included in the Bill:

Sec. 602. Hazardous duty pay for members of the Armed Forces performing duty in response to the Coronavirus Disease 2019.

Sec. 612. Increase in special and incentive pays for officers in health professions. This provision increases the amounts of the accession bonus, retention bonus, incentive pay, and board certification pay.

Sec. 703. Waiver of fees charged to certain civilians for emergency medical treatment provided at military medical treatment facilities. A military MTF may waive a fee charged to a civilian who in not a covered beneficiary under certain conditions. Please note there is related report language (to be conducted by GAO) in Sec. 751 entitled Assessment of receipt by civilians of emergency medical treatment at military medical treatment facilities.

Sec. 721. Modifications to transfer of Army Medical Research and Development Command and public health commands to Defense Health Agency. While this section is largely focused on Army and preserving the infrastructure and personnel of MRMC/MRDC, it does include language very similar to the house language with respect to delaying the transition of R&D and PH to DHA. The HASC is delaying until 2025, SASC is 2024.

Sec. 748. Audit of medical conditions of tenants in privatized military housing. GAO audit of the medical conditions of eligible individuals and the association between adverse exposures of such individuals in unsafe or unhealthy housing units and the health of such individuals.

With both the HASC and SASC bills moving to the floor of their respective chambers, we will keep you updated if we find anything of significant interest to Navy Medicine from amendments that are adopted. Once the House and Senate pass their versions of the bill, we will produce a Navy Medicine Leadership Side-by-Side including both versions of the Bill.

One of my Army colleagues sent me this summary of the proposed changes to the maximum pay caps:

  1. HPO Accession Bonus (AB) from $30,000/yr. to $100,000/yr.
  2. Critically Short Wartime Specialty Accession Bonus (CSWSAB) from $100,000/yr. to $200,000/yr.
  3. Retention Bonus (RB) from $75,000/yr. to $150,000/yr.
  4. 4. Incentive Pay (IP) for physicians and dentists from $100,000/yr. to $200,000/yr. and ancillary specialties from $15,000/yr. to $50,000/yr.
  5. Board Certification Pay (BCP) from $6,000/yr. to $15,000/yr.

 

Special Pays Update from BUMED

Here is a cut/paste of a message e-mailed to the Special Pay POCs that spells out the various Incentive Pays (IPs). As usual, anyone with questions should address them with their command admin/HRD, or to the BUMED Special Pays email address:

usn.ncr.bumedfchva.mbx.specialpays-bumed@mail.mil

Subject: IMPORTANT-INCENTIVE PAY DATES UPCOMING THIS SUMMER (UNCLASSIFIED)

Ladies and Gentlemen, please make sure this email is disseminated as much as possible. As you can see by all the names and email addresses, there are a large number of contacts for the special pays office, and this is only the ones we are aware of, and we communicate with on a regular basis. There are even more than this we work with, but do not necessarily have up to date POCs identified, such as Fleet Support Teams etc.

This email is to remind everyone of the dates for submitting for Incentive Pay, which particularly for Medical Corps is vital in the summer months. This information is also in the Pay Guidance for each Corps, and the Special Pays Information Power Point under reference on the BUMED Special Pays webpage.

For those MC completing residency 30 June, the GMO IP should have already been submitted to BUMED Special Pays. If not then get it done ASAP. For all commands when a MC or DC officer completes a residency 30 June, they cannot submit for the specialty IP until 60 days out from the effective date, which means if they completed the residency at another command they cannot submit for the specialty IP until they are at your command. Make sure individuals checking in are advised on when, and how to submit, for the IP at your command. DO NOT assume they know, or someone else in the command will tell them. Send out emails, advisories, or anything that will get out to your command telling them they need to submit. We are continuing to receive too many retroactive requests, and many do not have justification to support why an officer has not been paid for over a year.

Medical Corps –

New interns reporting to AD from Medical school via USUHS or HPSP etc. Eligibility for IP is 3 months after completing medical school, and on AD, so if an officer completes Med School 3 May 2020, is eligible for Internship IP effective 3 August 2020, provided on AD on that date.

Residency IP – If completing Internship eligible for IP 3 months after completing internship, but must be licensed. If not licensed at 3 months, then not eligible for IP until become licensed, and eligibility date is date licensed. If entering residency after GMO/UMO/Flight Surgery tour, then eligibility date is residency start date, and must submit.

GMO IP – If completing internship, same as residency IP, 3 months after completing internship, and licensed. If completing residency, eligible for GMO IP day after completing residency if residency completed while on AD.

Specialty IP – 3 months after completing residency/fellowship.

Dental Corps –

General Dentist IP – 3 months after completing dental school, and must be licensed. If not licensed at 3 months, then eligibility date is date licensed.

Specialty IP – Same as MC specialty IP, 3 months after completing residency.

MSC/NC –

Specialty IP is same as MC specialty IP 3 months after completing qualifying training program.

COVID-Related Updates on PCSing/Travel, Promotion Boards, and Changes to Military Health System

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Here are two good documents that explain the recent PCS/travel updates:

Conditions-Based Movement Fact Sheet

PCS Restart Fact Sheet-QA

 

Here is a newsletter with an article on the restarting of promotion boards:

MyNavy Sailor to Sailor – JUNE 2020

In brief, it says:

  • Although the boards were postponed, those who are selected for promotion can expect to be assigned the original date of rank and receive any back pay and allowances they’re warranted.
  • Sailors’ Official Military Personnel Files will be reviewed as of the original board convening date and their eligibility will remain the same.
  • Deadlines for letters to the board remain the same as originally set, except for the Reserve E-7 Board, which had a deadline of May 18, 2020, to compensate for delays in their eligibility determination. The remaining deadlines remain the same to maintain a fair and impartial balance across the fleet, but Sailors are encouraged to submit a letter if they feel their eligibility is unclear.
  • Officer promotion boards require additional reviews and results are expected to be approved and announced 100 days after a board adjourns.

 

Here’s a link to Military.com and Federal News Network articles about MHS changes:

Big Changes to Military Health System Will Be Delayed, Top Health Official Says

DoD pressing ahead with plans to close, realign medical facilities despite GAO warnings

VADM(r) Bono Discusses Concerns About Transferring Medical Facilities to the DHA

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Here’s a link to this 6 minute video:

VADM(r) Bono Discusses Concerns About Transferring Medical Facilities to the DHA

Here’s a transcript:

Date: February 18, 2020
Title: VADM (Ret.) Raquel Bono on Government Matters
Source: Government Matters

Francis Rose: The Secretary of the Army Ryan McCarthy wants to put a hold on
transferring the Army’s medical treatment facilities to the Defense Health
Agency, at least for now. He says he’s concerned about a lack of performance
and planning. Vice Admiral Raquel Bono, U.S. Navy retired, former Director
of the Defense Health Agency, Rocky, welcome back, it’s great to have you.

VADM Bono: Thank you.

Rose: What do you see when you look at the reports about Secretary McCarthy,
his concerns about the DHA, based on your experience from inside the
organization?

Bono: I think the most important thing Francis, is the people are continuing
to work together towards the end goal. It’s very clear where Congress wants
us to go and the work that the Defense Health Agency  — with the Services
— has already put in place quite a few changes.

Rose: What are the changes that are happening? What are the changes that
it’s your takeaway that Secretary McCarthy wants that he hasn’t seen yet?

Bono: Yes, so I believe that as I was leaving, we had already transferred
some of the MTFs to the Defense Health Agency, and with the beginning of
this new calendar year there were going to be some new military treatment
facilities that were going to be rolling over. And so, I believe that in
that, we already had an established set of metrics that we wanted to use to
monitor the progress. I think it’s wise to be able to stop and assess those
metrics and make sure that the progress that we wanted to achieve is
actually occurring.

Rose: A Federal News Network reports say that Secretary McCarthy wants to
halt the transition until a detailed budget strategy and plan to transfer
functions from the Services is delivered. What has to happen – I know you’re
not inside the Agency now, but based on your knowledge how far along is that
effort and what does that look like? Does that answer the concerns do you
think that Secretary McCarthy and other military leaders maybe in the other
branches might have if how this shift of MTFs is happening?

Bono: Well, I think the nice thing about it before I left, is that we had
the conversations with the Services to understand how best to undertake a
transfer of function that would include not only the capabilities, but the
personnel involved. So, I believe that that conversation has already been
put in place, those plans have already been laid out, and what is probably
of merit is going over and perhaps doing a rehearsal of capability, and
being able to show how that actually plays out.

Rose: What did you find were the major differences among the branches and
the way they provided care to their members?

Bono: There are always differences in delivery, also differences in how
appointments are made, and so what the overall goal for the Defense Health
Agency was to make the experience of care for our patients similar, no
matter where they went to get their care.

Rose: That strikes me as kind of back office stuff, that’s not the way, the
type of care that maybe an airman needs to receive compared to the way that
the type of care that a soldier needs to receive. I imagine there are some
differences, but not major differences… maybe I don’t know what I’m talking
about, I’m not a medical professional, but you are. Are there major
differences between what a cohort of airmen need, versus a cohort of
sailors, versus a cohort of Marines, versus a cohort of soldiers?

Bono: Well, there’s always going to be unique nuances, depending on the
Service, but you’re right, most of the care that we give is primary care,
preventive care and when needed, specialty care, and all of that is pretty
similar.

Rose: What do you think are the major milestones that we should watch coming
out of DHA, not necessarily just pertinent to the concerns that the Army
has, but also more broadly?

Bono: You’ll continue to see more of the MTFs coming under the Defense
Health Agency. You’ll also probably see identification of markets where
there are collections of military treatment facilities in certain geographic
areas that will also start migrating to the Defense Health Agency, and in
the backdrop of that you’ll also see coordination and parallel movement with
the deployment of the electronic health record, MHS GENESIS, and then you’ll
also see refinement of the TRICARE health plan.

Rose: When you mentioned the movement of places where there are a number of
facilities, everybody hates the word consolidation, but it strikes me, the
quantity of care that DHA provides will have to equal the quantity of care
that’s provided, so consolidation isn’t necessarily a dirty word in this
case, is it?

Bono: No, as a matter of fact, that’s where a lot of the efficiencies will
be realized, by consolidating as you mentioned previously, those back-office
functions.

Rose: The back-office function consolidation, what does that look like? How
is that continuing and what are the gains that the person who is seeking
care from DHA will see? Will it make a difference to that person?

Bono: It shouldn’t make an obvious difference. Where they will probably
experience a difference, and this is actually the goal, is in their
experience of care. So how they make an appointment on the east coast should
be the same as they make an appointment on the west coast.

Rose: GENESIS is the backbone of that, right?

Bono: GENESIS has a very large role to play in that, exactly.

Rose: What are the markers we should watch for on GENESIS moving forward?

Bono: GENESIS is actually moving really nicely now. And now that we
understand what some of our challenges are in the infrastructure area and
what we needed to do, the Defense Health Agency is continuing that, and then
as the migration of medical devices and user devices to that new network, as
well as the adoption of workflows.

Rose: Was the big game changer for the GENESIS rollout the shift in the way
that you trained providers how to use it?

Bono: That had a big, big impact on that.

Rose: The big change there from, I believe that last time we talked before
you retired was that you were training people before how to use software and
you kind of shifted that mindset to get them to understand this is just a
facilitator to provide the care, here’s how you provide care in the context
of this new thing, is that a fair statement?

Bono: Yes, absolutely.

Rose: Admiral Bono thanks very much for coming on, it’s great to have you
back.

Bono: My pleasure thank you.

NDAA 2017 Section 703 Report on MTF Restructuring

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There is no classic post on Thursday because the DHA just released its National Defense Authorization Act (NDAA) 2017 Section 703 report on the Military Treatment Facility (MTF) restructuring. There has been a lot of press and info sent out, so here is what I’ve got:

Health.mil articles:

Military Times article:

Health.mil page that has the entire report to Congress:

Here’s the entire report to Congress:

The February message from the Assistant Secretary of Defense for Health Affairs that discusses it:

Here is General Place’s message about it as well as the summary attachment he sent:

Teammates:

Today marks another milestone in Military Health System reform. This morning, the Department delivered a report to Congress outlining results from the MHS’s review of military medical treatment facilities (MTFs) and their contributions to military readiness. The extensive analysis was initiated in response to Section 703(d) of the FY17 National Defense Authorization Act. You can find the report here: www.health.mil/MTFrestructuring.

The report is the culmination of nearly three years of analysis that identified the MTFs critical to maintaining medical and force readiness. In other words, the department evaluated how facilities support service members so they are medically ready to train and deploy. Further, it assessed how well the facilities support our military medical personnel to develop and maintain the right clinical skills and experience required to support global military operations.

The report includes plans for changes in the scope of operations at 50 facilities across the United States. (See excerpt attached.) Some facilities will have expanded services while others will scale down. The largest change is the decision to transition more than 30 facilities to providing care for active duty personnel only. Seven of these facilities may continue to enroll active duty family members on a space-available basis.

We know these changes may cause concern because health care is very personal. Requiring our patients to leave a trusted provider at an MTF for another provider in the civilian network may cause anxiety for some. The DHA’s responsibility is to implement the changes the Department determined necessary, ensuring the least possible disruption for our beneficiaries.

It’s important for you to know restructuring changes will not occur immediately. We will only begin implementing these changes after thoroughly collaborating with local communities, MTF Directors, network providers, senior mission commanders, and others. The DHA will work closely with the TRICARE managed care support contractors to support the patients impacted.

In addition to creating implementation plans, the DHA’s next steps include a massive outreach and information effort. We will provide resources to MTF Directors so they can inform patients of what the changes mean for them. The process will take time and we will not transition any patients until we are confident the applicable local markets have providers available.

I’m committed to maximum transparency at every step so all stakeholders understand how these changes may affect them, and so those who rely on us retain uninterrupted access to health care. Above all, our focus must remain on producing great outcomes. That’s why the Military Health System exists. Together, we can adapt and strengthen the military medical enterprise so it is even more effective for the 9.5 million people depending on us.

rjp

Ronald J. Place, MD
LTG, US Army
Director, Defense Health Agency
Twitter:        @DHADirector
Facebook:       https://www.facebook.com/DefenseHealthAgency
LinkedIn:       https://www.linkedin.com/company/defense-health-agency/
Web:            https://health.mil/
MHS Minute:     https://www.youtube.com/watch?v=IN4tgyAgWUY