NDAA

Senate Version of FY19 Defense Authorization Bill Disestablishes BUMED

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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:

Senate’s NDAA admonishes DoD for failure to obey prior health reform mandates

 

Did Senate Panel Go Too Far on Officer Management Reforms?

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This is certainly an interesting read by the Military Officers Association of America:

Did Senate Panel Go Too Far on Officer Management Reforms?

Construct for Implementation of Section 702 of NDAA 17 (Translation – Who’s Running the MTFs Under DHA?)

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The document that tells us who is going to run military treatment facilities (MTFs) under the Defense Health Agency (DHA) was just released:

Construct for Implementation of Section 702

This quote from the first page gives you the bottom line:

As a general rule, at each MTF there will be a single military officer who will be dual­ hatted as the MTF Director, under the authority, direction, and control of the Director, Defense Health Agency (DHA), and the Service Commander, under the authority, direction, and control of the Military Department concerned. Acting on behalf of the Director, DHA, the MTF Director will determine the capacity of each MTF required to support both operational readiness and quality, access, and continuity in the delivery of clinical/health care services to members of the Armed Forces and other authorized beneficiaries.

With the objective of ensuring a “ready medical force” and a “medically ready force”, MTFs will be the default choice for the assignment, allocation, detail, or other utilization of military medical personnel. Such default will be subject to the capacity of the MTF to afford military medical personnel opportunities to obtain and maintain currency in the clinical Knowledge, Skills, and Abilities associated with their medical specialties and communities, at or above minimum established thresholds.

The drive for operational readiness and support of war fighting and operational missions take primacy over the delivery of clinical/health care services and the execution of business operations in an MTF. To this end, each Military Department will have unrestricted access to its military medical personnel for all validated war fighting and operational requirements.

 

Message from Acting Assistant Secretary of Defense for Health Affairs

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(I was at the MHS Senior Leader Symposium last week, so I can answer any questions people have in the comments section of this post.)

MHS Team:

With six months to go until October 1, 2018-our long-anticipated target of
NDAA 2017 Section 702 implementation-I wanted to share with you a few key
updates and reflections as we move towards this significant transition for
the Military Health System.

First, thank you to the more than 100 leaders that convened last week from
across the DHA, Services, and MTFs for the MHS Senior Leader Symposium
focused on developing performance plans to operationalize, target, and
tailor our efforts throughout the MHS transition process. Thank you for
sharing your perspectives, expertise, and insights as we work together to
build out our plans for October 1 and beyond.  Your feedback will help
inform our efforts as we move forward to implement the Department’s
construct to carry out the reforms required by NDAA FY17 Section 702.

I emphasized to that group that MHS leadership remains laser-focused on
achieving an even more integrated, higher-performing MHS that meets the
intent laid out in the NDAA and continues years of Department progress in
strengthening the MHS’s ability to deliver high-quality care and support our
readiness mission. This requires a collective effort to reduce stovepipes
and enhance standardization across the MHS and to increase our effectiveness
by eliminating unnecessary duplication. The more we can reduce the costs of
running the system, the more we can invest to improve readiness and patient
care.

We’ve made great strides these past few months in operationalizing the MHS
transition, but much work remains. As we move forward, I’d like to reaffirm
three key takeaways from this past week to the MHS team.

First, the MHS transition process and change we’ve set out to do are hard.
But this change is also necessary. Since my first day at the Department of
Defense, I have been deeply impressed by the culture of adaptability and
resilience-the United States military lives, breaths, and succeeds by its
ability to accept change, take on a challenge, and accomplish results. While
the MHS embarks on some of the most sweeping changes in 30 years, I am
confident that you will adapt, lead, and successfully execute the next
chapter in our story.

Second, I understand how critical communications will be these next six
months, and I am committed to sharing updates on decisions and plans
regarding the MHS transition as they become available. Communications will
be key to ensuring every level of the MHS understands what changes are
taking place, how they impact the way we do business, and enable feedback
loops to confirm continuity of high-quality care to our patients. My ask to
you is to communicate these messages to your audiences, be they providers,
leaders on installations, or patients.

And third, now through October 1 and beyond, I’d like us all to uphold a few
key priorities that will guide our collective approach. We must never lose
sight of our core mission, which is to support the warfighter and care for
the patient. We must leverage the 702 transition to build and strengthen a
truly integrated and even more effective health care system. And lastly, we
must commit to integration and coordination of our readiness and health care
delivery missions.

Thank you for making the MHS a leader in health care and for working every
day to keep improving what we do and how we do it. And thank you for your
patience and perseverance in the months ahead to make this transition
successful. I look forward to working with this talented MHS team to make
these changes real and in doing so, improving the support and health care to
our 9.4 million Service members, retirees, and families who rely on your
efforts every single day.

Tom McCaffery
Acting Assistant Secretary of Defense for Health Affairs

National Defense Authorization Act (NDAA) for FY18 Summary

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Here is a summary of the NDAA for FY18:

FY18 NDAA Fact Sheet

Things of note that are related to Navy Medicine include:

  • Over the last several years, the Department of Defense has expressed concerns that some military officer career management laws were overly restrictive and outdated. The NDAA requires the Department of Defense to conduct a comprehensive review of the Defense Officer Personnel Management Act (DOPMA) and Reserve Officer Personnel Management Act (ROPMA) to identify deficiencies in the law and what steps the Department of Defense can take within existing authorities to improve officer career management. The important analysis required by this report will help inform Congress as to whether DOPMA and ROPMA reform is needed.
  • It continues the important Military Health Systems reform by further clarifying the roles of Commanders or Directors of Military Medical Treatment Facilities and the Service Surgeons General.
  • The report also prohibits the reduction of inpatient care for military Medical Treatment facilities located outside the United States, until a certification is completed ensuring no operational impact for the Geographic Combatant Commander or impact on a beneficiary’s access to the same quality health care currently provided throughout the Military Health System.
  • In addition, the NDAA also provides commonsense resources to help families manage challenges like relocations, permitting the Services to reimburse a service member up to $500 for a spouse’s expenses related to obtaining licensing or certification in another State because of a military move.

JAMA Article on Transforming the Military Health System

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A recent JAMA article was published that discusses transforming the Military Health System (MHS). It can be read for free here:

https://jamanetwork.com/journals/jama/fullarticle/2663037

If you prefer PDF, here it is:

JAMA – Transforming the Military Health System