NDAA

Surgeon General Statement on Military MTF Transition

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SUBJ/ NAVY SURGEON GENERAL STATEMENT ON MILITARY MEDICAL TREATMENT FACILITIES 
TRANSITION//

RMKS/1.  This NAVADMIN provides Sailors and their families with information 
about the transition of Navy military medical treatment facilities (MTF) to 
the Defense Health Agency (DHA).  The Department of Defense Military Health 
System (MHS) is undergoing a transition as administration and management of 
the Services' hospitals and clinics are transferred to DHA.  This is 
occurring over several years with a goal envisioned by Congress that the MHS 
become a more standardized and a more integrated system of healthcare 
services.  The Services have been working closely with DHA on the details and 
specifics of this transition.

2.  This transition should be seamless to you.  During this transition, you 
should see no immediate impact to access, healthcare services, or the things 
you and your families need.  As this is a new role for DHA, the Services have 
continued, and will continue, to provide support and assistance to ensure our 
MTF's remain fully functional, and there is no immediate impact to care or 
services during transition until DHA is able to assume full administrative 
and management responsibility.  Likewise, our Fleet and Fleet Marine Force 
Commanders should see no changes in Fleet or Fleet Marine Force support.  
Medical and medical support services required for operational support, all 
personnel who provide those services, and all uniformed personnel will remain 
within the Navy lifelines and under Navy control.

3.  This transition is a multi-year effort, which started for the Navy in 
October 2018 when Naval Hospital Jacksonville transferred under DHA's 
administration and management.  On 1 October 2019, more Navy MTFs in the U.S. 
will transition to the DHA.  OCONUS MTFs, in a phased approach, will 
transition after all CONUS facilities, with the transfer of administration 
and management completed no later than 30 September 2021.

4.  As we shift administration and management responsibilities of these MTFs 
to DHA, it will create opportunity for Navy Medicine to increase focus on 
operational support and keeping Service Members healthy and on the job.  It 
will also enable us to enhance focus on unit support during sustained high 
tempo operations while creating opportunities for us to better prepare the 
medical force to deliver high combat survival and support in the future.  We 
make a commitment to every Sailor, Marine, and their family that we will 
provide them the best care our nation can offer and do all in our power to 
return them home safely and alive.   This transition will assist us in 
honoring that commitment.

5.  For additional information, contact your local MTF or ask your care 
providers.  More information on the overall initiative can be found at 
https://navymedicine.navylive.dodlive.mil/.

6.  We at Navy Medicine will always honor the trust placed on us to provide 
the best care possible to those who defend our freedom and their families.  
Wherever a Sailor or Marine goes, Navy Medicine will always be there.  My 
commitment is to keep you fully informed as this continues.  Thank you so 
much for the trust and faith you place in Navy Medicine every day.

7.  Released by Ms. Steffanie B. Easter, Director, Navy Staff.//

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July Message from the Principal Deputy Assistant Secretary of Defense for Health Affairs

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MHS Team,

The Military Health System (MHS) continues implementing FY17 and FY19 NDAA-directed reforms – planning and executing the most significant changes to the military medical enterprise in decades. These reforms are looking at different areas of the MHS, from the way we manage healthcare services, to the infrastructure and staffing capacity of Military Treatment Facilities (MTFs), to the broader manpower structure enabling the best possible support to the readiness and lethality of the Department and the National Defense Strategy. While each reform area is distinct, together, they will modernize our approach to military medicine to establish an even more effective, integrated system of health and readiness to support the warfighter and care for the patient.

FY17 NDAA Section 702 will enhance the effectiveness of the MHS by transitioning administration and management of the MTFs from the Military Departments to the Defense Health Agency (DHA). In essence, we are merging four separate healthcare delivery systems into one, consolidating for ease of beneficiary access to high-quality care and standardizing processes and procedures. This will ensure a consistent patient experience at any one of our MTF’s – from appointment scheduling to streamlined referral processes, with standardized performance management systems to monitor readiness, health, access, quality, safety, and cost – and, in turn will enhance clinical competency to ensure a ready medical force and a medically ready force. Last October, eight large MTFs and their associated clinics transitioned to DHA. October 1, 2019 is another major milestone as more MTFs will come under DHA.

One of the provisions in NDAA 2017 requires the Department to conduct a review of the Direct Care System to ensure that MTFs are operating in support of their missions as training platforms for military medical personnel and supporting the medical readiness of operational forces. This review is in its final phase and has included on-site evaluations of select MTFs and assessments of the capabilities of local health care systems to absorb care from the MTFs. Conclusions from these evaluations are being reviewed by senior leaders who will make recommendations to the Secretary of Defense for identification of MTFs for transition to increase or decrease capabilities. The Department will submit a report to Congress outlining recommended MTFs for transition. Facilities designated to transition would begin in FY2020 and could extend through FY2022, depending on transition and local healthcare system expansion timelines. Prior to any change, Congressional notification will be completed in accordance with statute. This reform effort is distinct from MTF consolidation; we are looking at the structure and needs to advance the MHS’s highest priority: to ensure medical forces are ready to support combat forces downrange, and that we continue to build and sustain a world-class health care system geared toward ensuring a medically ready force.

Finally, in order to best support the National Defense Strategy, the Department is comprehensively analyzing medical manpower requirements to meet operational requirements. The Military Departments have recommended force changes based on manpower needed to achieve operational needs. Health Affairs, the DHA, and the Military Medical Departments continue to work closely, developing staffing plans that would achieve the highest readiness and quality of care standards for the warfighter and patient. This effort illustrates the MHS’s inextricable link to the Department’s priorities guiding our strategic direction: getting the military medical force structure right means optimizing personnel, resources, and most importantly, building lethality and support of the force in lockstep with the National Defense Strategy.

While MHS reform brings incredible change, it’s not our only area of focus. We also have new tools at our disposal to deliver on our mission. Next week, I’ll be joining hundreds of uniformed, civilian, contract, and vender experts at the Defense Health Information Technology Symposium (DHITS) in Orlando to talk about how the new MHS GENESIS electronic health record advances readiness, with preparation underway for deployment at Naval Air Station Lemoore, Travis Air Force Base, Army Medical Health Clinic Presidio, and Mountain Home Air Force Base this fall. MHS GENESIS remains a key priority, enabling easier monitoring and response to patient health through an enhanced set of tools to capture the readiness of MHS personnel and service members. The EHR also will improve the way we serve our beneficiaries, whether military members, retirees, or family members.

It’s a productive time for the MHS, and I am grateful for your continued commitment to deliver on our mission. Earlier this week, I joined the 120th Veterans of Foreign Wars (VFW) conference in Orlando to speak with beneficiaries about some of the major MHS transformation efforts underway. I reinforced that while change can be difficult, it also provides the MHS great opportunity to identify innovative ways to more effectively carry out our responsibilities. No matter the organizational reform or change developments to the way we do business, our work together as a team is setting up the future military medical enterprise for success. Keep up the great work!

Tom

Update on DHA Transition in June Message from the Principal Deputy Assistant Secretary of Defense for Health Affairs

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MHS Team,

As the Military Health System (MHS) has continued implementation of FY17 National Defense Authorization Act (NDAA) Section 702, we’ve revised our approach for transitioning administration and management of the Military Treatment Facilities (MTFs) from the Military Departments to the Defense Health Agency (DHA). Our original implementation framework required maintaining Military Department Headquarters and Intermediate Management Organization (IMO) MTF management responsibilities for an extended period of time to support those MTFs in geographic regions as we phased in MTF transfers to the DHA over several years. Recognizing this approach had several challenges in addressing civilian personnel changes, financial resources, and the Military Departments’ ability to focus on medical readiness, in May the MHS leadership team recommended a new transition framework to DOD and Military Department senior leadership. Our new framework has DHA assuming authority, direction, and control of all MTFs on October 1 of this year and DHA will oversee the MTFs through a Direct Support relationship from Military Department IMOs. The DHA will relieve the Military Departments of this support during a transition period during which responsibility for specific functional capabilities are fully transferred from the Military Departments to DHA under a controlled “hand off.” For the remainder of FY19, the DHA and the Military Departments will finalize and implement the necessary memoranda of agreement to formalize this Direct Support approach.

At the same time, our work to carry out FY17 NDAA Section 703 continues as we prepare to adjust the MHS infrastructure to better support operational readiness requirements. Over the past several months, OASD/Health Affairs-led teams have conducted site visits to dozens of facilities, assessing both “on base” health services and needs, as well as the capacity of nearby civilian networks. The goal is to complete a top-to-bottom review of MTF capacity to ensure we dedicate the right personnel and resources to meet readiness requirements and identify any insufficient network coverage for our 9.5 million beneficiaries. To date we’ve identified 73 MTFs that merit additional analysis, and we are working to provide a final report and recommendations to Congress later this summer.

The Department continues to assess the medical manpower requirements in support of the National Defense Strategy. The Military Medical Departments have put forward their recommendations for force changes based on operational requirements, manpower needed, and subsequent proposed manpower reductions. Health Affairs, the DHA, and the Military Departments continue to work closely together to implement the medical force changes to meet future operational requirements while ensuring the MHS continues to provide the highest quality health care services possible to our patients.

Amidst these major organizational changes, our colleagues across the MHS continue to support medical operational requirements and deliver outstanding medical care to service members, retirees and their families. Earlier this month I had the opportunity to see firsthand evolving capabilities of the MHS when we visited Nellis and Creech Air Force Bases, Nevada. The trip illustrated how greater integration of services between the Military Health System, VA and local health systems can strengthen readiness support to the combatant forces and the delivery of quality care to the entire beneficiary population. I had the honor to meet with several military unit commanders and their staffs including: The 99th Medical Operations Squadron (99th MDG) at the Mike O’Callaghan Military Medical Center; 66th Rescue Squadron; 57th/757th Aircraft Maintenance Squadron (AMXS); Creech Medical Clinic; and the 42d Attack Squadron (42 ATKS) and 42d Attack Squadron-Human Performance Team (HPT).  I toured the Reaper Operation Center (ROC) Orientation & Ground Control Station (GCS) where General Hogg, Air Force Surgeon General, and I had the rare opportunity to fly a Remotely Piloted Aircraft mission in the flight simulator.

Rounding out the time with the Air Force components was the opportunity to visit the University Medical Center (UMC) to learn about the benefits of the Nellis partnership with this leading Las Vegas provider. Through this partnership Air Force physicians, nurses and technicians are able to temporarily work and train at UMC of Southern Nevada to help ensure they stay current and maintain the highest levels of readiness.

Last month, Dr. Terry Rauch, Acting DASD Health Readiness Policy and Oversight and our Global Health Engagement team participated in the 43rd International Committee on Military Medicine World Congress in Basel, Switzerland. Since 1921, the ICMM has worked to strengthen cooperation between the health services of militaries worldwide. The United States is proud to be one of the founding members of the ICMM, and U.S. military medicine remains committed to this enduring partnership as we step into the Vice Chair role. That commitment is fully in keeping with one of the pillars of our National Defense Strategy, which calls for strengthening our existing global partnerships and seeking to work with new partners.

Back at the Pentagon, the Health Affairs team bid farewell to COL Jesse Ortel, CDR Tilford Clark and LCDR Kishla Askins. A special thanks to these exceptional staff members for their significant contributions and unwavering dedication to the Health Affairs team over the past years. I wish them all the best in their future endeavors. As they depart, we are pleased to hail the newest members to Health Affairs: COL Chris Warner, Military Deputy and Chief of Staff; LCDR Chris Barnes, Military Assistant; LT Ariel Campbell, Deputy Director for MHS Governance/Integration Officer; Dr. Jill Sterling, Program Director, Medical Quality Assurance and Clinical Quality Management Policy; and Dr. Richard Mooney, Director of Health Services Policy and Oversight. Welcome to the team!

Lastly, I’d like to recognize our MHS Communications Team for winning the prestigious Silver Anvil Award from the Public Relations Society of America, as well as the Hermes Creative Award for the Take Command campaign executed last year to inform TRICARE beneficiaries about the many changes to their benefit. Congratulations on this great achievement – a true testament to the MHS’s commitment to meeting the needs of our beneficiaries.

MOAA – Defense Bills: House and Senate Versions Compared

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Here’s an article that compares the House and Senate versions of the NDAA 20. Here are the two bullets most readers would care about:

  • A pay raise win. Summaries from leaders of both the House and Senate Armed Services Committees pledge that their final legislation will include a 3.1% military pay raise, which would align with the administration’s FY 2020 budget request and with MOAA efforts to sustain pay comparability with the private sector. While nothing’s settled until passage, this appears to be one of few issues that won’t be affected by ongoing debate – a key House member said as much at a recent news event.
  • Halfway on health care? While House Armed Services Committee (HASC) members included language that would put a stop to a proposal to cut up to 18,000 medical billets, the Senate Armed Services Committee (SASC) has not. House committee members shared MOAA’s concerns about the potential consequences of cutting roughly 20 percent of the military’s medical force. They included language requiring DoD to study the issue further and report back to Congress.

What the HASC Version of NDAA 20 Says About Medical Billet Cuts

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Here is a summary of the House Armed Service Committee’s (HASC’s) version of the FY20 National Defense Authorization Act (NDAA). The bullet point about medical billets says:

– Prohibits the Secretary of Defense and the Secretaries of the military departments from realigning or reducing military medical end strength until analyses are conducted on potential manpower realignments and the availability of health care services in the local area.