GAO Report on Military Medicine

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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.

Executive Director, Defense Health Board, Defense Health Agency – O6

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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:

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


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

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

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:


If you prefer PDF, here it is:

JAMA – Transforming the Military Health System

Military Health System Online Transparency Site Launch

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(original article link here)

Patients who use military hospitals and clinics will find it easier to see how their facility is performing thanks to June 28 changes by the Military Health System to its transparency website.

The MHS has put military hospital and clinic quality, safety, and patient satisfaction information online for years, but not always in ways that could be easily found or understood. The recent changes to the site are a good first step to fixing that problem, said Dr. Jill Sterling, co-chair of the MHS Transparency Initiative Group.

“We put all of our public data on health.mil after the Secretary of Defense review in 2014, and added additional measures when Congress passed the Fiscal Year 2016 National Defense Authorization Act,” said Sterling. “Making so much information public from so many sources as fast as we did meant there wasn’t much time to design with the user in mind. The site wasn’t very easy to use.”

The website improvements include:

  • Each military hospital and clinic now has a landing page where patients can see all the data in one place. In the past, patients had to download multiple spreadsheets and search for their facility.
  • Users can find a U.S. hospital or clinic by ZIP code search. Users can find any hospital or clinic that reports data, including those overseas, through a name search.
  • Users can compare up to three nearby hospitals or clinics on one custom report.
  • MHS data managers now have a flexible system that lets them update performance measures. They can also add new measures and remove old ones that are no longer used. In the past, adding a new measure could take months. Now MHS can make most changes in days or weeks.

“We think the improvements we just made are a good step forward. However, it is just one step forward. We still have work to do, and we’re looking for feedback from users to improve how we share that data,” said Sterling.

The new site includes a random sample survey of users to help the MHS get feedback from patients. The site also includes a way for users to send feedback by email. MHS plans to have volunteers perform user testing at several military hospitals and clinics. This will ensure patients have a say in future improvements.

Users can visit the site directly, or go to the main landing page of the health.mil website and click a link to the MHS Transparency pages. Individual military hospital and clinic websites will also link to the transparency site from their webpages.

Bono: New TRICARE Laws, Contracts to Drive ‘Historic’ Reforms

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Here is a link to another summary of comments made by VADM Raquel Bono, Director of the Defense Health Agency, about the future of the Military Health System:

Bono: New TRICARE Laws, Contracts to Drive ‘Historic’ Reforms

Top Military Health System Leaders Discuss Achievements, Priorities in the Defense Health Agency and National Capital Region

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Here is a link to a summary of VADM Raquel Bono’s (Director, Defense Health Agency) remarks at the Interagency Institute for Federal Health Care Executives course:

Top MHS Leaders Discuss Achievements, Priorities in the DHA, NCR