DoD Moves Forward with Plans to Close and Realign Medical Facilities Despite GAO Warnings

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The Defense Ministry is moving forward with plans to close or restructure nearly 50 of its military processing facilities. This is despite a recent GAO report that found the DoD was targeting these facilities for “proper sizing” without collecting enough data to know whether the patients they serve can be absorbed into the civilian health care system. .

The plan released by the Pentagon in February called for changes to medical services at 43 military treatment centers across the country and the complete shutdown of five more. Defense officials originally planned to implement the first of these changes by September.

The military health care system has been concerned about the response to COVID-19 and changes have been delayed, but the Pentagon still believes the first of the realignments could still take place by the end of 2020, Secretary Thomas McCaffery said. Defense Assistant for Health Affairs.

“Implementation has always been conditional, but our number one priority is to make sure that whatever we do, we maintain access to care for our beneficiaries,” he told reporters. last week. “If the COVID response has affected this private sector network in a local community, we will need to take that into account when implementing these changes. “

But according to a new report from the Government Accountability Office, the DoD is just not ready to make the transition.

Once all is said and done, an estimated 200,000 family members of military and retirees would be moved from military treatment facilities to private sector care, mainly due to MTFs reducing their services to treat only active duty members. .

But according to GAO, the department still doesn’t have a process in place to ensure the transition goes smoothly. Its analysis found that the DoD also compiled its initial list of facilities targeted for closure or downsizing without first collecting enough data.

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“We found that they often used incomplete or inaccurate information – sometimes both,” said Brenda Farrell, GAO’s director of defense capabilities and management, in an interview with Federal News Network. “We found incomplete and inaccurate information in three areas: one was about the quality of civilian providers, information was missing. The number of civilian providers available was also questionable – we thought it might have been underestimated. And the third dealt with the standardized time that the DoD sets for a patient to visit their provider. “

The DoD says it is still committed to not making any changes to any MTFs until it is satisfied that the local providers in its TRICARE network can handle the additional workload. But McCaffery argued that much of that data collection work has already been done.

“We worked with our TRICARE program and their knowledge of what’s in the network. We asked the local FIM commander and the installation commander about their experience in the field. And we used a commercial tool that other health plans are using to assess the adequacy of the network, ”he said. “So I think we did some due diligence in the data before making our recommendations on the change.”

The department also believes it is faithfully adhering to Congress’ mandate to re-examine its MTF footprint.

Under the National Defense Authorization Act 2017, lawmakers called on the ministry to focus its MTFs in areas where civilian health facilities are not adequate to treat the military population cost-effectively, and on maintaining the readiness of the DoD medical services. staff.

“There are some communities where there is no private sector network or it is insufficient, and in this case, we are not making any changes. Again, it’s all very much about the conditions, ”said McCaffery. “The objective of Congress, which we share, is that the primary purpose of these facilities is to meet military requirements.”

Indeed, when the DoD released its initial list in February, officials said the restructuring was primarily aimed at refocusing military clinicians on the same active-duty populations they would be expected to care for in wartime.

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But from GAO’s perspective, it’s not clear that the methodology the department used does either, as it only represented a subset of the uniformed health providers the DoD needs to maintain. medical preparation.

“The focus was more on wounded combat service providers, medics, rather than other positions required for primary care, such as nurses, enlisted medical and surgical specialties. So they only looked at a small portion of the medical manpower needed for military medical readiness, ”Farrell said. “They did it because they didn’t have metrics for all of the categories. They had the settings for combat casualty care providers, but they didn’t have the settings for those other categories. So there is still a huge gap in terms of the medical manpower that would be required to help ensure the military medical readiness of service members and vendors. “

The changes to medical facilities come as the DoD is also pushing to downsize its uniformed medics and reassign those positions to functions more directly involved in the war.

The department originally proposed to cut 18,000 uniformed medical jobs, but Congress ordered that the plan be put on hold until the DoD provides a detailed analysis of the number of medical providers they would need in all scenarios of the crisis. national defense strategy.

McCaffery said that report is expected to make it to Capitol Hill in the coming weeks. And like the installation plans, the workforce plan is likely to be influenced by DoD’s recent experience with COVID-19.

“The final proposal will specify who these homes are, what type of homes, which of our facilities and over what period,” he said. “And obviously, as part of any implementation of this reform or others, we will be looking at what we have learned and what we are learning about the pandemic and its impact on the military health system and our capacity. to meet military needs. . “

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