The Defense Department is moving ahead with plans to close or restructure almost 50 of its military treatment facilities. That’s despite a recent GAO report that found DoD targeted those facilities for “right sizing” without gathering enough data on whether the patients they serve can be absorbed into the civilian health care system.
The plan the Pentagon released in February called for changes to medical services at 43 military treatment facilities around the country and the complete closure of five more. Defense officials initially planned to implement the first of those changes by September.
The military health system has been preoccupied by the response to COVID-19 and the changes have been delayed, but the Pentagon still thinks the first of the realignments could still happen by the end of 2020, said Thomas McCaffery, the assistant secretary of Defense for health affairs.
“The implementation has always been conditions based, but our number one priority is making sure whatever we do we maintain access to care for our beneficiaries,” he told reporters last week. “If the COVID response has affected that private sector network in a local community, we’re going to have to consider that as we implement those changes.”
But according to a new report by the Government Accountability Office, DoD simply isn’t ready to make the transition.
Once all is said and done, roughly 200,000 military family members and retirees would be moved from military treatment facilities and into private sector care, mostly as a result of MTFs scaling back their services to only treat active duty service members.
But according to GAO, the department still doesn’t have a process in place to make sure the transition goes smoothly. Its analysis found DoD also drew up its initial list of facilities targeted for closure or downsizing without gathering enough data first.
“We found that often they used incomplete or inaccurate information — sometimes both,” Brenda Farrell, GAO’s director for Defense capabilities and management said in an interview with Federal News Network. “We had three areas where we found some incomplete and inaccurate information: One dealt with the quality of civilian providers, there was missing information there. The number of available civilian providers was also questionable — we thought it might be understated. And the third one dealt with the standardized time that DoD sets for a patient to drive to their provider.”
DoD says it’s still committed to not making any changes to any MTF until it’s confident that local providers in its TRICARE network can handle the additional workload. But McCaffery contended a good deal of that data gathering work has been done already.
“We worked with our TRICARE program and their knowledge of what’s in the network. We asked the local MTF commander and installation commander about their experience on the ground. And we used a commercial tool that other health plans use to evaluate network adequacy,” he said. “So I think we did do good due diligence in data before we made our recommendations on change.”
The department also believes it’s faithfully complying with a Congressional mandate to reexamine its MTF footprint.
As part of the 2017 National Defense Authorization Act, lawmakers told the department to focus its MTFs in areas where civilian health care facilities aren’t adequate to care for the military population in a cost-effective way, and on maintaining the readiness of DoD’s medical personnel.
“There are certain communities where there is either not a private sector network or it’s insufficient, and in that case, we are not making any changes. Again, it’s all very conditions-based,” McCaffery said. “The focus from Congress, which we share, is that the primary purpose of these facilities is to meet military requirements.”
Indeed, when DoD released its initial list in February, officials said the restructuring was mainly intended to refocus military clinicians on the same active duty populations they would be expected to care for in wartime settings.
But in GAO’s view, it’s not clear that the methodology the department used does that either, because it only accounted for a subset of the uniformed health providers DoD needs to maintain medical readiness.
“Their focus was more on casualty combat providers, the physicians, rather than the other positions needed for primary care, like nurses, enlisted medical and surgical specialties. So they only looked at a small portion of the medical workforce that is needed for military medical readiness,” Farrell said. “They did that because they didn’t have metrics for all the categories. They had the metrics for the combat casualty care providers, but they didn’t have the metrics for those other categories. So there’s still a huge gap in terms of the medical workforce that would be needed to help ensure the military medical readiness of the service members and the providers.”
The changes to medical facilities come while DoD is also pressing to downsize its overall uniformed medical workforce and reallocate those positions toward functions that are more directly involved in warfighting.
The department initially proposed cutting 18,000 uniformed medical jobs, but Congress ordered that the plan be put on hold until DoD delivers a detailed analysis on how many medical providers they would need under all the scenarios in the National Defense Strategy.
McCaffery said that report is expected to head to Capitol Hill in the next several weeks. And like the facility plans, the workforce plan is likely to be influenced by DoD’s recent experience with COVID-19.
“The final proposal will articulate who are those billets, what type of billets, which of our facilities and over what time period,” he said. “And obviously as part of any implementation of that or other reforms, we’ll look at what we’ve learned and what are we learning with regard to the pandemic and its impact on the military health system and our ability to support the military requirement.”