Moving more TRICARE patients to civilian care would cause ‘significant harm,’ study finds

A new study is casting doubt on the plan to “right size” the Military Health System by moving some TRICARE beneficiaries away from Defense Department facilities for medical care.

The report, funded by the Pentagon and published in Health Services Research journal, said moving patients away from care at military treatment facilities (MTFs) could cause significant harm.

The study goes as far to say that taking 10% of the population away from MTFs could cause significantly worse mortality rates and safety for patients.

“On average, Military Health System beneficiaries treated in MTFs experienced better inpatient-quality and improved patient-safety compared to MHS beneficiaries treated in locally-available civilian hospitals,” the study states. “Simulations of proposed changes resulted in consistently worse outcomes for Military Health System patients, whether reducing MTF access by 10%, 20%, or 50% nationwide; limiting MTF access to active-duty beneficiaries; or closing MTFs with the worst performance on patient-safety.”

The current strategy would close about 50 MTFs and move approximately 200,000 patients from getting care on base to using their TRICARE insurance to get assistance from private providers.

The report is the first look into how TRICARE beneficiaries could be directly impacted by the plan.

DoD sent a report to Congress in February 2020 laid out some issues that the downsizing might create, including making some bases less desirable, forcing troops to take off work to escort family members to health services off base and possible issues in finding standardized care for women.

DoD outlined mitigation strategies in the report like providing alternative transport strategies for family members.

The Defense Health Agency said it would rethink which facilities might be downsized after COVID exposed issues in civilian medical facility capacity.

In the beginning of the pandemic the Government Accountability Office released a report stating that DHA’s original assessment of the civilian marketplaces did not consistently account for provider quality and that inaccurate information was used to calculate how far patients would have to drive to get healthcare.

“MTF officials we interviewed also expressed concerns that the assessments did not account for traffic, including bridges and tunnels that create traffic chokepoints. In other words, they believed that even providers that appeared to be within drive time standards based on mileage could actually exceed the standard depending on their location and time of day,” the report stated. — SM

Senate appropriators ding Pentagon for inadequate transparency on middle-tier, OTA programs

In 2016, Congress gave DoD two new authorities that let it bypass much of the traditional Defense acquisition bureaucracy when it’s building or buying new prototypes. The tradeoff was supposed to be detailed reporting on how the Pentagon used those new authorities, but the Senate said DoD still isn’t living up to its end of the bargain.

The Senate Appropriations Committee’s version of the 2022 Defense appropriations bill, released last week, critiques DoD on transparency grounds on its use of both middle-tier acquisitions (MTAs) and other transaction agreements (OTAs.)

On MTAs, the committee points out the military services are now using the rapid prototyping and rapid fielding avenue — sometimes called “Section 804” authority — for 74 separate weapons programs. In a report accompanying the bill, lawmakers said MTAs look like they’re becoming a “de facto” approach to buying end items.

But at least so far, DoD hasn’t complied with an existing law that requires it to send Congress detailed information on R&D funds used for MTA programs that make their way into operational use. And the committee said there’s reason to be concerned that a lack of detail on MTAs might prompt the military services to make unwise procurement planning decisions.

DoD’s existing approaches “may limit the services’ ability to successfully manage their acquisition programs in the long term by eliminating the complete understanding of full program costs up-front, unnecessarily narrowing the industrial base early in the acquisition process, and eliminating opportunities for future innovation by reducing competition over the life of the acquisition,” senators wrote. “Further, the committee is concerned that budgeting for these de facto end-items incrementally with research and development appropriations instead of fully funding them with procurement appropriations obfuscates costs and limits transparency and visibility into services’ procurement efforts.”

The Senate bill would order DoD to send Congress a list of all its acquisition programs that are using prototyping or rapid acquisition authorities, along with rationales for those decisions and cost estimates and contracting strategies for each one. Though it doesn’t mandate it, the committee report also opines that DoD needs an overarching policy on how the military services should plan and budget sustainment costs for weapons that start out as MTA projects.

Senators have similar complaints when it comes to other transaction agreements.

The same committee report laments that the Federal Procurement Data System still hasn’t been updated to capture important data on DoD’s use of OTAs, forcing the department to fall back to manual data calls to gather basic information.

“This issue is exacerbated when analyzing OTAs awarded through consortiums and provides limited visibility on the industry partners that are executing the work on behalf of the consortium,” according to the report.

The DoD inspector general raised similar concerns in a report earlier this year, noting that government spending databases contain almost no information about individual projects managed by consortiums. Under those circumstances, since the only contractual relationship is between the government and the consortium, official spending records only reflect the large, initial award to the consortium. Data on the actual tasks being done by consortium members is stored on individual spreadsheets that aren’t accessible to Congress or the public, obscuring billions of dollars in annual Defense spending.

Congress has already ordered DoD to improve its data collection and reporting on OTAs. The Senate bill would also require Defense acquisition officials to brief the Congressional defense committees on what they’re doing to improve the Federal Procurement Data System — or possibly use a different data system for OTAs altogether. —JS

Senate pumps brakes on DoD proposal to expand ‘colorless’ software appropriation

DoD’s prospects for moving more of its IT programs into a new, experimental software appropriation are looking dimmer, at least in the near term.

Last month, the House Appropriations Committee voted to allow the military services to expand the colorless money pilot to 12 programs, up from nine in 2021. In general, the approach lets managers fund an entire IT program using solely R&D funds, eliminating the distinctions between R&D, procurement and operations and maintenance funding that are largely irrelevant to modern software development.

But the Senate’s version of the 2022 Defense appropriations bill put the brakes on any expansion of the Software and Digital Technology Pilot Program. It’s not that appropriators necessarily think it’s a bad idea, they say, but they’d like to see some data on how it’s working before it gets any bigger. And DoD still hasn’t delivered information on the pilots that Congress demanded in last year’s appropriations bill.

“Objective quantitative and qualitative evidence is required to evaluate the ongoing approved pilot programs prior to considering an expansion of programs,” according to the committee report. “Reporting requirements … have not been submitted to the congressional defense committees on a timely basis, and have not yet provided a baseline for analyzing the effectiveness of the pilot programs compared to traditional appropriation practices.”

The Senate bill would order DoD to draw up an analysis of how the eight existing pilot programs are performing so far, compared against eight similar IT programs that use the traditional appropriations method. —JS

Congress starting to sweat over space acquisition

One of the biggest selling points of creating a Space Force was to consolidate the Defense Department’s space acquisition efforts.

But, nearly two years after the branch was created, some of the biggest issues around how the Pentagon will buy space assets are still unsolved and Congress is taking notice.

In the 2022 Senate defense appropriations bill, lawmakers said they are worried about how slowly DoD’s new space acquisition process is developing.

“The committee understands that multiple military services and agencies across the Department of Defense retain equities in acquisition programs tied to the space domain and that consolidation of space based acquisition programs is an ongoing endeavor,” the committee report states. “However, the committee is concerned that delaying consolidation of space based acquisition programs under the Space Force may result in inefficiencies across the Department of Defense.”

The bill asks DoD to submit a report identifying space-related development and acquisition programs.

“This report shall include a list of programs for each service or agency and the executing program office; a brief description of the capability provided; a determination of whether the program will be transferred to the Space Force; timeline for transfer; and explanation of the rationale leading to the transfer decision,” the report said.

One of the biggest issues surrounding how DoD buys space systems is the office that will lead the effort.

The creation of a Space Force, Space Development Agency and space acquisition office in the Air Force were meant to address criticisms that the Defense Department’s fragmented leadership on buying space weapons was delaying critical capabilities.

The 2020 defense authorization act requires DoD to appoint a space acquisition executive.

That position, which must be created by October 2022, would work with the Air Force service acquisition executive on space systems. The position would also be in charge of the Space Development Agency, the Space Rapid Capabilities Office and the Space and Missile Systems Center.

Space News reported that Air Force Secretary Frank Kendall is trying to speed up that nomination process by asking Congress to authorize an assistant secretary for space acquisition before that 2022 deadline.

Kendall is in talks with Congress about amending the 2022 defense authorization bill to do that.

The Air Force has already made some preparations for what the office will look like. At the beginning of the year the Air Force revamped its space acquisition shop by splitting it into three directorates.

“We have gone from an organization that was largely focused on policy and providing advice and counsel to the Air Force secretary to one that is now focused on, or will be focused on, acquisition, architecture, and then policy and integration,” Shawn Barnes, who is performing the duties of Air Force assistant secretary for space acquisition and integration, said when the Air Force undertook the initiative.

The three directorates are each run by a colonel and focus on the three areas Barnes mentioned: Acquisition, architecture, and policy and integration.

“Underlying those three key directorates,” Barnes said. “I have a number of subject matter experts that effectively work for all three of those directorates. They’re set up into different teams based on mission areas. We have a mission area related to precision navigation, timing and communications. We have a team that is focused on space control, a team that is focused on launch in space logistics, and then a team that’s focused on space control.” — SM

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