Planned cuts would re­duce med­i­cal bil­lets

Daily Press - - Local News -

The Army, Navy and Air Force are fi­nal­iz­ing plans to elim­i­nate over the next few years more than 17,000 uni­formed med­i­cal bil­lets — physi­cians, den­tists, nurses, tech­ni­cians, medics and sup­port per­son­nel.

The re­duc­tion will al­low those bil­lets to be re­pur­posed as war fight­ers or com­bat-sup­port skills to in­crease lethal­ity and size of op­er­a­tional units. An­other goal is to deepen the work­load of re­main­ing med­i­cal bil­lets at base hos­pi­tals and clin­ics to strengthen med­i­cal skills and also to im­prove qual­ity of care for ben­e­fi­cia­ries, de­fense of­fi­cials ex­plained.

One se­nior ser­vice of­fi­cial shared the lat­est fig­ures he has seen show­ing the uni­formed Army med­i­cal staff fall­ing by al­most 7,300, the Navy by al­most 5,300 and the Air Force by just over 5,300.

Spread across a com­bined med­i­cal force of 130,000, both ac­tive-duty and re­serve, the planned cuts would lower uni­formed med­i­cal strength by roughly 13 per­cent, a drop steep enough to alarm some health care lead­ers as well as ad­vo­cates for mil­i­tary health care ben­e­fi­cia­ries.

“If the goal is to tear down the mil­i­tary health sys­tem, this would be a rea­son­able way to do it,” warned one ser­vice health of­fi­cial who asked not to be iden­ti­fied.

Given the num­bers in­volved, said re­tired Navy Capt. Kathryn M. Beasley, direc­tor of gov­ern­ment re­la­tions for health is­sues at the Mil­i­tary Of­fi­cers As­so­ci­a­tion of Amer­ica, the staff cuts eyed are wor­ri­some for pa­tient ac­cess, par­tic­u­larly to physi­cians young fam­i­lies rely on such as pe­di­a­tri­cians and ob­ste­tri­cians.

“We need to see the fi­nal num­bers to un­der­stand the im­pact,” she said.

But se­nior de­fense of­fi­cials, who say they col­lab­o­rated closely with the ser­vices on over­all staff re­duc­tion plans, con­tend the cur­rent force is larger than needed to meet to­day’s op­er­a­tional mis­sions and is over­loaded with skill sets not use­ful for de­ploy­ment and de­liv­er­ing of bat­tle­field care.

Also, they con­tend, the over­sized staffs harm qual­ity of care be­cause, at too many base hos­pi­tals and clin­ics, these care providers don’t treat enough pa­tients to keep skills sharp.

“So, part of this drill is to re­align our peo­ple to the ap­pro­pri­ate level of work­load so that their skills, both for bat­tle­field care and for ben­e­fi­ciary care, im­prove,” said one De­fense De­part­ment of­fi­cial.

Top de­fense of­fi­cials agreed to dis­cuss rea­sons be­hind the planned staff cuts for the mil­i­tary health care sys­tem, but de­clined to con­firm any num­bers for med­i­cal slots tar­geted, which some ser­vice of­fi­cials did share, be­cause no fig­ures will be firm un­til the fis­cal 2020 de­fense bud­get re­quest is ap­proved by the White House and sent to Con­gress in Fe­bru­ary.

If Con­gress ap­proves the cuts, to be pre­sented bil­let by bil­let, the re­duc­tions would be­gin to take ef­fect in fis­cal 2021.

Pre­lim­i­nary Navy doc­u­ments show uni­formed staff at Wal­ter Reed Na­tional Mil­i­tary Med­i­cal Cen­ter fall­ing by 534 per­son­nel, with, for ex­am­ple, 82 taken from direc­tor of clin­i­cal sup­port, in­clud­ing 28 of 39 corps­men, 5 of 12 ra­di­o­log­i­cal di­ag­nos­ti­cians, 4 of 7 phar­ma­cists, 8 of 19 phar­macy techs, and 9 of 45 med­i­cal lab tech­ni­cians.

De­fense of­fi­cials de­scribed a year-long col­lab­o­ra­tion be­tween ser­vice med­i­cal de­part­ments, the Joint Chiefs, the De­fense Health Agency and CAPE, the Cost Anal­y­sis and Pro­gram Eval­u­a­tion Of­fice of the Sec­re­tary of De­fense. The force cuts are just one part of an enor­mous trans­for­ma­tion oc­cur­ring across mil­i­tary medicine.

Con­trol of all med­i­cal fa­cil­i­ties is be­ing trans­ferred to the De­fense Health Agency (DHA), where func­tions of the three sep­a­rate ser­vice med­i­cal de­part­ments al­ready are be­ing con­sol­i­dated to stream­line health care op­er­a­tions, slash sup­port costs and stan­dard­ize prac­tices and pro­ce­dures, from sched­ul­ing ap­point­ments to re­port­ing on provider er­rors. Mean­while, the mil­i­tary health sys­tem is adopt­ing MHS Ge­n­e­sis, a new elec­tronic health record sys­tem.

Just as Con­gress di­rected these changes, it told the sec­re­tary of de­fense in its fis­cal 2017 Na­tional De­fense De­part­ment Au­tho­riza­tion Act to col­lab­o­rate with ser­vice branches on defin­ing med­i­cal and den­tal per­son­nel re­quire­ments to en­sure op­er­a­tional readi­ness, and to con­vert mil­i­tary med­i­cal po­si­tions to civil­ian po­si­tions if deemed un­nec­es­sary to meet op­er­a­tional readi­ness needs.

The med­i­cal force re­duc­tion ef­fort, how­ever, isn’t be­ing funded for a mass con­ver­sion of mil­i­tary bil­lets to civil­ian med­i­cal po­si­tions. In­stead, the em­pha­sis is on pro­vid­ing more ef­fec­tive and ef­fi­cient care, on bat­tle­fields and through mil­i­tary treat­ment fa­cil­i­ties.

Tom Philpott Mil­i­tary Up­date

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