The COVID-19 pandemic is having a significant impact on reforms of the Pentagon's health system, delaying plans to reduce services at 48 hospitals and clinics by months and forcing additional reviews of civilian care in locations affected by the changes.
Assistant Secretary of Defense for Health Affairs Thomas McCaffery told reporters June 11 that efforts to alter operations at some military treatment facilities was scheduled to begin in September, but now may start "more toward the end of the year" or later.
The changes, designed to focus the facilities on providing medical care to active-duty personnel only as well as training military medical personnel, thereby shedding non-uniformed beneficiaries to the Tricare network, will result in outsourcing health care for at least 200,000 patients.
For the plan to work, the Defense Department is dependent on the availability of providers within Tricare. With the ongoing pandemic, however, "it's going to affect the timeline as to when that happens," McCaffery said during a conference call with the Defense Writers Group, an association of defense and national security correspondents.
"Because of the requirements of the health system -- that we really have been diverting more time and resources to the COVID response -- it could be something more to the end of the year that we would have a better idea of which military treatment facilities of the 48 would be earlier implementation and which would be later," he said.
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The changes originally were expected to take two to four years. McCaffery said implementation at each MTF will largely depend on the ability of local providers to absorb new patients. But with both military and civilian health care workers engaged in pandemic response, local networks "may not be able to engage with us at this moment," he said.
"The key driver here is whatever change we make, we want to maintain access to care for our beneficiaries, and obviously that only works if that private-sector network is available," McCaffery said.
Efforts to reform the military health system date to 2012 with the creation of the Defense Health Agency, a DoD department created to standardize and consolidate health care functions and services across the Army, Navy and Air Force medical commands.
But the transformation snowballed under the fiscal 2017 National Defense Authorization Act, which required DHA to assume management of all military hospitals and clinics, as well as many medical functions, and left the service medical commands to focus on providing medical care only to military personnel.
Defense officials say the efforts will curb costs and improve care and services across the board for beneficiaries. But the changes have met pushback from the services -- which continue to support DHA with hospital management and face a reduction of medical personnel billets -- as well as some military advocates.
In December, Army Secretary Ryan McCarthy sent a memo to Deputy Defense Secretary David Norquist expressing concern over what he saw as a "lack of performance and planning with respect to the transition” by the Defense Health Agency.
McCarthy asked for a delay in transitioning Army health facilities to DHA and also sought to keep the Army Public Health Center and Army Medical Research and Development Command, slated to transfer to DHA.
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On June 11, McCaffery did not comment on McCarthy's request, but said much of the DoD's funding for research and development comes through his office, and he works with the DHA and the services to determine priorities and allocate the money to various offices and research arms.
"We think that approach works well, and we are going to continue that," he said.
Among the ongoing reforms within the military health system is a planned reduction of more than 17,000 medical billets. Early last year, the Army, Navy and Air Force quietly began planning to eliminate positions for several thousand doctors, nurses, technicians, medics and corpsmen and administrative personnel.
But which positions have been targeted has not been made public: Neither the DHA nor the services have released their plans, even as they have said they already are jettisoning those jobs through attrition.
Congress has requested a detailed report on the reductions; McCaffery said June 11 it will be forwarded to the House and Senate this month.
But even that plan may be subject to change as a result of the pandemic, he added.
"Obviously, implementation of that or other reforms will be tied to what we have learned and what we are learning with regard to the pandemic," he said.
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As of June 11, more than 7,400 military members, 1,213 family members, 1,691 civilian DoD employees and 771 defense contractors have tested positive for the coronavirus. Thirty-six, including three service members, have died.
McCaffery, a former health industry executive who took office last August, said he initially was concerned at the two- to three-year turnover of military medical community positions, the result of changes in duty stations and deployments.
But he expressed enthusiasm for the DoD's ability this year to switch rapidly from focusing on health system reform to responding to a national emergency.
"It's very easy for [health system leadership] to quickly pivot. ... Usually, when our medical forces are deployed, whether it's overseas or domestically, it's for trauma-related events. This was very different, a very different enemy," he said.
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