- The Department of Defense (DoD) is restructuring its medical treatment facilities (MTFs), including transferring MTF administration and management from the military departments to the Defense Health Agency (DHA), according to a new GAO report.
The changes are required by section 702 of the National Defense Authorization Act (NDAA) for Fiscal Year 2017. They are designed to streamline the military health system management, improve efficiency, and sustain operational medical force readiness. The act gave DoD until Sept. 30, 2021, to complete the transfer.
The DHA director will be responsible for the administration of each MTF, including budgetary matters, information technology, healthcare administration and management, administrative policy and procedure, military medical construction, and any other matters the defense secretary determines to be appropriate.
The DoD’s MTFs include 51 hospitals, 381 ambulatory care and occupational health clinics, and 247 dental clinics.
Section 702 also included a provision directing the GAO to review DOD’s implementation plan. In October 2018, GAO reported that DOD had taken steps through its plan to improve the effectiveness and efficiency of MTF administration.
To reduce duplication and improve efficiency, GAO recommended that DOD resolve weaknesses in the plan by defining and analyzing operational readiness and installation-specific medical functions for duplication, validating headquarters-level personnel requirements, and identifying the least costly mix of personnel.
The GAO report explained that the DoD has identified four categories, or roles, of operational medical care provided to U.S. military personnel and other eligible individuals:
- Role 1 – First responder care. This role provides immediate medical care and stabilization in preparation for evacuation to the next role of care, and treatment of common acute minor illnesses. Care can be provided by medics or corpsmen, or battalion aid stations
- Role 2 – Forward resuscitative care. This role provides advanced emergency medical treatment as close to the point of injury as possible to attain stabilization of the patient. In addition, it can provide postsurgical inpatient services, such as critical care nursing and temporary holding. Examples of role 2 units include forward surgical teams, shock trauma platoons, area support medical companies, and combat stress control units.
- Role 3 – Theater hospital care. This role provides the most advanced medical care available outside the United States, such as in Iraq and Afghanistan. Role 3 facilities provide significant preventative and curative health care. Examples include Army combat support hospitals, Air Force theater hospitals, and Navy expeditionary medical facilities.
- Role 4 – U.S. and overseas definitive care. This role provides the full range of preventative, curative, acute, convalescent, restorative and rehabilitative care. Examples of role 4 facilities include MTFs such as Brooke Army Medical Center at Joint Base San Antonio, Texas, and Naval Medical Center Portsmouth at Portsmouth, Virginia.
Medical personnel assigned to deployable units provide care in roles 1-3. Role 4 care facilities are MTFs that also provide medical care in nondeployed settings.
In addition to the four roles of medical care, en-route care to transport patients is provided via casualty evacuation, medical evacuation, and/or aeromedical evacuation from the point of injury, illness, or wounding.
Casualty evacuation involves the unregulated movement of casualties aboard ships, land vehicles, or aircraft. Medical evacuation is the efficient movement and en-route care by medical personnel of the wounded, injured, or ill persons from the battlefield and/or other locations to and between MTFs. Aeromedical evacuation is the movement of patients under medical supervision to and between MTFs by air transportation.
Congress has raised concerns that the MHS has focused on the delivery of peacetime healthcare to the detriment of its combat medical care capabilities, such as trauma surgery and critical care, the GAO report noted.
To correct the imbalance, DoD has budgeted $43 billion for fiscal year 2019 “to deliver both a ready medical force and a medically ready force,” GAO concluded.