Defense Health Agency officials are examining military treatment facilities across the military medical system, facility by facility, to determine their fate — which could include closing some facilities or downgrading some hospitals to clinics.
The process is in the “pre-decisional” stage, said DHA officials, speaking during a panel discussion at the Association of Defense Communities National Summit in Arlington, Virginia, on Monday. “We have to match our resources against the mission set that we have,” said Dr. Michael Malanoski, DHA’s deputy director.
“There will be some changes in services across the system,” he said. The process of evaluating the military treatment facilities started “many, many moons ago,” he added.
No decisions have been made yet at DHA, according to Rear Adm. Matthew Case, acting assistant director for health care administration at DHA. Any changes would have to be approved by Defense Department leadership, and Congress would have to be notified by law.
The issue is resources, Case and Malanoski said. The priority is readiness, especially at the largest facilities, where staff provide combat casualty care support, Case said. Those facilities, such as Walter Reed National Military Medical Center in Bethesda, Maryland, and Tripler Army Medical Center in Hawaii, must be ready to receive casualties, he said.
The Defense Health Agency has been fighting to keep its military treatment facilities staffed in recent years, as a shortage of medical personnel has affected facilities nationwide.
At the same time, officials are evaluating the situation in communities around military installations, recognizing there are locations in “medical deserts,” where not enough care is available in the civilian community for military beneficiaries.
“So we have to go ‘rack and stack’ of what the capabilities are,” Case said.
A rigorous analysis “facility by facility, location by location” is underway, Case said.
“We’re looking at not only is there an adequate Tricare network, but how [civilian medical facilities] are doing on Leapfrog scores,” he said. Those scores, compiled by a national nonprofit organization, collect and evaluate medical facilities’ information about quality and safety.
“Where are our patients going? What are the scores in those facilities? Are those facilities doing better than we are?” Case said.
At Monday’s panel discussion, a member of the Fort Leonard Wood, Missouri, community asked about the status of the study, saying the community is concerned about the future of its military hospital because it is in a medical desert.
“When is this going to happen, and what should we be doing to provide input to you?” he asked panelists.
Senators Josh Hawley, R-Mo., and Robert Marshall, R-Kansas, have written to DHA officials demanding answers to whether the medical facilities at Fort Leonard Wood, Fort Leavenworth, Kansas, and Fort Riley, Kansas, were being considered for downgrades.
Although Case said he couldn’t speak specifically to Fort Leonard Wood’s military treatment facility, he said, “You have a beautiful, relatively new facility, but being able to man that properly is a challenge for us.”
Meanwhile, the military medical system has been working to attract patients back to military treatment facilities after forcing many military beneficiaries to seek outside care in the private sector. That push is being driven by both costs and medical readiness. DOD’s overall health care costs have risen as patients have migrated to the civilian sector. That decline in patients has also spurred the military services to seek more private-sector training opportunities to keep their medical staff’s clinical skills current.
Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book “A Battle Plan for Supporting Military Families.” She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.
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