Wholesale changes to military health care could destroy a system that achieved a 98 percent survival rate for hospitalized troops in the Iraq and Afghanistan wars, military hospital commanders told members of Congress on Wednesday.

Addressing the House Armed Services personnel subcommittee on potential reforms to the Defense Department medical system, Army, Navy and Air Force hospital leaders admitted that their hospitals and clinics sometimes fall short in providing timely medical care but said they are seeking innovative ways to improve care and bring patients back into military treatment facilities.

They said the current system allows flexibility to train personnel in both military and civilian hospitals and maintain medical readiness for all members of the hospital team — doctors, nurses and administrators.

"I would urge caution before we begin entertaining thoughts of changing the system. It works pretty well. Could it be better? Absolutely. Do we have to have better access? Absolutely," said Army Col. Mike Place, commander of Madigan Army Medical Center, Joint Base Lewis-McChord, Washington state.

The hearing was part of a series scheduled by the House and Senate Armed Services committees as they determine whether the defense health system needs a major overhaul.

The Defense Health Agency is preparing to publish its plans for addressing problems in the system, from access issues and cost to maintaining medical readiness.

But congressional members also are weighing input from the Military Compensation and Retirement Modernization Commission, which last year recommended that military treatment facilities treat active-duty personnel but also compete for other patients within a framework where military family members and retirees choose health care providers under a private insurance program.

The commission also recommended combining the three military medical commands under one unified command — a cost-savings measure that Rep. Tom MacArthur, D-N.J., has expressed interest in.

"You each oversee facilities within the individual branches of the Defense Department. I'm interested to see whether that matters or whether all health care facilities could be managed together," MacArthur said.

The officers said that when it comes to treating patients and working with colleagues, providers don't differentiate by uniform.

But each service has its own medical requirements and environments that should not be discounted, said Navy Capt. Rick Freedman, commander of Naval Hospital Camp Lejeune, North Carolina,

"There are service-specific things, and this important part of the readiness mission cannot be overstated. We are an embedded Navy-Marine Corps team. We have to be trusted partners in leadership," Freedman said.

A review of the military health system in 2014 found that although most military treatment facilities met DoD access standards, patients say their inability to get timely appointments is their top complaint with the system.

The officers said their facilities are coming up with innovative ways to reach patients: creating apps to communicate to providers, stationing specialty medical personnel at clinics on bases where their training, such as physical therapy, is in high demand, and establishing clinics at schools to treat military kids.

Facilities also are stepping up efforts to bring patients back to military treatment facilities. In the past year, some facilities have sent letters to Tricare Prime beneficiaries reassigning them from their private provider to a military medical home, while others have launched public relations initiatives to entice new patients to military hospitals and clinics.

The military health system has 55 hospitals and 361 clinics operated by the service medical commands. The Defense Health Agency provides support to the service medical commands, overseeing common services such as logistics and the pharmacy benefit as well as training, education and more.

The Armed Services committees have promised a thorough review of the system as members determine how to position it for the future.

Subcommittee chairman Rep. Joe Heck said he found the hearing on Wednesday informative.

"I am interested to hear from our witnesses about the challenges of running a military treatment facility. How are they different than civilian medical facilities? How does leadership balance readiness requirements and the needs of the beneficiary population?" Heck said.

About Patricia Kime

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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