As the Department of Defense continues to streamline and transform its military health system, more military hospitals and clinics will stop taking retiree patients, their families and even some active-duty family members, according to the Defense Health Agency director.

At the annual meeting of AMSUS, the Society of Federal Health Professionals, in National Harbor, Md., Lt. Gen. Ronald Place told attendees that after the Pentagon completes its assessments of its medical facilities and their contributions to readiness, more non-active duty beneficiaries will be transferred to Tricare networks. Until the report is completed, however, there’s no way of knowing how many retirees and family members will be forced to leave military treatment facilities or which hospitals and clinics will be affected.

Place said as installations undergo personnel fluctuations and changes in mission, military health facilities will adapt, and those changes are likely to affect non-uniformed beneficiaries.

He cited recent changes at Fort Knox, Kentucky, Fort Jackson, S.C., and Fort Sill, Okla., that downgraded those posts’ military hospitals to outpatient clinics — a reconfiguration that resulted in the disenrollment of retirees, retiree family members and some active duty family members from those facilities.

“I do anticipate more of that happening in the future,” Place said. “I’m not talking about tomorrow, I’m not even talking about next week. But as an evolving organization, we will have changes.”

The Pentagon is three years into a massive health transformation that will place all military hospitals and clinics under management of the Defense Health Agency and reorganize the services’ medical forces to focus primarily on supporting active-duty personnel and operations.

As part of the plan, the Army, Navy and Air Force expect to trim 17,944 uniformed medical billets from their ranks, and the Defense Health Agency is assessing all military medical facilities, weighing whether to expand some and close others that “do not offer now, and will not be able to offer in the future, a platform for maximizing capabilities,” Assistant Secretary of Defense for Health Affairs Thomas McCaffery said.

As the system focuses more on force readiness, the Defense Department is weighing options for its next generation of Tricare contracts, which are expected to handle more non-uniformed beneficiaries.

The fiscal 2017 National Defense Authorization Act dictated the changes, but DoD’s failure to be transparent about the effort, which includes being a year late on a report on the future of each military medical treatment facility, has some lawmakers worried.

In a House Armed Services hearing Dec. 5, Rep. Jackie Speier, D-Calif., chairwoman of the Subcommittee on Military Personnel, and ranking member Rep. Trent Kelly, R-Miss., said they found that in some areas, including San Francisco Bay and Seattle, family members can’t get timely appointments at military facilities, nor is care available in the community.

The civilian healthcare networks in those areas, Speier said, “either lack the capacity or are unwilling to admit Tricare beneficiaries” because the markets are “oversaturated.”

“DoD seems intent on gutting our military health system and calling it an efficiency,” Speier told military health officials, including McCaffery, Place and the services surgeons general.

“I believe the department may be viewing [reforms] as a cost-saving exercise,” Kelly agreed. “It is crucial that prior to any reductions in medical treatment facility services, DoD fully understand the civilian network capability to absorb those patients.”

McCaffery assured lawmakers that while the principal mission of the military health system is to enable force readiness, that includes military families and retirees.

“After all, while service members who deploy must be medically ready to do their jobs, they also need to know that their families back home are cared for and that, in retirement, they will receive a health benefit that recognizes the value of their service,” McCaffery said.

Rep. Susan Davis, D-Calif., wasn’t satisfied with the answers, saying the changes are a “great source of anxiety for our families.”

“What’s the strategy? What’s the plan? How do we make certain that as we move further into Tricare for beneficiaries that there are is a “there” there for them and they are not going to lose benefits that they have already had?” Davis said.

As part of the transformation, the Army has begun shedding at least 6,935 medical billets, the Navy, 5,386, and the Air Force, 4,000 – all medics. The cuts are occurring in phases, starting this year with the elimination of vacant positions. In fiscal 2021, additional personnel reductions will be taken to meet the goals.

McCaffery said at AMSUS that the report on the medical treatment facility restructuring plan, which was due to Congress in December 2018, will be submitted to Congress “very soon.”

He said under the plan, some facilities may be expanded while others will close.

“We need to be open to right-sizing MTF services capabilities to ensure that we’re using finite resources most efficiently while not compromising our ability to meet mission,” McCaffery said.

Lawmakers told McCaffery and the services to tread carefully when considering personnel cuts and closures.

“You talk about near peer and future threats, let me tell you what, civilians don’t go downrange,” said Kelly, a brigadier general in the Mississippi Army National Guard, “That takes guys and girls in uniform to get our soldiers to the right level of care in that magic hour.”

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

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