Service leaders urge SecDef to halt DHA takeover of military hospitals

Elizabeth Howe
August 11, 2020 - 11:57 am
Military Health

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By Elizabeth Howe and Abbie Bennett

The merging of the Military Health System with the Defense Health Agency has been on the table for years. Now, top leadership from every branch of the Armed Forces is urging the Secretary of Defense to put an end to it once and for all.

In a memo originally obtained by a reporter for Synopsis, a Capitol Hill newsletter, the secretaries of the Army, Navy and Air Force, along with the branch chiefs of the Army, Navy, Air Force, Marine Corps and Space Force, wrote Secretary of Defense Mark Esper that the merge between DHA and military health is "not viable."

This lack of viability was partially brought to light by the COVID-19 pandemic -- though leadership has been vocally against the merger long before the global outbreak. The military health system was forced to diverge from ongoing merger operations in order to plan for both the immediate and long-term effects of the pandemic. DHA has been similarly preoccupied with COVID-19, reaching into its stores to provide more than 10 million masks, along with other supplies such as ventilators, respirators, and medications, and now it's working to replenish those supplies.

The pandemic "introduces barriers, creates unnecessary complexity and increases inefficiency and cost," the memo reads. "The proposed DHA end-state represents unsustainable growth with a disparate intermediate structure that hinders coordination of service medical response to contingencies such as a pandemic."

Originally, the pandemic delayed the next step of the merge by 90 days. The service chiefs are asking that the delay become indefinite and that all facilities already transferred to DHA domain be returned to each of the service branches. 

A systemwide overhaul

Four years ago, Congress directed DHA to manage all Army, Navy and Air Force healthcare facilities, including 59 hospitals and 360 clinics at military installations across the globe. The Defense Health Agency was set to continue with what has become the largest overhaul of the military health system in decades, including moving millions of patients to private care providers, closing hospitals and clinics and cutting military medical jobs.

Congress and the president mandated those changes in the 2017 National Defense Authorization Act, which passed in 2016.

But the coronavirus pandemic threw a wrench into the plans, causing some delays.

Military families and retirees have told Connecting Vets they worry about changes to the military health system. Those plans include limiting access to some military treatment facilities to active-duty troops only, and outsourcing family or retiree care to private providers

Families said they're concerned they could struggle to find adequate care.

Earlier this year, the Pentagon released a report due to Congress that showed it planned to transition dozens of its hospitals and clinics to serve only active-duty service members, booting hundreds of thousands of dependents and former troops to civilian Tricare network doctors instead.

In April, members of the Defense Department Military Family Readiness Council told officials families already were struggling to find quality pediatricians or mental healthcare.

Plans to move patients out of military hospitals are part of a massive restructuring of what was at one time a $50 billion military healthcare system. Those efforts began in 2013, with the goal of improved force readiness, better services and reduced costs by eliminating redundancies.

"In the market, we find that when you standardize care, you always see increased quality and a reduction in cost," Butler said.

Rather than have each military branch run its own hospitals and clinics, now the Defense Health Agency will manage all facilities, running the system using regional markets -- similar to private sector healthcare systems.

So far, the National Capital region; Jacksonville, Fla., area; coastal Mississippi; and central North Carolina markets have been activated.

On March 25, Defense officials announced a decision to delay the next phase of that process. Five more markets were expected to come under DHA management, but that's been delayed until July at the earliest -- a 90-day pause that could lead to further delays, depending on how the pandemic plays out, Butler said.

The delay affected five markets, Butler said: Tidewater, Va.; San Antonio, Texas; Colorado; Puget Sound, Wash.; and Hawaii. Some of those areas are parts of the country hit hardest by the coronavirus pandemic.

The delay allowed defense medical facilities to focus on "the whole of government response" to the pandemic, including deploying supplies and staff to help overwhelmed hospitals nationwide.

DHA is still on track to complete the transition for 21 markets within the continental United States by 2020, but Butler said things could get pushed back to January. Outside the United States, DHA plans to complete transitions and stand up markets by the end of 2021.

Another change includes the service medical commands' plans to eliminating about 18,000 uniformed medical jobs. That plan has not changed, Butler said, adding that DHA will balance military hospital and clinic staffing using civilian contractors.

To families' concerns about access to care, Butler said DHA is monitoring each network.

"We're making sure the network around those clinics is robust enough and has enough capacity to take on that extra workload," he said. "We're also letting the Tricare (providers) know the kinds of numbers we expect and giving them time to build the capacity so it's a very seamless transfer. The key for us is to make sure we have continued access to quality care for our beneficiaries."

Officials are also analyzing plans to cut military medical billets to prevent harm to patients, Butler said.

"We're taking time to give an analysis to make sure that will not hurt or delay the delivery of health care," he said. "A report on that is being worked on now."

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