Recommendation: To fully assess the size and composition of the medical force, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to conduct a new analysis of the required number of active-duty and civilian medical personnel that mitigates known limitations.
Agency: Department of Defense
Status: Open
Comments: DOD concurred with this recommendation. As of August 2020, DOD has not addressed this recommendation. In response to a provision in Senate Report 115-125, we assessed DOD's interim and final draft responses to a requirement in the National Defense Authorization Act (NDAA) for Fiscal Year 2017 to assess the required number of wartime medical and dental personnel. In our ensuing February 2019 report, we found that DOD had not determined the required size and composition of its operational medical and dental personnel who support the wartime mission or submitted a complete report to Congress. Specifically, leaders from the Office of the Secretary of Defense (OSD) disagreed with the military departments' initial estimates of required personnel that were developed to report to Congress. OSD officials cited concerns that the departments had not applied assumptions for operating jointly in a deployed environment and for leveraging efficiencies among personnel and units. We found that the military departments applied different planning assumptions in estimating required personnel, such as the definition of "operational" requirements. Further, although not required by the NDAA for Fiscal Year 2017, DOD's assessment did not include civilian medical personnel. Until DOD completes such an analysis, it cannot be assured that its medical force is appropriately sized.
Recommendation: To strengthen ongoing efforts to analyze the costs of medical force readiness and establish clinical currency standards, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to take steps to identify and mitigate limitations regarding the standard for maintaining providers' clinical skills, including improving the accuracy of information concerning providers' workload and conducting an analytically rigorous calculation of active-duty providers' time devoted to military-specific responsibilities.
Agency: Department of Defense
Status: Open
Comments: DOD concurred with this recommendation. As of August 2020, DOD has taken steps to address this recommendation, but has not completed all necessary actions. In February 2019, we reported that DOD had begun work on a metric to assess the clinical readiness of providers, but noted that the department's methodology was limited. In particular, the methodology did not provide complete, accurate, and consistent data or fully demonstrate results. Further, although DOD provided documentation in February 2020 outlining the medical specialties to which its clinical readiness metric would apply, it has not fully budgeted for the cost of implementing the metric. DOD's July 2018 report in response to Section 703 of the National Defense Authorization Act for Fiscal Year 2017 notes steps taken to assess the accuracy of information concerning providers' workload, but does not address the time active-duty providers devote to military-specific responsibilities. Until DOD addresses these issues, its efforts to analyze the costs of medical force readiness and establish clinical currency standards will remain limited.
Recommendation: To help achieve DOD's goals for transferring health care into its own facilities and increasing the productivity of active-duty medical providers, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to develop a strategy for achieving these goals that reflects the leading practices of effective federal strategic planning.
Agency: Department of Defense
Status: Open
Comments: DOD concurred with this recommendation. As of September 2020, DOD has not yet addressed this recommendation.
Recommendation: To strengthen ongoing efforts within DOD to address the Study's recommendations to use the provider model outputs to inform execution of health care delivery and to refine the model for future use, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to modify DOD's model to reflect the military service of the physicians and military treatment facilities included in the model.
Agency: Department of Defense
Status: Open
Comments: DOD concurred with this recommendation. As of September 2020 DOD has not implemented this recommendation. In its July 2018 report in response to Section 703 of the National Defense Authorization Act for Fiscal Year 2017, DOD stated in response to this recommendation that facilities in several large Military Health System (MHS) markets are staffed in a multi-service manner. While this is an important point, it remains true that, as the report notes, DOD's model "assumed uniformed providers were interchangeable," and that such an approach does not reflect the single-service nature of most medical treatment facilities within the MHS. Until DOD's model reflects this, the results of its approach will continue to be limited.
Recommendation: To strengthen any future assessments of additional changes to DOD's network of military treatment facilities, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to describe steps taken to assess the reliability of data supporting the assessment, including, at a minimum, the sources of data, data limitations, and efforts to test data reliability.
Agency: Department of Defense
Status: Open
Comments: DOD concurred with this recommendation. As of September 2020, DOD has taken steps to address this recommendation, but has not completed all necessary actions. In its July 2018 report in response to Section 703 of the National Defense Authorization Act for Fiscal Year 2017, DOD included the sources of its data and some data limitations, but not efforts to test data reliability. Until DOD fully incorporates assessments of data reliability into its analysis of future changes to the Military Health System, such as its implementation plan Section 703, it will continue to lack assurance that its approach is fully supported by reliable information.
Recommendation: To strengthen any future assessments of additional changes to DOD's network of military treatment facilities, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to include in any accompanying cost estimates an appropriate level of detail, all significant costs, and an assessment of the reliability of the data supporting the cost estimate.
Agency: Department of Defense
Status: Open
Comments: DOD concurred with this recommendation. As of September 2020, DOD has not addressed this recommendation. As we reported in May 2020, DOD's plan to restructure MTFs in response to Section 703 of the National Defense Authorization Act for Fiscal Year 2017, DOD concluded that civilian health care was more cost-effective than care in its MTFs without considering other assumptions that could affect its conclusions. For example, DOD applied assumptions about the cost of military personnel salaries, MTF workloads, and reimbursement rates for TRICARE that likely underestimated the cost-effectiveness of MTFs. Until DOD's approach to assessing changes to its network of MTFs is accompanied by cost estimates with an appropriate level of detail, all significant costs, and an assessment of the reliability of the data supporting the cost estimate, its approach will remain limited.
