More than 155,000 military family members and retirees will be moved from the military hospital system to civilian health providers starting later this year, a process expected to last through mid-2026, according to a new Defense Department report.
Under a revised plan, however, at least 29 facilities that were slated to serve only active-duty patients may still see some active-duty family members to sustain their staffs' clinical skills.
In a report sent to Congress on July 1, Under Secretary of Defense for Personnel and Readiness Gil Cisneros said that the number of facilities scheduled for downsizing has changed and active-duty family members might be kept in the military system, depending on location and training needs.
The plan gives 29 clinics the option of keeping some active-duty family members "as appropriate for provider skill sustainment."
The facilities will "generally transition non-active duty Service member Primary Care to the purchased care component of the Tricare program," including the provider network and those in Tricare for Life, the defense health program that serves as a wraparound for Medicare, according to the report to the congressional defense committees.
But unlike the original recommendations, all 29 will "enroll active duty family members as appropriate."
The changes are part of an effort that began in 2017 to reform the military health system to slow the rising cost of health care, sending more patients to the private sector, paid for by Tricare, and focusing military providers mainly on active-duty personnel and training. The DoD process called for downsizing or closing dozens of hospitals and clinics.
In the revised plan, developed after studying the effects of the COVID-19 pandemic on the health system and the availability of care in communities near military bases, three clinics will be spared from downsizing or becoming military-only facilities: Kimbrough Ambulatory Care Center at Fort Meade, Maryland, and Joel and Robinson Clinics at Fort Bragg, North Carolina.
Kimbrough was slated to transition to an outpatient-only clinic that served all beneficiaries, while the Joel and Robinson clinics were to transition to active-duty only facilities.
But the review determined that Kimbrough is a vital part of the military health system in the National Capital Region in Washington, D.C., while changes at Fort Bragg made by the Army improved the efficiency and service of the clinics to military families, resulting in their preservation.
Two facilities will still close, Community Based Medical Home Columbus Georgia and the Air Force's Sabal Park Clinic in Brandon, Florida.
In Columbus, patients will have the option of enrolling with Martin Army Community Hospital on a space-available basis or use Tricare.
In Brandon, all patients will transition to Tricare.
One clinic, at Naval Submarine Base New London, Connecticut, will continue serving active-duty troops and active-duty family members, but no retirees.
Since the effort began, 12 facilities have transitioned to active-duty only clinics or have closed.
Reforms have been underway within the military health system since 2013, when the Pentagon established the Defense Health Agency to assume duties such as medical administration, IT, logistics and training that existed in triplicate under the separate Army, Navy and Air Force medical commands.
In 2017, Congress gave the DHA broad authority to reevaluate the scope of its facilities and how the DoD serves Tricare beneficiaries who aren't in the military, such as family members and retirees.
The services became responsible mainly for military operational medicine and maintaining combat-ready medical forces.
"The purpose of this program is to increase the readiness of military medical staff by allowing them to be concentrated at medical platforms that have the volume and complexity of medical cases required to maintain medical skills," the report noted.
Congress has 180 days to examine the proposal, which the Defense Department will begin implementing at the start of fiscal 2023, which begins in October, according to the report.
Members of Congress have expressed concerns that some areas lack the capacity to accept new patients into the community. Most recently, Rep. Greg Murphy, R-N.C., wrote Defense Health Agency Director Lt. Gen. Ronald Place asking him to ensure that military personnel and dependents had access to timely appointment and care, including obstetrics care.
Military physicians and spouses reported missing appointments and waiting weeks for pregnancy care as the result of a shortage of providers.
"This issue may not be just one that my district is experiencing but may be systemic to all military hospitals due to reforms DHA is leading to cut costs," Murphy wrote April 6.
In their report to Congress, Defense officials said network assessments have determined that there were at least enough network primary care managers to absorb 120% of patients expected to transition.
According to the report, the military treatment facilities will continue to care for patients until they have a primary care manager. Those who are in a case management program will be reviewed for remaining in the program and continue in the program or transition to private care.
And those with complex medical needs who transition will receive a "warm hand off" with their new primary manager
"The MHS' commitment to beneficiaries' health care is not changing. While the location where care is received may change, access to quality health care will be provided," the report noted.
As a result of the post-pandemic review, the following changes have been made, including clinics that will be closed to retirees and their family members but will retain the option to treat active-duty family members:
- Goodfellow Air Force Base, Texas
- Barksdale Air Force Base, Louisiana
- Maxwell Air Force Base, Alabama
- Dover Air Force Base, Delaware
- Hanscom Air Force Base, Massachusetts
- MacDill Air Force Base, Florida
- Robins Air Force Base, Georgia
- Dyess Air Force Base, Texas
- Patrick Space Force Base, Florida
- Joint Base McGuire-Dix-Lakehurst, New Jersey
- Navy Weapons Station Earle, New Jersey, Colts Neck Earle clinic
- Naval Air Station Patuxent River, Maryland
- Portsmouth Naval Shipyard, New Hampshire, outpatient clinic
- Naval Support Activity Mid-South, Tennessee, outpatient clinic
- Naval Air Station Corpus Christi, Texas
- Naval Air Station Belle Chasse, Louisiana, outpatient clinic
- Naval Support Facility Dahlgren, Virginia, Naval Branch Health Clinic Dahlgren
- Naval Support Facility Indian Head, Maryland, outpatient clinic
- Naval Station Newport, Rhode Island, Naval Health Clinic New England
- Marine Corps Logistics Base Albany, Georgia, Naval Branch Health Clinic Albany
- Aberdeen Proving Ground, Maryland, Kirk Army Health outpatient clinic
- Redstone Arsenal,
- Fort Detrick, Maryland, Barquist outpatient clinic
- Rock Island Arsenal
- Southern Command (SOUTHCOM), Miami, Florida, Gordon outpatient clinic
- Fort Lee, Virginia, Kenner-Lee outpatient clinic
- Defense Distribution Center in New Cumberland, Pennsylvania, outpatient clinic
- Naval Technical Training Center Meridian, Mississippi, outpatient clinic
Facilities that may continue to see active-duty families
Naval Submarine Base New London, Connecticut, Naval Branch Health Clinic Groton
Facilities that will retain current functions:
- Fort Meade, Maryland, Kimbrough Ambulatory Care Center
- Fort Bragg, North Carolina, Joel and Robinson Clinic
Facilities that will close completely to all users:
- MacDill Air Force Base's Sabal Park community clinic in Brandon, Florida
- Fort Benning, Georgia, North Columbus-Benning clinic
Two facilities are slated to receive upgrades, but those have been deferred, according to the report. They include Naval Hospital Camp Lejeune, North Carolina, and Tripler Army Medical Center, Hawaii.
-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime