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Military Health Care Comparable to Private Sector, Still Needs Improvement, Review Finds

By Connor O'Brien, CQ Roll Call

October 1, 2014 -- The Defense Department's health care system provides good quality care to its beneficiaries in a timely manner overall and is comparable to private-sector care, but requires improvements in areas that fall below national benchmarks, a months-long review found.

The Military Health System, which provides health care to 9.6 million service members, retirees, and dependents, contains "pockets of excellence," Defense Secretary Chuck Hagel told reporters Wednesday, but also has "gaps" that must be improved. Hagel said he would task Deputy Secretary Robert Work with leading the effort to improve the system over the next year, in coordination with the top civilian and military health officials at the Pentagon.

"We cannot accept average when it comes to caring for our men and women in uniform and their families," Hagel said. "We can do better. We all agree we can do better."

The review, which was led by Assistant Secretary of Defense for Health Affairs Jonathan Woodson, examined issues related to access to care, patient safety and quality of care. Reviewers analyzed an array of Defense Department metrics and compared them to existing national standards in civilian health centers. The working group tasked with the review also visited a selection of military hospitals and clinics to validate the metrics.

Hagel said military facilities that were deemed outliers would be required to provide action plans for improvement within 45 days. Hagel also directed that the working group develop systemwide analytics and that all current data on the department's health care system be made publicly available. He characterized his directives as "first steps."

Laura Junor, the principal deputy undersecretary of Defense for personnel and readiness, said the review did not find facilities that were deficient across the board in their performance.

"We found that no hospital systematically underperformed ... in any of the three dimensions of access, quality or safety," Junor said. "We continue to provide safe and reliable health care, but we can do better."

Junor said that the review found that, according to its metrics, the Pentagon met its healthcare access goals for scheduling appointments, and even exceeded them in some areas. She told reporters that the Military Health System's goal for specialty care was four weeks, compared with an actual average wait time of 13 days. Junor said the wait time goal for routine care was one week, compared with an actual average wait time of six days, and that the department met its goal of seeing patients needing emergency care within one day.

The review, however, did find a discrepancy between access time performance and the perception of the beneficiaries it surveyed. Work described the working group as "a little cautious" with regard to access metrics, and said the Pentagon would rely on a wide variety of feedback to determine how well military health facilities met the goals, including input from military and veterans' service organizations.

"Access is one of the issues that we have heard back that our data is not actually reflecting what our beneficiaries perceive," Work said.

"We're going to ask for a wide variety of different sources to help our feedback," he added.

Hagel ordered the review on May 28, at the height of public furor over health care access deficiencies at Veterans' Affairs Department medical facilities. Work said the Defense Department and VA systems were not comparable.

"I don't want to compare our department with their department because the have two fundamentally different missions," said Work, who described VA's patients as a stable and defined group, whereas the Military Health System serves patients with a much higher turnover rate.

"We were satisfied with the finding that we are comparable with the health care system and we have no crisis," he said, "but as everyone has said, we want to do better, we have to do better and we can do better."

Work told reporters that he would coordinate with Woodson, Junor and the surgeons general of the military services and provide regular updates to Hagel. Work described improving military health care as one of Hagel's top two priorities and said the Pentagon's efforts would not be beholden to "programmatic pressure" imposed by budget concerns.

"This is one of [the areas] that we would not skimp in what we need to do to make this system as good as we can," Work said.

"We don't — luckily, we don't believe that that is going to require a lot of more resources," he added. "What this is going to require is us digging into the data and getting better."

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