Pentagon plans to force 200k family members, retirees out of military hospitals to civilian doctors

Photo credit Photo by Mark Oswell/Walter Reed National Military Medical Center

The Department of Defense plans to transition dozens of its hospitals and clinics to serve only active duty service members, sending hundreds of thousands of family members and retirees to civilian doctors instead. 

Assistant Secretary of Defense for Health Affairs Tom McCaffery told reporters Wednesday that 200,000 family members and retirees would likely be moved from military treatment facilities (MTFs) to Tricare network providers. The entire military health system includes about 9 million beneficiaries. 

Of those 200,000, about 80,000 are active-duty family members. The rest are retirees and their families. 

The move is part of a transition to focus military medical facilities on wartime readiness, which officials said means ensuring that uniformed medical staff gets the training they need to treat deployed troops, such as trauma care and other combat medical needs. 

“Simply, much of our daily work at many facilities -- while vitally important to our beneficiaries -- is less relevant to supporting readiness,” McCaffery said. “We have an obligation to deliver access to care for our patients but also to focus precious military resources on activities with the highest readiness value.” 

The Pentagon analyzed hundreds of its hospitals and clinics before deciding 77 needed a closer look, McCaffery said. Of those, 50 will be changing, transitioning to serve only active duty, becoming outpatient, specialty or ambulatory care facilities, or closing. 

Some of those decisions were made before the Pentagon completed its systemwide assessment, officials said, and some have already been implemented, according to the report.

Of the 50 military hospitals and clinics that will see major changes, 36 will transition to treat only active duty service members, and one will serve only active-duty troops and their families. 

Those facilities are located in 22 of the 50 states: Texas, Louisiana, Alabama, Delaware, Florida, Massachusetts, Georgia, New Jersey, Virginia, Maryland, Pennsylvania, California, Illinois, Kansas, North Carolina, Connecticut, Mississippi, Tennessee, New Hampshire, Rhode Island, Washington and Colorado. 

List of affected hospitals and clinics 

Moving to Tricare network providers 

McCaffery said the Defense Department is “committed to ensuring access to quality healthcare for all beneficiaries” and cautioned that “nothing is changing immediately.” 

Some of the changes could take 2-4 years, McCaffery said, as DHA goes from MTF to MTF, deciding which Tricare markets could bear the burden of potentially thousands more patients.

“That process will take time,” he said. “It could be several years for implementation in some areas … We will help guide (patients) through every step when the time for action arrives.” 

But the full effects of those changes are still unclear. 

“We are aware that seeing new care providers will be a big change for families,” McCaffery said. “We recognize the shift from MTF care to civilian care may involve more out of pocket costs for some retirees.” 

Pentagon officials did not elaborate on what those additional costs may be, or if families and retirees could see any compensation for longer travel times. They did say that active-duty families likely will not see increased costs unless they fill their prescriptions at non-military pharmacies. 

For more than 60 years, each branch of service has managed its own healthcare system. But that's all changing under the Pentagon's plans, already three years in. 

The Defense Health Agency (DHA) is taking over hospitals and clinics from individual military branches, placing them under one Pentagon umbrella. DHA officials have said repeatedly that the change is Congressionally mandated and focused on increasing force medical readiness. 

All military hospitals and clinics are expected to fall under DHA management by 2021, managed by geographic regions, or markets. Plans also include standardizing appointment scheduling and referrals across all military hospitals.

Pentagon officials told reporters Wednesday that they have not spoken to any of the 200,000 family members or retirees who may be affected by the change. 

The change also likely will coincide with the department’s plan to draw down about 16,000 uniformed medical staff jobs, department officials said. 

A change to support mission readiness was mandated in the 2017 defense spending bill passed by Congress and signed into law by then-President Barack Obama in 2016. 

In it, Congress and the president directed DHA to manage military hospital budgets, IT, administration, policies and procedures and construction. The changes also include "the authority to convert military medical and dental positions to civilian positions," with remaining staff in uniform focused mainly on operational medicine. DHA already manages Tricare. 

The legislation also called for the Pentagon to assess all of its hospitals and clinics to determine how they were serving the readiness mission. 

Pentagon officials said Wednesday that plans to decrease uniformed staff by the thousands were made by the branches -- not DHA. The effect those cuts (expected as soon as October 2020) will have on the military community -- active, families and veterans -- remains to be seen. 

Cost savings are expected beyond cutting staff, though. For the Pentagon, it’s often cheaper for beneficiaries to get care from Tricare network providers than at MTFs. But officials said it’s unclear exactly how much money will be saved throughout the process. About $36 million in savings is expected for Fiscal Year 2021, which officials called a “byproduct” of changing the mission of the military health system to increase force readiness. 

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Reach Abbie Bennett: or @AbbieRBennett.
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