Military Health System Reform: Military Treatment Facilities

Military Health System Reform: Military Treatment Facilities

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March 12, 2020
Military Health System Reform: Military Treatment Facilities
The Department of Defense (DOD) administers a statutory
to the House and Senate Committees on Armed Services no
health entitlement (under Chapter 55 of Title 10, U.S.
later than 60 days after the report’s submission.
Code) through the Military Health System (MHS). The
Congressional approval of DOD’s plan to restructure its
MHS offers health care benefits and services to
MTFs is not required.
approximately 9.6 million beneficiaries composed of
servicemembers, military retirees, and family members.
How did DOD develop this plan?
Health care services are available through DOD-operated
After the enactment of the FY2017 NDAA, DOD
hospitals and clinics (i.e., military treatment facilities
established a workgroup consisting of representatives from
(MTFs)), or through civilian health care providers
the Office of the Assistant Secretary of Defense for Health
participating in DOD’s health care program, TRICARE.
Affairs, DHA, Joint Staff, and the military departments.
The workgroup screened 343 U.S.-based MTFs to identify
On February 19, 2020, DOD submitted a report to Congress
where a “transition of capabilities might be possible.” The
outlining its plan to restructure selected MTFs, herein
screening applied the following criteria:
referred to as the 703 Report. DOD indicates that detailed
1. Readiness (is there enough clinical volume to
planning and implementation will begin within 90 days of
support critical physician specialties and
the report’s submission, with restructure activities occurring
graduate medical education requirements?);
over the next several years.
2. Network adequacy (can the TRICARE
Background
network absorb additional patients?); and
Statute (10 U.S.C. §1073d) requires DOD to maintain
3. Cost-effectiveness (is it cheaper to provide
MTFs for the purposes of supporting the “medical readiness
care in the MTF than through the TRICARE
of the armed forces and the readiness of medical
network?).
personnel.” There are three distinct categories of MTFs:
ambulatory care clinics, hospitals, and medical centers. In
If an MTF met at least one of the criteria, DOD
FY2020, DOD administers 721 MTFs within the United
discontinued screening of the MTF and did not proceed
States and at overseas military installations. DOD entities
with the next phase. The initial screening identified 73
that administer MTFs include the Defense Health Agency
MTFs for further evaluation. Four other MTFs were added
(DHA), Army Medical Command, Navy Bureau of
at the request of the military departments.
Medicine and Surgery, and the Air Force Medical Service.
By the end of FY2021, the administration and management
For each of the 77 MTFs subject to additional evaluation,
of all MTFs are to transfer to the DHA.
DOD compiled a Use Case, (i.e., a compendium of health
care data collected from the MTF, TRICARE contractor,
Why is DOD planning to restructure
military installation, and other stakeholders) for each
MTFs?
facility. Each Use Case also included a recommendation on
the MTF’s future
Congress directed numerous MHS reforms in the National
-state. The military departments reviewed
Defense Authorization Act for Fiscal Year (FY) 2017
and provided comments to the workgroup on the Use Cases.
(NDAA; P.L. 114-328) and subsequent NDAAs, including:
A senior transition leadership team, composed of senior
defense officials, reviewed and validated each Use Case
 transfer of MTF administration and management from
recommendation. The Secretary of Defense accepted the
leadership team’s
the Service Surgeons General to the DHA Director
recommendations, which include 50
(§702);
MTFs identified for restructure, 21 MTFs for no change,
 reorganization of DHA’s internal structure (§702);
and six MTFs deferred for further review.
 redesignation of Service Surgeons General as principal
What is DOD’s plan to restructure
health advisors for their respective military service and
MTFs?
as service chief medical advisors to DHA (§702); and
 restructuring or realignment of MTFs to best support
The 50 MTFs identified for restructure are to transition to
military medical readiness and the readiness of medical
one of the eight future-state categories (see Table 1).
DOD’s next steps include developing estimates of
personnel (§703).
implementation costs and “detailed implementation
planning” beginning no la
The 703 Report fulfills the requirement, established in
ter than May 2020.
section 703(d) of the FY2017 NDAA, that the Secretary of
Implementation plans are to include tasks that address care
Defense submit “an implementation plan to restructure or
coordination and case management, access to care,
realign the military medical treatment facilities…” In
TRICARE network adequacy, changes in MTF staffing,
addition, the FY2017 NDAA requires the Government
and a communication strategy to inform stakeholders.
Accountability Office to provide a review of the 703 Report
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Military Health System Reform: Military Treatment Facilities
Table 1. MTF Restructure Decisions
# of
Future-State Category
Future-State Description
MTFs
Upgrade Trauma Center
MTF to enhance capabilities for a higher-level trauma designation.
1
Hospital-to-Clinic
MTF to eliminate inpatient services and provide outpatient care only with ambulatory
1
(no urgent care)
surgical services.
Hospital-to-Clinic
MTF to eliminate inpatient services and provide outpatient care only with ambulatory
1
(with urgent care)
surgical services and 24-hour urgent care services.
No-Surgery Clinic
MTF to eliminate ambulatory surgical services and provide outpatient care only.
3
MTF to support active duty servicemembers only with primary care and limited specialty
Active Duty Care Clinic
37
care services. Active duty family members may be seen on a space-available basis.
MTF to support occupational health, industrial hygiene, and preventative medicine
Occupational Health Clinic requirements for military installation employees only. Primary care services may be offered
1
to active duty servicemembers and family members on a space-available basis.
DOD to develop recapitalization plan for restructuring MTF assets with a potential military
Recapitalization
1
medical construction project.
Closure
MTF to eliminate all health care services and close.
5
Source: CRS analysis of DOD, Restructuring and Realignment of Military Medical Treatment Facilities, February 19, 2020.
Note: Future-state categories based on DOD’s description of MTF restructure decisions. Certain active duty care clinics are to continue to
offering pharmacy services for eligible beneficiaries. For the ful list of DOD’s MTF restructure decisions, see pp. 7-11 of the report.
DOD estimates that MTF restructuring activities will begin
Military Readiness
in FY2021 and occur over a 2-5 year period. The
 How will MTF restructuring improve clinical readiness
Department also intends to evaluate additional MTFs for
requirements for military medical providers and
future restructuring opportunities.
maintain a medically ready force?
When did DOD last restructure its
Cost Implications
MTFs?
 What implementation costs are associated with
As military requirements and health care demand shifts
restructuring MTFs?
over time, DOD uses a dynamic process to periodically
 Does DOD anticipate cost-savings when restructuring
review and modify its military medical capabilities—
activities are complete?
including its MTFs. Since 2001 for example, DOD has
conducted at least two assessments with recommendations
Relevant Statutes and Policies
for MTF restructuring: the 2005 Base Realignment and
Closure Commission Report and the 2015 MHS
10 U.S.C. §§1073c, 1073d, 1077a
Modernization Study Team Report. DOD has since
DOD Directive 6010.04, Healthcare for Uniformed Services
implemented many of those recommendations and
Members and Beneficiaries, updated June 1, 2018
continues to assess MTFs to optimize resources and support
DOD Instruction 6000.19, Military Medical Treatment Facility
clinical readiness requirements.
Support of Medical Readiness Skills of Health Care Providers,
February 7, 2020
Considerations for Congress
DOD provides periodic, informal briefings on MHS reform
CRS Products
to the congressional armed services committees. The
CRS In Focus IF10530, Defense Primer: Military Health System,
following lines of inquiry may assist Congress in
by Bryce H. P. Mendez
overseeing DOD’s planning, resourcing, and
CRS In Focus IF11273, Military Health System Reform, by Bryce
implementation of the 703 Report recommendations.
H. P. Mendez
Implementation Activities
Other Resources
 What is DOD’s implementation timeline for MTF
DOD, Restructuring and Realignment of Military Medical
restructure activities?
Treatment Facilities, February 19, 2020
 How will DOD coordinate MTF restructure activities
DOD, Military Medical Treatment Facilities, June 23, 2018
with ongoing MHS reform efforts?
DOD, Military Health System Modernization Study Team Report,
Impacts of MTF Restructuring
May 29, 2015
 As MTFs restructure, what is DOD’s plan to reassign or

reshape the medical workforce?
 How will restructure activities impact beneficiary
Bryce H. P. Mendez, Analyst in Defense Health Care
satisfaction and access to care?
Policy
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Military Health System Reform: Military Treatment Facilities

IF11458

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