Military Medical Care: Mitigating Impacts From Medical Unit Deployments

Military Medical Care: Mitigating Impacts From Medical Unit Deployments

INSIGHTi

Military Medical Care: Mitigating Impacts
From Medical Unit Deployments
Updated September 22, 2020
Contingency and peacetime missions consistently require temporary reassignment of military medical
personnel from military treatment facilities (MTF) to a deployable medical unit. In certain instances, MTF
services may be limited in times of war, operations other than war, natural disasters, or other
contingencies. This restriction is not uncommon. Notwithstanding these circumstances, the Department of
Defense (DOD) is required to provide statutory health benefits to its eligible beneficiaries by mitigating
fluctuations in MTF services. Chapter 55 of Title 10, U.S. Code, specifies health care entitlements for
military personnel, retirees, and their families. The delivery of those benefits can vary based on current or
projected military operations and the availability of medical personnel in MTFs.
Listed below are two examples of MTF services having been, or soon to be, limited as a result of military
medical deployments.
 On November 1, 2018, DOD approved a request for military assets (e.g., planning,
engineering, transportation, logistics, and medical) in support of the Department of Homeland
Security and U.S. Customs and Border Protection (CBP). Military medical personnel
assigned to numerous U.S. Army MTFs were reassigned to deployable medical units tasked
to support CBP.
 On March 18, 2020, DOD announced preparations for the deployment of the U.S. Navy’s
hospital ships, USNS COMFORT and USNS MERCY, to support the domestic response to
the Coronavirus (COVID-19). Approximately 900 medical personnel primarily from Naval
Medical Center Portsmouth and Naval Medical Center San Diego, respectively, staffed each
ship. In May 2020, both ships returned to their respective homeports, but remain available for
future tasking.
To understand the impact of these deployments on MTF services, it may be helpful to first consider how
the Military Health System (MHS) delivers care and staffs its MTFs.
How is health care delivered in the MHS?
The MHS offers health care to 9.6 million beneficiaries (i.e., active duty servicemembers, eligible
members of the National Guard and Reserve, retirees, and their family members) in MTFs or through
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civilian providers participating in DOD’s health care program—TRICARE. MTFs range in size and
capability, from small primary care clinics to large academic medical centers. However, they are generally
tailored to ensure military personnel are medically ready.
TRICARE pays for care delivered by civilian providers. There are three main benefit plans: a health
maintenance organization option (TRICARE Prime), a preferred provider option (TRICARE Select), and
a Medicare wrap-around option (TRICARE for Life) for Medicare-eligible retirees.
How are military medical personnel selected for deployment?
MTFs are staffed by military, civil service, and contract personnel. Military personnel are subject to
mobilization, deployment, temporary duty, or reassignment based on requirements established by a
combatant commander and tasking by the Joint Chiefs of Staff or their respective Service. Requirements
and tasking may occur during peacetime or contingencies, with short or long-term notice.
At some MTFs, preidentified military personnel are concurrently assigned to deployable medical units
(e.g., hospital ship, combat support hospital, or medical logistics company). In general, these assignments
allow military personnel to work at an MTF during nondeployment periods, and be reassigned to their
deployable medical unit if activated.
Military personnel not concurrently assigned to a deployable medical unit may also deploy with another
medical unit or as an individual augmentee. These individuals are typically ordered to deploy because of a
unique skill set or clinical expertise required for a specific mission.
The length of reassignment is dependent on the deployment mission, but can typically range from a few
days to nine months.
How are MTF services impacted when military medical personnel deploy?
When military staff deploy, they leave a staffing gap at the MTF. This gap can result in reduced MTF
capabilities, reduced capacity to provide health care services, and longer wait times. Loss of, or degraded
MTF capabilities and capacity are dependent on the number and type of personnel deployed. In a previous
USNS COMFORT deployment, Naval Medical Center Portsmouth reported impacts that include “longer
wait times for appointments for primary and some specialty care services, as well as increases in out-
patient pharmacy wait times.”
How do MTFs mitigate the staffing gap?
To mitigate the staffing gap, MTF commanders can use a range of options.
Table 1. Options to Mitigate MTF Loss of Personnel
Mitigation Options
Description
Use the reserve component

Call up reserve medical personnel to fil gapped positions
Use contract personnel

Initiate a new, or modify an existing, health care staffing contract to fil gapped
positions
Use civil service personnel

Hire additional civil service personnel or expand employee overtime opportunities

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
Decrease clinical capabilities that would typically be available (e.g., reduce number
Reduce MTF health care services
of staffed hospital beds and operating rooms or discontinue clinical services)
offered and refer patients to
TRICARE

Prioritize MTF care available according to Health Affairs Policy 11-005

Refer patients to TRICARE for services no longer available in the MTF
MTF commanders may use a mitigation strategy that incorporates multiple options listed above; however,
they may also be constrained by their budgets. Additional funding may be available from an MTF’s
parent organization.
In addition to MTF mitigation strategies, what is TRICARE’s role during military
medical deployments?
The Defense Health Agency contracts three managed care entities to administer DOD’s health
benefits through the TRICARE program. Each contractor is required to “ensure that health care
services are continuously available for TRICARE-eligible beneficiaries” when MTFs are
impacted by military medical deployments. This is accomplished through an individual
agreement between a TRICARE contractor and an MTF that outlines how health care services
will be made available during an event that impacts MTF staffing. Individual agreements may
also include details about how the TRICARE contractor will expand its provider networks to
accommodate an increase in patient workload due to MTF staffing gaps caused by a military
medical deployment. The TRICARE contractors must also continue to meet access to care
standards as required by 32 C.F.R. §199.17(p)(5) and Health Affairs Policy 11-005.

Author Information

Bryce H. P. Mendez

Analyst in Defense Health Care Policy

Disclaimer
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