By Sandra Basu
WASHINGTON — In an effort to ensure that military emergency medicine and trauma specialists are able to maintain their skills off the battlefield, a proposed program would establish a Joint Trauma Education and Training Directorate.
The provision was contained in the House of Representative’s National Defense Authorization Act (NDAA), passed last month. The Senate was working on passage of its version late last month. The bills will then need to be reconciled before a bill can move forward.
At a hearing held earlier this year, lawmakers on the House Armed Services Committee expressed concern about how military medical personnel are currently maintaining their skills, particularly trauma specialists, without constantly treating injured troops.
“During periods of limited deployment, trauma skills can quickly degrade, which is why we must do everything possible to maintain proficiency in both trauma and emergency medicine,” said Rep. Joe Heck (R-NV), who chairs the House committee on Armed Services’ Subcommittee.
Establishment of the trauma training program was just one of many proposals that lawmakers were considering as they sought ways to use the NDAA to help reform the military healthcare system.
Some of the proposals were far reaching, including reorganizing TRICARE plans into TRICARE Prime and TRICARE Preferred, with a range of options and fees. According to the bill, the new fees would apply for future enrollees who join the military after Jan. 1, 2018.
Advocacy groups expressed relief, however, that fee increases in the bill did not go as far as DoD had proposed for pharmacy copays and other areas to make up revenue.
“From multiple vantage points, including cost and structure, it is clear the DoD must pursue reasonable health benefit reform now as part of a balanced approach, given the reduced sequestration level funding for FY 2018 and beyond,” the agency said in a FY 2017 proposed budget document.
The House bill would also make the Defense Health Agency responsible for the administration of the military treatment facilities. A bill summary explained that this would allow “the military services to focus on medical readiness.”
Speaking about the reforms, Heck noted that, over the past year, legislators had “arduously studied ways to reform and improve important benefits earned by our servicemembers and their families.”
“We have approached this reform from the perspective of the beneficiary and the effects that change could have on the value and sustainability of the benefit, whether it is the commissary system or the delivery and quality of healthcare,” he added.
As for the Senate version, lawmakers were considering a major overhaul that included disestablishing the medical departments of the military and putting their activities under the Defense Health Agency. The surgeons general from each service would serve as advisers to the DHA under this proposal.
“The current stove-piped military health system command structure leads to inevitable turf wars among the military services and the Defense Health Agency, paralyzing decision-making and stifling healthcare innovation,” the Senate Armed Services committee explained in a bill summary.
In addition, the Senate version would create new TRICARE health plans — Prime, Choice, and Supplemental. It would also fund a pilot program to provide commercial health insurance coverage for Reserve component members and their families.
“This is something I am really excited about as an alternative to the current TRICARE system for Guard and Reserve families who live in remote areas,” said Sen. Lindsey Graham (R-SC), who chairs the Senate Committee on Armed Services’ Subcommittee on Personnel.
That bill would also address skill maintenance of medical providers by expanding military-civilian trauma training sites. At the same time, it would eliminate graduate medical education training programs not directly supporting operational medical readiness requirements and the medical readiness of the Armed Forces.
Consideration of these initiatives comes a year after the Military Compensation and Retirement Modernization Commission (MCRMC) released a report calling for far-reaching changes. The MCRMC specifically recommended that DoD should replace TRICARE with a selection of commercial insurance plans, similar to the Federal Employees Health Benefits Program.
Such a change would apply to families of active duty members, Reserve component members and retirees not eligible for Medicare and their families, according to the group.
“Under an insurance model, the ease and timeliness of patients’ access to health care would improve because beneficiaries would not be subject to DoD’s lengthy and frustrating process for making appointments and obtaining referrals,” the MCRMC explained.
DoD, meanwhile, proposed what it says is “a simpler system,” in which beneficiaries are provided “with two care alternatives” — TRICARE Select a managed care-like option and TRICARE Choice, a preferred provider organization-like option “offering greater choice at a modestly higher cost.”
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