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Report Finds ‘Average Care’ by MHS; DoD Officials Not Satisfied

by U.S. Medicine

November 10, 2014

By Sandra Basu

WASHINGTON – A highly anticipated review of the MHS has found that its care is comparable to average private sector healthcare, but that there is “wide performance variability with some areas better than civilian counterparts and other areas below national benchmarks.”

Military officials said they were not satisfied with average care.

“We cannot accept average when it comes to caring for our men and women in uniform and their families,” Defense Secretary Chuck Hagel said of the results.

The review of the MHS was ordered by Hagel at the end of May against the backdrop of an investigation into the VA healthcare system over manipulation of reporting long wait-times for veterans seeking appointments.

“Even small lapses in care can lead to devastating and heartbreaking losses or injuries. We must hold the entire military health system to the same exacting standards that we demand of our combat missions,” Hagel said of the review’s results.

As a result of the findings, Hagel emphasized that DoD would be taking steps to “ensure that the entire military healthcare system is not merely an average system, but a leading system.” Those steps include:

  • All healthcare facilities identified as outliers in the categories of access, quality and safety must provide action plans for improvement within 45 days.
  • MHS leadership and the surgeons general must ensure unified standards for purchased, as well as direct care and establish a mechanism for patients and concerned stakeholders to provide ongoing input.
  • DoD’s healthcare leadership will establish a system-wide performance management system to scrutinize lapses and monitor progress.
  • To enhance transparency, all currently available data on DoD’s healthcare system will be made publicly available.
  • By the end of the year, DoD will have a detailed implementation plan to ensure the military healthcare system becomes a top performing system.pph

Report Findings

In ordering the review, Hagel directed that it cover three areas:

  • Whether access to medical care in the MHS meets defined access standards;
  • Whether the quality of healthcare in the MHS meets or exceeds defined benchmarks; and
  • Whether the MHS has created a culture of safety with effective processes for ensuring safe and reliable care of beneficiaries.

The review, conducted by six external experts, was billed as the first time the MHS has taken an enterprise view of such a broad scope in the three areas.

In explaining the findings, Laura Junor, PhD, principal deputy undersecretary of defense for personnel and readiness, said last month that the review found “no hospital systematically underperformed in any of the three dimensions of access, quality or safety.”

Yet, problems were identified. For example, the report found that mothers are more likely to suffer hemorrhaging after childbirth at military facilities than at civilian hospitals.

“The direct-care component averages of postpartum hemorrhage have increased and have remained significantly higher over the past four years as compared to the NPIC [National Perinatal Information Center] average, which has remained flat since 2010,” the report explained.

In addition, the review found that surgical morbidity was statistically significantly higher than expected in eight of the 17 MTFs for which data was available and was sustained over the reporting period (July 2010-June 2013) in several of these facilities. On the other hand, surgical mortality in all 17 facilities was in the expected norm during the most recent data period.

Investigators also held townhall meetings at each of seven medical facilities visited.

The largest number of comments (37%) from staff concerned the focus on quality. While staff said they felt they delivered good care, “they expressed concern that a focus on efficiency and quantity of visits, coupled with understaffing, was putting quality at risk (27% of all negative comments),” the report noted.

In addition, some staff said they feared retaliation for reporting safety issues. “There were several troubling, though small in number, references to fear of retaliation or a toxic leadership climate,” according to the document.

While the review showed that standards of access to care was being met in DoD facilities, Junor pointed out that beneficiaries “were telling us a slightly different story,” pointing to access challenges.

“So on the access side, we’re a little cautious right now, because we want to see, is the data telling us what is really happening? And we’re going to ask for a wide variety of different sources to help our feedback,” responded Deputy Secretary of Defense Robert Work.


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