Non-Clinical Topics

As DHA Takes More Control, Military Medicine Undergoes Changes

by Sandra Basu

September 5, 2018
Healthcare leadership from across the DoD, the Army and Fort Bragg met in July at U.S. Army Forces Command to discuss the upcoming transition of the administration and management of Womack Army Medical Center from the Army Medical Command to the Defense Health Agency. (Army photo by Eve Meinhardt/FORSCON PAO)

WASHINGTON—In a bill recently signed into law, Congress signaled its intent to give the Defense Health Agency (DHA) greater control over the administration of military health care and medical research.

The 2019 National Defense Authorization Act (NDAA) directs the creation of new organizations under DHA and requests reports on the feasibility of others.

One anticipated change, moving DoD’s healthcare facilities from under the control of the military medical commands to the DHA, actually was delayed until 2021, to allow phase-in.

To consolidate medical research, the law orders DoD to create a Defense Health Agency Research and Development Organization subordinate organization that will be comprised of the Army Medical Research and Materiel Command and “such other medical research organizations and activities of the armed forces as the Secretary considers appropriate.”

That group will be responsible for “coordinating funding for the Defense Health Program Research, Development, Test and Evaluation, the Congressionally Directed Medical Research Program and related Department of Defense medical research.” The establishment of a subordinate organization called the Defense Health Agency Public Health also is included in the law and will include Army Public Health Command, the Navy-Marine Corps Public Health Command, Air Force public health programs and “any other related defense health activities the Secretary considers appropriate.”

Lawmakers also are gathering information on the benefits of establishing a Defense Health Agency Education and Training organization, which would be led by the president of the Uniformed Services University of the Health Sciences (USUHS) and include the current Medical Education and Training Campus, USUHS and the medical education and training commands of the military branches.

Additionally, lawmakers want a report on the feasibility of setting up a command called the Defense Health Command that would actually supersede the DHA.

‘Enormity of Changes’

As for reporting structure for MTFs, lawmakers previously directed DoD to make the change by Oct. 1, 2018, in the Fiscal Year 2017 NDAA. The recently signed FY 2019 NDAA extends the deadline to Sept. 30, 2021, in response to a request by DoD officials who cited the “enormity of the changes.”

“Department leaders determined that a phased approach will introduce less risk and provide an opportunity to adjust as the implementation progresses,” DoD explained in a June report to Congress.

The first facilities to phase-in next month, as of the original deadline, are Womack Army Medical Center at Fort Bragg, NC; Naval Hospital Jacksonville, FL; the 81st Medical Group, Keesler Air Force Base (AFB), MS; the 628th Medical Group, Joint Base Charleston, SC, and the 4th Medical Group, Seymour Johnson AFB, NC, according to an Army press release.

In the Senate version of the recent bill, legislators asserted that DoD has failed to provide a credible plan on how it intended to move control to DHA and said they were seeking to “clarify the intent” in the 2019 NDAA.

The new law details how DHA will have the responsibility of determining the scope of medical care provided at each MTF, determining workforce requirements, selecting commanders or directors of MTFs and direct joint manning at MTFs, and issuing performance ratings for the commanders of the medical facilities and control over intermediary organizations between DHA and MTFs.

“The Secretary of Defense shall establish a timeline to ensure that each Secretary of a military department transitions the administration of military medical treatment facilities,” by the deadline, the bill explains.

The law also stipulates that, as part of the structure, DHA regions will be established, with no more than two DHA regions in the United States and no more than two outside of the United States.

DHA came into being in 2013 after much debate on how the MHS should be best reorganized and what the role of the military medical commands should be. Based on a task force’s analysis that evaluated options for governance, as well as other considerations, DoD leaders endorsed the creation of a Defense Health Agency.

That solution was viewed as less drastic than suggestions to eliminate separate medical commands for the Army, Navy and Air Force and establish a Unified Medical Command.

In its recent June report to lawmakers, DoD acknowledged that, while “significant progress has been made to achieve greater integration through consensus based governance, it has come at the expense of agility and speed of decision-making.”

It further explained that “MHS Governance, as it currently stands, continues to be based on a broad set of councils, work groups, integrated product teams and other formally-chartered working groups as well as ad hoc working groups that often require unanimous support to advance initiatives and change.

“These governance bodies consume a significant amount of time and personnel resources. The result is often a sclerotic decision-making process that has the effect of demoralizing staff and other stakeholders who seek to make timely improvements in MHS policy, readiness and health care delivery,” the report noted.

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