A comprehensive review of the military health care system finds that patients face broad disparities in appointment wait times and quality of care — and have little way of finding out how their Defense Department hospital or clinic measures up regarding safety or potential harm to their health.
The review, ordered in May by Defense Secretary Chuck Hagel to determine whether the Pentagon provides safe, effective care to active-duty beneficiaries, retirees and family members, found that by and large, the system provides “good quality care that is safe and timely” and is comparable to civilian care.
But the military system has several notable discrepancies across its 56 hospitals and 361 clinics, with wide variability in timely access to care, patient safety and quality.
According to the report, at least three of the 17 hospitals surveyed failed to meet national standards for surgical complications and the system as a whole measured poorly on some standards for obstetrics care.
Military Health System Review: Action Plan
The review, led by Deputy Defense Secretary Bob Work, also found that the Defense Health Agency — the Pentagon’s new administrative entity for its health system — as well as the medical departments of the Army, Navy and Air Force, lacked consistent data and statistics on patient access, care and safety, making it difficult to draw conclusions or even measure facilities against one another or against the civilian health system.
“Our external experts point out that the MHS generally performs as well as the private sector in the delivery of safe, quality care. I believe our service members, retirees and their families deserve better than average,” Hagel wrote in a memo accompanying the Military Health System Review-Final Report.
Hagel ordered the review partially in response to the scandal over patient appointment wait lists and data manipulation at Veterans Affairs Department hospitals and clinics, a system run by the federal government but separate from the DoD medical system.
But the New York Times also has published two articles on patient safety at military hospitals following a yearlong investigation into deaths and severe injuries related to poor care.
Military Health System Review: Executive Summary
Earlier this year, the commander of Womack Army Medical Center at Fort Bragg, North Carolina, was fired after several misdiagnoses and mishaps that ended in patient deaths.
More recently, Brig. Gen. John Cho, the Western Regional Medical Command chief in charge of 11 hospitals in the Western U.S., was suspended for unspecified causes, becoming the eighth Army medical commander to be relieved or suspended in the past two years.
The current DoD review addressed three major areas: access to care, quality of care and patient safety.
According to the report, in terms of access, the medical experts conducting the review found that on average, “access to care meets the defined standards.”
But it added that because patients reported extreme dissatisfaction with their ability to get timely appointments, further investigation is needed.
Military Health System Review: Final Report – Main Body
The reviewers found that while most hospitals meet the access standards for specialty care, they failed in providing timely primary care for acute conditions, with 11 percent of the 17 hospitals reviewed not meeting the 24-hour standard for an appointment.
In “town hall” meetings with patients, the reviewers received an earful on patient wait times.
“Every time … I go to make an appointment, it’s, ‘No, I’m sorry we don’t have anything for 4-6 weeks. I could go to the emergency room but I would like to have my appointment before 4-6 weeks,” one patient said, according to the report.
The report also noted that data on access was unavailable for those who get their care at private facilities through the Tricare program.
Regarding quality of care, the review showed “mixed results” with “considerable variation across the system.”
While all medical hospitals and clinics are accredited or certified by external agencies, the review found variances in meeting standards and said that while the system in general meets or exceeds targets, it needs improvement.
For example, while most military hospitals exceed national standards for infant mortality and maternal trauma, the system was statistically below standards for postpartum hemorrhage and neonatal trauma.
Surgical complication rates also were all over the map, according to the report.
Of the 17 hospitals reviewed, one in two had higher than acceptable surgical complication rates. Three ranked in the top tier nationally on that particular issue, while three others had persistent poor performance.
Military Health System Review: Final Report – Appendices
In terms of patient safety, the review also found that some military hospitals and clinics failed to provide required reports on patient complications and preventable deaths.
“The self-reporting of events related to patient safety is a key concern for all health systems,” noted the report, speaking of the Army, Navy and Air Force medical systems as well as the National Capital Region, which encompasses the Walter Reed National Military Medical Center and Fort Belvoir Community Hospital.
The review was conducted by outside experts collecting and analyzing data provided by DoD, the services’ medical departments, military hospitals and clinics and outside reports and sources. The 17 facilities selected represent a range of DoD facilities — large, small, rural, urban, domestic and international.
The reviewers recommend that the Pentagon take steps to improve underperformance, establish clear performance goals and institute changes systemwide.
Hagel also ordered:
■ All military treatment facilities that don’t meet access standards to develop action plans to improve timely appointments at both military facilities and through Tricare in 30 days.
■ A yearlong study to review appointment access for all Tricare beneficiaries.
■ All military hospitals failing to meet quality and safety standards to develop a plan for fixing their problems in 45 days.
■ The Defense Health Agency to provide a plan in 90 days for better assessment of quality and safety in private care and to establish a performance management system that will monitor measures.
■ DHA to develop a plan to make available all statistics on quality and safety for each military treatment facility.
