Team Infidel
Forum Spin Doctor
Newport News Daily Press
December 17, 2006 Military Update
By Tom Philpott
Air Force opposition has scuttled Army and Navy plans to merge the three services' large medical bureaucracies - now led by three surgeons general - into a single Unified Medical Command.
Deputy Defense Secretary Gordon England decided this month not to endorse such a major streamlining of the military health care system, given that Air Force leaders were so strongly against it.
Instead, England approved a more modest "new governance plan" for the health care system that directs joint oversight over four "key functional areas." Dr. William Winkenwerder, assistant secretary of defense for health affairs, explained England's "conceptual framework" in an interview Tuesday.
Areas targeted for joint oversight are:
*Medical research. The Army Medical Research and Material Command based at Fort Detrick, Md., would oversee all military medical research. Winkenwerder said a process would be established "to ensure that the interests and equities of all three services are represented in setting priorities and ensuring that appropriate research gets done."
*Medical education and training. The 2005 Base Realignment and Closure legislation calls for the creation of a joint center for enlisted medical training at Fort Sam Houston in San Antonio. England embraces that change and wants more common training, standards and approaches.
At the same time, Winkenwerder said, England recognizes that certain aspects of medical training will have to remain service-unique.
*Health care delivery in major military markets. Starting with San Antonio and Washington, D.C., the services are to shift toward a single service being in charge of care delivery in areas where there are large beneficiary populations and multiple hospitals.
*Shared support services. The services are to consolidate certain support services. Those would include information management and technology; site construction, contracting and procurement; and logistical and financial functions.
Whatever entity is created to oversee shared support services, it will report directly to his office, Winkenwerder said. But just as the Army will control medical research, a single service will be responsible for medical education and training and for health care delivery in major markets.
The details are left to a transition team that soon will be named to review options and recommend steps to enact England's concept. The TRICARE Management Activity will remain but will focus on health insurance, support-contractor management and benefit delivery.
The TMA will lose other joint support responsibilities such as information technology. Those duties will shift to the new shared support-services organization.
The course that England has set is less ambitious than a unified medical command, but it still "needs to be planned and implemented in a very careful, detailed, thoughtful way," Winkenwerder said.
How much England's revised plan will save isn't known. But Winkenwerder said it would "create greater efficiencies and cost savings, improve coordination of medical care, improve support to our war fighters, better leverage medical research, and create greater 'jointness' and standardization in our training and education of ... medical personnel."
Lt. Gen. James Roudebush, Air Force surgeon general, had argued against a unified command on the grounds that the services' missions and cultures were just too different and that those differences justified keeping separate medical staffs and resources.
Vice Adm. Donald Arthur, Navy surgeon general, conceded that he had "a different concept" for the future of military medicine.
But it came down, he said, to "what could realistically get done without a lot of disruption to the system."
He said, "The point was to get us talking about what are things we could be doing together" to achieve "more collaborative, more interoperable combat service support."
Many hurdles remain. It can be managed, he suggested, but the medical departments clearly have a lot of negotiation ahead.
December 17, 2006 Military Update
By Tom Philpott
Air Force opposition has scuttled Army and Navy plans to merge the three services' large medical bureaucracies - now led by three surgeons general - into a single Unified Medical Command.
Deputy Defense Secretary Gordon England decided this month not to endorse such a major streamlining of the military health care system, given that Air Force leaders were so strongly against it.
Instead, England approved a more modest "new governance plan" for the health care system that directs joint oversight over four "key functional areas." Dr. William Winkenwerder, assistant secretary of defense for health affairs, explained England's "conceptual framework" in an interview Tuesday.
Areas targeted for joint oversight are:
*Medical research. The Army Medical Research and Material Command based at Fort Detrick, Md., would oversee all military medical research. Winkenwerder said a process would be established "to ensure that the interests and equities of all three services are represented in setting priorities and ensuring that appropriate research gets done."
*Medical education and training. The 2005 Base Realignment and Closure legislation calls for the creation of a joint center for enlisted medical training at Fort Sam Houston in San Antonio. England embraces that change and wants more common training, standards and approaches.
At the same time, Winkenwerder said, England recognizes that certain aspects of medical training will have to remain service-unique.
*Health care delivery in major military markets. Starting with San Antonio and Washington, D.C., the services are to shift toward a single service being in charge of care delivery in areas where there are large beneficiary populations and multiple hospitals.
*Shared support services. The services are to consolidate certain support services. Those would include information management and technology; site construction, contracting and procurement; and logistical and financial functions.
Whatever entity is created to oversee shared support services, it will report directly to his office, Winkenwerder said. But just as the Army will control medical research, a single service will be responsible for medical education and training and for health care delivery in major markets.
The details are left to a transition team that soon will be named to review options and recommend steps to enact England's concept. The TRICARE Management Activity will remain but will focus on health insurance, support-contractor management and benefit delivery.
The TMA will lose other joint support responsibilities such as information technology. Those duties will shift to the new shared support-services organization.
The course that England has set is less ambitious than a unified medical command, but it still "needs to be planned and implemented in a very careful, detailed, thoughtful way," Winkenwerder said.
How much England's revised plan will save isn't known. But Winkenwerder said it would "create greater efficiencies and cost savings, improve coordination of medical care, improve support to our war fighters, better leverage medical research, and create greater 'jointness' and standardization in our training and education of ... medical personnel."
Lt. Gen. James Roudebush, Air Force surgeon general, had argued against a unified command on the grounds that the services' missions and cultures were just too different and that those differences justified keeping separate medical staffs and resources.
Vice Adm. Donald Arthur, Navy surgeon general, conceded that he had "a different concept" for the future of military medicine.
But it came down, he said, to "what could realistically get done without a lot of disruption to the system."
He said, "The point was to get us talking about what are things we could be doing together" to achieve "more collaborative, more interoperable combat service support."
Many hurdles remain. It can be managed, he suggested, but the medical departments clearly have a lot of negotiation ahead.