Inspector Normal Highlights Staffing Shortages in Army Well being System

A Nov. 29 report from the Inspector Normal of the US Division of Protection highlighted issues about entry to care and staffing shortages within the Army Well being System and made suggestions for tactics to start to deal with the problems.

After assembly with the 4 Service IGs, the DoD IG determined to publish a administration advisory detailing ongoing issues. The advisory consists of knowledge supplied by the Service IGs, Service Audit Businesses, and the Protection Well being Company (DHA) IG to the DoD Workplace of Inspector Normal (OIG), and contains findings from the DoD OIG primarily based on its printed work and acquired by hotline complaints. The DoD OIG didn’t independently confirm the knowledge supplied by the Providers.

The Army Well being System (MHS) offers well being care to 9.6 million beneficiaries,
together with energetic obligation service members and their households, army retirees and their
dependents, and in some situations DoD civilians and contractors. The MHS consists of a direct care system, the place beneficiaries acquire care at army therapy services (MTFs), and a bought care system, the place beneficiaries acquire care from personal sector suppliers administered by TRICARE community contracts.

The DoD OIG has recognized points with the power of beneficiaries to obtain entry to
well timed healthcare in prior printed reviews associated to psychological well being and care supplied through the COVID-19 pandemic.

Throughout visits to the INDOPACOM Space of Duty in Might and June 2023, the DoD IG was repeatedly knowledgeable by senior army and civilian officers of challenges with accessing healthcare, together with challenges with entry to psychological healthcare.

The DoD OIG has acquired no less than seven hotline complaints during the last yr from MHS beneficiaries and MHS suppliers highlighting issues with the power to entry care at MTFs, potential to entry care within the TRICARE community, and staffing shortages on the MTFs.

The Service IGs additionally supplied correspondence, documentation, and knowledge
papers to the DoD OIG in April and Might 2023 expressing issues with the power of
beneficiaries to entry healthcare providers throughout the MHS. The Service IGs particularly highlighted issues with the power of presidency civilian and contractor staff to entry healthcare providers abroad, and entry to care at smaller MTFs, in addition to staffing shortages. 

The Naval IG performed focus teams in 2023 and constantly discovered medical care to be among the many high causes that service members are dissatisfied. The Naval IG supplied focus group feedback from Service members expressing dissatisfaction with their entry to care and wait instances for varied well being providers, together with routine main care and psychological healthcare. Additional analysis by the Naval IG recognized explicit challenges with beneficiary entry to care in areas which can be both small, distant, or lately downsized from a hospital to a clinic. For instance, the Navy recognized access-to-care challenges in Pearl Harbor, Hawaii; Lemoore, California; Oak Harbor, Washington; and Pensacola, Florida, typically as a consequence of a scarcity of MTF and native community suppliers. In line with the Naval IG, small MTFs typically solely serve active-duty service members and ship all different beneficiaries, resembling relations and retirees, to the TRICARE supplier community.

Nevertheless, the Service IGs supplied knowledge exhibiting that some TRICARE networks are usually not
sturdy or satisfactory to satisfy this want and beneficiaries might have issue acquiring community care. For instance, Naval Well being Clinic Pearl Harbor in Hawaii offers restricted specialty care and is presently solely enrolling energetic obligation Service members. Beneficiaries should use a community in Hawaii that solely has one degree 1 trauma heart (in comparison with San Diego which has three) and exceeds the 28-day DoD entry to care requirements for some specialties, resembling gastroenterology (49 days common wait time for an appointment), psychiatry (52 days common wait time for an appointment), and urology (67 days common wait time for an appointment).

Knowledge supplied by the Service IGs point out that entry to psychological well being providers continues to be a specific drawback. For instance, at Naval Hospital Pensacola and surrounding clinics, the Naval IG supplied knowledge exhibiting that many Substance Abuse Rehabilitation Program (SARP) counselor positions are presently empty, and Naval Hospital Pensacola has to constantly rotate these counselors throughout areas. 

The Air Pressure IG supplied info from a number of MTFs describing psychological well being supplier shortages and issues concerning the potential of beneficiaries to entry psychological well being care. For instance, officers from Ellsworth Air Pressure Base Medical Clinic acknowledged that entry to care has been affected by a scarcity of three civilian psychological well being suppliers. The officers stated that with out these

The DoD IG recommends that the Director of the Protection Well being Company determine all
specialties, by location, the place the managed care help contractor supplier community
is just not assembly DoD entry to care requirements and, in coordination with the managed care help contractors, develop and implement a plan to carry these supplier networks into compliance with the DoD entry to care necessities.

It additionally recommends that the Director of the Protection Well being Company, in coordination with
the Service Surgeons Normal:
• Conduct a survey of TRICARE beneficiaries, civilians, and contractors
stationed abroad about their entry to healthcare providers.
• Conduct a survey of suppliers and clinic directors at abroad
Army Therapy Services about entry to well being providers at their location.

The DoD IG report stated that “regardless of being supplied a chance to reply to the report and an extension of the unique due date, the Director of the Protection Well being Company didn’t reply to the suggestions within the report. Subsequently, the suggestions are unresolved. We request that the Protection Well being Company Director present feedback inside 30 days of issuance of the ultimate report.”