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Military Health Care Facilities to See More Shortages under Sequestration

by Wendy Innes, published

cuts to military health care Susan Montgomery /

The new fiscal year is quickly approaching and that means a fresh round of cuts, unless Congress works together to find a solution to the ongoing budget crisis. However, the future doesn't look good, especially the future of health care for active duty military members and their families.

To add insult to injury, it's really a matter of where a person falls in the system as to whether or not they will receive care. The reason is that the Veteran's Health Administration (VHA) has been exempted from sequestration, and there is no information to suggest that will change in FY2014.

So, if someone is discharged from the military, they would have complete access to care from the VA, provided that they meet the standard eligibility requirements that have been in place for years.

But, if that person is awaiting a review board to determine if they can be discharged, they are out of luck. Those on active duty and their families who receive care through Tricare and military treatment facilities run by the DoD will continue to see shortages if sequestration continues, according to Dr. Jonathan Woodson, Assistant Secretary of Defense for Health Affairs.

In a post to the Military Health System's blog, Woodson said the MHS is "closely monitoring the effects of sequestration on the health services provided to our 9.6 million beneficiaries."

He then went on to detail the cuts that military treatment facilities have faced in FY2013, including cuts to appointment availability, longer wait times, and less time spent with providers, as well as cuts to maintenance and equipment upgrades.

While FY2013 is rapidly drawing to a close, Pentagon brass have previously said that military members and their families should expect more of the same and then some in the coming year, unless something is done to stop the automatic cuts.

Sequestration poses significant challenges to the military's health care system, Woodson has said, adding that the effects would be disastrous if it continues through FY2014. Military medicine has already had to cut $3.2 billion, he pointed out, which is almost an 8 percent reduction. About half has come from the money to pay for Tricare, the military's medical benefits program, and health care providers in the private sector who are absorbing some of the patients who can't get services in the military because of sequestration cutbacks.

However, even this will eventually backfire.

Tricare pays more for care provided by civilian network practitioners, so if more people are being referred out to civilian network providers because of the furloughs in the military system, the DoD will end up spending more money in the long run, according to a recent article in USA Today.

The same article also highlighted internal memos that spelled out just how challenging the cutbacks have been for military hospitals, and instructs providers to "please show (patients) the utmost understanding and care while we are asking them to accept longer wait times and in some cases, curtailed or limited services."

The "colleagues" memo came from Rear Adm. Alton Stocks, hospital commander, on July 12. The same memo spells out other instructions for staff members, some that imply a compromised quality of care for military members.

Despite the fact that the memo says that patients won't be discharged unless it is medically safe to do so, it also issues instructions that encourages the speedy discharge of patients. The memo says that beds are in "critically short supply" and mandates "dispositions/discharges as soon as possible."

With an all-time high number of patients with PTSD and TBI, the number of beds in the mental health ward at Walter Reed National Military Medical Center has been reduced from 28 to 22. Operating rooms have been cut back as well, from 23 to 20 Monday through Thursday and down to just 10 on Friday, the day that most employees have elected to take their furlough day and, perhaps most disturbing, surgeons are urged to rush surgeries to finish by 3 p.m. to save costs.

Between 10 to 20 percent of beds are sitting vacant because off staffing shortages.

Army Major General Richard Thomas, commander of 11 hospitals, says sequester is "definitely impacting our ability to deliver health care." He said that more than 10,000 appointments have been rescheduled due to cutbacks, and said, "The impact on morale is huge."

Thomas also said that some providers have quit, opting instead to go to the Department of Veterans Affairs for jobs.

The recent Strategic Choices and Management Review (SCMR) found that the only way that more of the same can be avoided in the coming fiscal year is to implement the current proposed budget, which will allow cuts to be made strategically instead of repeating the automatic cuts of the past year.

However, negotiations have stalled, leaving many in the government with no hope of passing the much needed budget and leaving the country's military members in limbo once again.

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