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Sept. 25, 2006
Army Times
Medical merger
Putting all health workers under one command would standardize training,
boost jointness, doc says
By Gayle
<mailto:[email protected]?subject=Question%20from%20ArmyTimes.c
om%20reader> S. Putrich
Staff writer
The most sweeping overhaul of the military's medical system in more than
60 years would combine all Army, Air Force and Navy hospitals, clinics,
doctors and staff under a single joint medical command.
And it would do all that in the next three months.
The Defense Business Board, a panel of senior business executives who
act as advisers to Defense Secretary Donald Rumsfeld, recommended Sept.
6 that Rumsfeld immediately appoint a transition team and pull together
the unified medical command by Jan. 1.
The Army and Navy support the concept, which, according to the Center
for Naval Analyses, could save $344 million or more. But the Air Force
is vigorously opposed to a wholesale combination of medical assets,
fearing that wing commanders would lose control of a vital support
function on their bases.
Some Defense Department officials, as well as lawmakers, are advocating
a cautious, incremental approach. But board members said there is no
reason to delay.
"We're saying, don't wait until fiscal '08 to begin," said Henry
Dreifus, founder and CEO of Dreifus Associates Limited Inc., a business
consulting firm. Dreifus headed the business board task group that
studied the unified medical command concept.
"There is no reason not to do this sooner," he said.
Under the plan:
* Tricare would need to be realigned to work alongside the new unified
command.
* The Pentagon's Office of Health Affairs would take over policy
control, budget authority and accountability and oversight of all
medical health activities.
* All fixed military clinics and hospitals would come under the unified
command, including research, contracting, logistics and training.
* Emergency and operational field care would stay under the individual
services, at least for the time being.
"The whole idea here is to continue to provide outstanding health care
to the active and the retiree," said William "Gus" Pagonis, head of the
Defense Business Board and a retired Army three-star who served as
logistics chief in the 1991 Persian Gulf War.
What a unified medical command means to the average Joe or Jane is not
yet clear, but redundant medical facilities serving different military
populations likely could be eliminated as those medical facilities start
to look more purple and serve multiple military communities in the Air
Force, Navy, Army and Marine Corps instead of being focused on just one,
board members said.
Training of medical personnel could also be streamlined.
"Part of the unification will then bring the way we educate and train
these people to common standards," Dreifus said. "Common logistics means
you will be able to have better force projection across the services
with the delivery of that medicine and not have people working with
incompatible equipment or procedures."
All this could bring changes to manning within the medical community -
but it does not necessarily mean shrinking medical personnel within the
military, Pagonis said.
Pentagon officials acknowledge that areas such as logistics, operations
and purchasing are replicated in triplicate within each service, said
Dr. David Tornberg, deputy assistant secretary of defense for clinical
and program policy.
Consolidating communications, data sharing and personnel management
would save money - and perhaps, lives - by making delivery of care
quicker and more efficient, he said.
Some hesitation
Still, Pentagon officials are far from ready to jump onboard. Tornberg
said combining some or all of the military's medical efforts into a
joint command is something the Pentagon has been seriously considering
for nearly a year - and they're still not done.
"This is an evolutionary process," Tornberg said. "I'm a proponent of
the concept, but I think it has to be done in a very deliberate way."
Rep. John McHugh, R-N.Y, chairman of the House Armed Services military
personnel panel that has jurisdiction over military medical issues,
agreed, saying unification seems inevitable but should not be rushed.
"It is important we have the best information available so we do this
right because we are, after all, talking about the health of service
members, retirees and their families," he said. "There are
interoperability issues that have to be worked out, which is one of the
major concerns expressed by the Army and Navy."
McHugh suggested a joint medical command could be based on the same
model as the U.S. Special Operations Command.
Operational mission orders come from the joint command and units work
together jointly, but troops still keep all of the benefits, promotion
regulations and traditions of their individual services. The command has
a joint headquarters planning and budgeting staff but also has
lower-level commands for service-specific capabilities.
McHugh said Congress won't move on this immediately, but "we need a
decision by the fiscal 2008 budget."
The BRAC effect
While Tornberg said he is not operating under any sort of time line to
set up a fully functioning joint medical command, there is an
expectation that some changes will have to come sooner rather than
later.
Some of that will be spurred by decisions made in the 2005 base
realignment and closure process, which is already pushing the services
toward increased "jointness" in the health care arena.
Walter Reed Army Medical Center and the National Navy Medical Center in
Bethesda, Md., for example, will cease to exist by the end of fiscal
2011, merging at the Bethesda site to become the Walter Reed National
Military Medical Center.
The Bethesda campus also will continue to be the home of the Uniformed
Services University of the Health Sciences.
The most recent BRAC round also will create the joint San Antonio
Regional Medical Center at Brooke Army Medical Center, where enlisted
medical technicians from all services will train. Medical specialty
training for the Army is now done at Fort Sam Houston in San Antonio,
the Air Force at Sheppard Air Force Base, Texas, and the Navy at three
locations across the nation.
The services have already proved they can work well together at joint
facilities abroad. Landstuhl Regional Medical Center in Germany has been
a cooperative Army/Air Force effort for more than 10 years. Balad
Hospital in Iraq is also an Army/Air Force facility.
Air Force objections
Still, the Air Force strongly opposes a unified medical command for fear
it would lose some of its service-specific capabilities.
Air Force Secretary Michael Wynne flatly said he is unwilling to cede
control to a centralized medical command, and added that the culture of
the Air Force would suffer if he did.
"Telling me that I have to forgo a unity of command on an individual air
base, from where I fight, and cede that command responsibility to
somebody else so that the wing commander no longer has cognizance over
his pilots' health, is a nonstarter for the Air Force," Wynne said in an
interview.
The Navy and Army, Wynne said, "don't fight from the bases they live
on," which makes them more willing to cede command authority in this
instance.
Under the unified command approach, Navy ships would deploy with Navy
doctors and corpsmen, Army units would deploy with Army doctors and
medics, but Air Force pilots flying bombing runs from their home bases
would return to hospitals manned by all manner of medical personnel.
Air Force Surgeon General Lt. Gen. (Dr.) James Roudebush made it clear,
however, that his service does not oppose the entire idea of a joint
medical command.
"We very strongly agree that there are opportunities for savings" in
such areas as eliminating redundancy and reducing costs on graduate
medical education, information technology, logistics and acquisitions
systems, Roudebush said.
Gains from working together
But Vice Adm. Donald Arthur, the Navy surgeon general, said the services
have nothing to lose and everything to gain by working together more on
the medical front.
"I think we would gain a lot of efficiencies by standardization of
equipment and training and things like that," he said. "What we would
gain is the ability to interoperate in combat service support with the
other services a lot better. So our communication would be better, we
would be able to swap people and equipment, and the flow of patients
would be facilitated."
The main advantage, Arthur said, would be in standardizing "the people
that we have, their training, the equipment, the supplies, the financial
management systems, the metrics, the communication, so that we are more
like a single operating medical system to support the joint war
fighter."
Col. Bernard DeKoning, the Army's assistant surgeon general for force
protection, said his service supports a unified medical command concept,
which he described as an outgrowth of joint efforts that have gone on
for some time. "The services have worked together for years in many
areas of health care, such as research, education, training and in
certain geographic areas where it makes sense to share health care
services," he said.
In congressional testimony earlier this year, Army Surgeon General Lt.
Gen. Kevin Kiley was quite candid in his Army-to-Air Force medical
comparisons.
"They have care in the air; we have care in the dirt," Kiley told the
Senate Appropriations Committee in May. "I very strongly support a
unified medical command."
Congress, for its part, has shown interest in a unified medical command,
but no one is rushing its creation.
The House Appropriations Committee said in its May report on the 2007
defense funding bill that the first thing to be cleared up is whether
the move will save significant money or simply form another level of
bureaucracy.
The committee wants a report from the Pentagon by Dec. 15 on the
feasibility of a unified command and the potential cost savings.
The House Armed Services Committee has expressed interest in any plan
that improves the effectiveness of military medicine, while noting that
the current health system has provided "superior, high-quality health
care."
Change for the sake of change is not going to win lawmakers' approval,
the committee said in its May report on the 2007 defense authorization
bill.
But the report acknowledges that improvements are possible.
Contributing to this report are staff writers Erik
<mailto:[email protected]?subject=Question%20from%20ArmyTimes.co
m%20reader> Holmes, Rick
<mailto:[email protected]?subject=Question%20from%20ArmyTimes.com%20reader
> Maze, Gordon
<mailto:[email protected]?subject=Question%20from%20ArmyTimes
.com%20reader> Lubold, William
<mailto:[email protected]?subject=Question%20from%20ArmyTimes.com%20read
er> H. McMichael and Kelly
<mailto:[email protected]?subject=Question%20from%20ArmyTimes.com%2
0reader> Kennedy.
Army Times
Medical merger
Putting all health workers under one command would standardize training,
boost jointness, doc says
By Gayle
<mailto:[email protected]?subject=Question%20from%20ArmyTimes.c
om%20reader> S. Putrich
Staff writer
The most sweeping overhaul of the military's medical system in more than
60 years would combine all Army, Air Force and Navy hospitals, clinics,
doctors and staff under a single joint medical command.
And it would do all that in the next three months.
The Defense Business Board, a panel of senior business executives who
act as advisers to Defense Secretary Donald Rumsfeld, recommended Sept.
6 that Rumsfeld immediately appoint a transition team and pull together
the unified medical command by Jan. 1.
The Army and Navy support the concept, which, according to the Center
for Naval Analyses, could save $344 million or more. But the Air Force
is vigorously opposed to a wholesale combination of medical assets,
fearing that wing commanders would lose control of a vital support
function on their bases.
Some Defense Department officials, as well as lawmakers, are advocating
a cautious, incremental approach. But board members said there is no
reason to delay.
"We're saying, don't wait until fiscal '08 to begin," said Henry
Dreifus, founder and CEO of Dreifus Associates Limited Inc., a business
consulting firm. Dreifus headed the business board task group that
studied the unified medical command concept.
"There is no reason not to do this sooner," he said.
Under the plan:
* Tricare would need to be realigned to work alongside the new unified
command.
* The Pentagon's Office of Health Affairs would take over policy
control, budget authority and accountability and oversight of all
medical health activities.
* All fixed military clinics and hospitals would come under the unified
command, including research, contracting, logistics and training.
* Emergency and operational field care would stay under the individual
services, at least for the time being.
"The whole idea here is to continue to provide outstanding health care
to the active and the retiree," said William "Gus" Pagonis, head of the
Defense Business Board and a retired Army three-star who served as
logistics chief in the 1991 Persian Gulf War.
What a unified medical command means to the average Joe or Jane is not
yet clear, but redundant medical facilities serving different military
populations likely could be eliminated as those medical facilities start
to look more purple and serve multiple military communities in the Air
Force, Navy, Army and Marine Corps instead of being focused on just one,
board members said.
Training of medical personnel could also be streamlined.
"Part of the unification will then bring the way we educate and train
these people to common standards," Dreifus said. "Common logistics means
you will be able to have better force projection across the services
with the delivery of that medicine and not have people working with
incompatible equipment or procedures."
All this could bring changes to manning within the medical community -
but it does not necessarily mean shrinking medical personnel within the
military, Pagonis said.
Pentagon officials acknowledge that areas such as logistics, operations
and purchasing are replicated in triplicate within each service, said
Dr. David Tornberg, deputy assistant secretary of defense for clinical
and program policy.
Consolidating communications, data sharing and personnel management
would save money - and perhaps, lives - by making delivery of care
quicker and more efficient, he said.
Some hesitation
Still, Pentagon officials are far from ready to jump onboard. Tornberg
said combining some or all of the military's medical efforts into a
joint command is something the Pentagon has been seriously considering
for nearly a year - and they're still not done.
"This is an evolutionary process," Tornberg said. "I'm a proponent of
the concept, but I think it has to be done in a very deliberate way."
Rep. John McHugh, R-N.Y, chairman of the House Armed Services military
personnel panel that has jurisdiction over military medical issues,
agreed, saying unification seems inevitable but should not be rushed.
"It is important we have the best information available so we do this
right because we are, after all, talking about the health of service
members, retirees and their families," he said. "There are
interoperability issues that have to be worked out, which is one of the
major concerns expressed by the Army and Navy."
McHugh suggested a joint medical command could be based on the same
model as the U.S. Special Operations Command.
Operational mission orders come from the joint command and units work
together jointly, but troops still keep all of the benefits, promotion
regulations and traditions of their individual services. The command has
a joint headquarters planning and budgeting staff but also has
lower-level commands for service-specific capabilities.
McHugh said Congress won't move on this immediately, but "we need a
decision by the fiscal 2008 budget."
The BRAC effect
While Tornberg said he is not operating under any sort of time line to
set up a fully functioning joint medical command, there is an
expectation that some changes will have to come sooner rather than
later.
Some of that will be spurred by decisions made in the 2005 base
realignment and closure process, which is already pushing the services
toward increased "jointness" in the health care arena.
Walter Reed Army Medical Center and the National Navy Medical Center in
Bethesda, Md., for example, will cease to exist by the end of fiscal
2011, merging at the Bethesda site to become the Walter Reed National
Military Medical Center.
The Bethesda campus also will continue to be the home of the Uniformed
Services University of the Health Sciences.
The most recent BRAC round also will create the joint San Antonio
Regional Medical Center at Brooke Army Medical Center, where enlisted
medical technicians from all services will train. Medical specialty
training for the Army is now done at Fort Sam Houston in San Antonio,
the Air Force at Sheppard Air Force Base, Texas, and the Navy at three
locations across the nation.
The services have already proved they can work well together at joint
facilities abroad. Landstuhl Regional Medical Center in Germany has been
a cooperative Army/Air Force effort for more than 10 years. Balad
Hospital in Iraq is also an Army/Air Force facility.
Air Force objections
Still, the Air Force strongly opposes a unified medical command for fear
it would lose some of its service-specific capabilities.
Air Force Secretary Michael Wynne flatly said he is unwilling to cede
control to a centralized medical command, and added that the culture of
the Air Force would suffer if he did.
"Telling me that I have to forgo a unity of command on an individual air
base, from where I fight, and cede that command responsibility to
somebody else so that the wing commander no longer has cognizance over
his pilots' health, is a nonstarter for the Air Force," Wynne said in an
interview.
The Navy and Army, Wynne said, "don't fight from the bases they live
on," which makes them more willing to cede command authority in this
instance.
Under the unified command approach, Navy ships would deploy with Navy
doctors and corpsmen, Army units would deploy with Army doctors and
medics, but Air Force pilots flying bombing runs from their home bases
would return to hospitals manned by all manner of medical personnel.
Air Force Surgeon General Lt. Gen. (Dr.) James Roudebush made it clear,
however, that his service does not oppose the entire idea of a joint
medical command.
"We very strongly agree that there are opportunities for savings" in
such areas as eliminating redundancy and reducing costs on graduate
medical education, information technology, logistics and acquisitions
systems, Roudebush said.
Gains from working together
But Vice Adm. Donald Arthur, the Navy surgeon general, said the services
have nothing to lose and everything to gain by working together more on
the medical front.
"I think we would gain a lot of efficiencies by standardization of
equipment and training and things like that," he said. "What we would
gain is the ability to interoperate in combat service support with the
other services a lot better. So our communication would be better, we
would be able to swap people and equipment, and the flow of patients
would be facilitated."
The main advantage, Arthur said, would be in standardizing "the people
that we have, their training, the equipment, the supplies, the financial
management systems, the metrics, the communication, so that we are more
like a single operating medical system to support the joint war
fighter."
Col. Bernard DeKoning, the Army's assistant surgeon general for force
protection, said his service supports a unified medical command concept,
which he described as an outgrowth of joint efforts that have gone on
for some time. "The services have worked together for years in many
areas of health care, such as research, education, training and in
certain geographic areas where it makes sense to share health care
services," he said.
In congressional testimony earlier this year, Army Surgeon General Lt.
Gen. Kevin Kiley was quite candid in his Army-to-Air Force medical
comparisons.
"They have care in the air; we have care in the dirt," Kiley told the
Senate Appropriations Committee in May. "I very strongly support a
unified medical command."
Congress, for its part, has shown interest in a unified medical command,
but no one is rushing its creation.
The House Appropriations Committee said in its May report on the 2007
defense funding bill that the first thing to be cleared up is whether
the move will save significant money or simply form another level of
bureaucracy.
The committee wants a report from the Pentagon by Dec. 15 on the
feasibility of a unified command and the potential cost savings.
The House Armed Services Committee has expressed interest in any plan
that improves the effectiveness of military medicine, while noting that
the current health system has provided "superior, high-quality health
care."
Change for the sake of change is not going to win lawmakers' approval,
the committee said in its May report on the 2007 defense authorization
bill.
But the report acknowledges that improvements are possible.
Contributing to this report are staff writers Erik
<mailto:[email protected]?subject=Question%20from%20ArmyTimes.co
m%20reader> Holmes, Rick
<mailto:[email protected]?subject=Question%20from%20ArmyTimes.com%20reader
> Maze, Gordon
<mailto:[email protected]?subject=Question%20from%20ArmyTimes
.com%20reader> Lubold, William
<mailto:[email protected]?subject=Question%20from%20ArmyTimes.com%20read
er> H. McMichael and Kelly
<mailto:[email protected]?subject=Question%20from%20ArmyTimes.com%2
0reader> Kennedy.
