All Branch Topic (ABT) $43 B For Staffing MTF’s

[militaryPHYS]

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Members don't see this ad.

DHA chooses 11 for $43B medical staffing vehicle

These awards are for the unrestricted portion and the Defense Health Agency is still working on the small business track's source selection.

www.washingtontechnology.com

DHA spending big money on staffing MTF’s. Building/expanding is a refreshing thing to hear.

 

[MedicalCorpse]

But wait...wasn't the whole idea of "rightsizing" military health care over the past three decades to save money?

Now we're going to spend more than twice as much to staff Military Treatment Facilities (MTFs) using civilian contractor hiring agencies than we would have if we had only kept the real Walter Reed, Wilford Hall, and other bulldozed major hospitals open and just hired active duty docs to staff them with a small part of that $43 billion dollars. So, is it finally time to admit that the Pentagon severely "wrongsized" military health care, to the permanent detriment of our troops, their families, and retirees who got poor or no care as a result?

Oh, and let's not forget the wonderful track record of contractors when they are tossed billions of dollars with inadequate oversight (hint: government oversight is always inadequate).

Lets start with KBR:

Despite Alert, Flawed Wiring Still Kills G.I.’s (Published 2008) (sadly, there was a paywall the second time I went there)

"American electricians who worked for KBR, the Houston-based defense contractor that is responsible for maintaining American bases in Iraq and Afghanistan, said they repeatedly warned company managers and military officials about unsafe electrical work, which was often performed by poorly trained Iraqis and Afghans paid just a few dollars a day."

"One electrician warned his KBR bosses in his 2005 letter of resignation that unsafe electrical work was “a disaster waiting to happen.” Another said he witnessed an American soldier in Afghanistan receiving a potentially lethal shock. A third provided e-mail messages and other documents showing that he had complained to KBR and the government that logs were created to make it appear that nonexistent electrical safety systems were properly functioning."

Wiring warning came months before soldier electrocuted - CNN.com (no paywall)

"Wiring warning came months before soldier electrocuted

• Story Highlights
• Sergeant complained about bad wiring months before another soldier died
• Soldier testified Wednesday that he sent a work order to fix the problem in 2007
• Staff Sgt. Ryan Maseth was electrocuted in a shower in the same quarters in 2008
• Executive from electrical contractor KBR blamed Army for wiring issue"

"He said the Army never authorized the electrical repairs identified in early 2007 or in a follow-up report that November. But Waxman said the Army had been warning of electrical hazards in Iraq since 2004, including one fatality similar to Maseth's.

A report that year warned U.S. commanders that contractors must properly ground electrical systems. "But despite these warnings, few actions were taken by Pentagon leadership or KBR officials," Waxman said.

Jeffrey Parsons, executive director of the Army Contracting Command, said the service does not have the expertise to adequately oversee contractors' electrical work."

Blink. So where will DHA get the expertise to oversee contractors' health care "provider" hiring work? Some of the corporations listed in the contract award are only a few years old. What's the probability that they have the first clue how to do the job being asked of them starting three months ago? Again, according to Defense Daily: "The period of performance is June 1, 2024, to May 31, 2034."

I'd help provide oversight for the right price...but they wouldn't give me a lousy million dollars, because they need that money to give billions to contractors instead, so the officials can get cushy, remunerative jobs with those same contractors when they leave the government. Did I say the quiet part out loud?

...and that's just the tip of the iceberg:

kellogg brown and root shoddy work iraq at DuckDuckGo

I have all faith that the Pentagon will get it right this time after 30 years of getting it wrong.

All we needed was *more* civilian contractors to siphon 75 cents off the dollar to give to their C-suites and shareholders in lieu of providing actual competent caregivers rather than the least expensive, least educated, least motivated mor0ns who barely qualify on paper they can find.

And where does that $43B come from? Do you hear that sound? It's the Fed printing money to push our nation further into debt, after we've been throwing cash at foreign governments as if we were "making it rain" at some lavish wedding.

Brilliant.

(end part 1)

 

[armytrainingsir]

Are you implying that the contractor ’US Got People’ isn’t worthy of a slice of that 43 billion??

hahahahahaha

 

[MedicalCorpse]

(part 2)
================================================================================
Excerpt from my still-unwritten book:

Military Medical Corpse: The Death of the Doctor in Military Medicine

Chapter 26: Snoutsourcing: Greedy Pigs Feeding at the Taxpayer Trough

from: Ignored Warnings Left the Military Health System Unprepared

"On the business side of things, outsourcing makes a great deal of sense to the civilian hospital administrators. The Pentagon provides them with a lot of business and pays its bills on time. As with all things related to the military, contracts for the military’s TRICARE civilian health care plan are lucrative. The Pentagon awarded California-based Health Net Federal Services a $17.7 billion contract in 2016 to manage the military’s western TRICARE region for five years. At the same time, Kentucky-based Humana received a $40.5 billion contract to manage the eastern region for five years. The Pentagon can and does use contractor medical personnel for deployments, but contractors are expensive. One job posting on the Defense Health Agency’s website for an emergency room physician position in South Korea pays as much as $365,000 per year. When a contracting firm’s billing rates are added on top of the salary, the cost to the taxpayer could more than double. A previous POGO investigation found the annual billing rate for contract nurses was, on average, 65% more than the federal employee’s average salary."

http://www.washingtonpost.com/wp-dyn/content/article/2005/06/27/AR2005062701220.html (link now dead of bit rot)

From Information Week IT salary survey, 25 April 05: Satisfied but Uncertain, by Eric Chabrow, p. 40

"Overwhelmingly, the survey-takers contend that the current trend toward outsourcing harms the IT profession: 68% say the results of outsourcing are fewer IT jobs; 61%, lower employee morale; 53%, new hires receive reduced salaries; and 42%, fewer chances for advancement."

=================================================================================

from: Contract Award: The Arora Group Inc. Gaithersburg Maryland (HT001524D9000); Decypher Health Services LLC San Antonio Texas (HT001524D9001); Dilligas Corp. doing business as U.S. Got People San Antonio Texas (HT001524D9002); Federal Staffing Resources LLC doing business as Epic Government Annapolis Maryland (HT001524D9003); KBR Wyle Services LLC Fulton Maryland (HT001524D9004); Loyal Source Government Services LLC Orlando Florida (HT001524D9005); Luke & Associates Inc. Rockledge Florida (HT001524D9006); Matrix Providers Inc. Denver Colorado (HT001524D9007); Optumserve Health Services Inc. La Crosse Wisconsin (HT001524D9008); Spectrum Healthcare Resources Inc. St. Louis Missouri (HT001524D9009); and Vesa Health & Technology Inc. San Antonio (Texas (HT001524D9010), will share a multiple award) - $43,000,000,000 - Defense Daily

"Contract Award:

The Arora Group Inc. Gaithersburg Maryland (HT001524D9000);"

from: Arora Group, Inc. v. U.S., No. 04-366C | Casetext Search + Citator

"In fact, the contracting officer's assessment of Arora, as recorded in each of her post-competitive range determination evaluations, demonstrates that she concluded that while Arora received excellent reviews from its references, 'they do not appear to have a record of performance (current or last three (3) years) in providing these services in the size and scope of this requirement (multi-state; multi-facility; multi-agency).'"

Decypher Health Services LLC San Antonio Texas (HT001524D9001);

Previously known as Psi-Decypher Government Solutions, LLC or Decypher-PSI (Protection Services Incorporated)

Decypher Health Services, LLC · 200 Concord Plaza Drive, Suite 780, San Antonio, TX 78216-6972

"Overview

DECYPHER HEALTH SERVICES, LLC is an entity in San Antonio, Texas registered with the System for Award Management (SAM) of U.S. General Services Administration (GSA). The entity was registered on March 10, 2023 with Unique Entity ID (UEI) #SW8EGTBBMA44, activated on February 19, 2024, expiring on February 14, 2025, and the business was started on December 9, 2022. The registered business location is at 200 Concord Plaza Drive, Suite 780, San Antonio, TX 78216-6972. The current status is Expired. The entity structure is 2L - Corporate Entity (Not Tax Exempt) - . The business types are 2X - For Profit Organization. The officers of the entity include [Redacted] (CFO)."

USAspending.gov

Given $11M for work with AFOSI. That's perfect training for choosing physicians, I guess.

Dilligas Corp. doing business as U.S. Got People San Antonio Texas (HT001524D9002);

https://www.justice.gov/d9/2024-02/1526.pdf

"This case arises under the Immigration and Nationality Act, as amended by the Immigration Reform and Control Act of 1986, 8 U.S.C. § 1324a. Complainant, the United States Department of Homeland Security, Immigration and Customs Enforcement, filed a complaint with the Office of the Chief Administrative Hearing Officer (OCAHO) against Respondent, Dilligas Corporation, doing business as US Got People, on June 23, 2023. Complainant alleges that Respondent failed to prepare and/or present Forms I-9 for seven individuals, in violation of 8 U.S.C. § 1324a(a)(1)(B). Compl. ¶ 6. Complainant further alleges that Respondent failed to ensure proper completion of Section 1 and/or failed to properly complete Section 2 or 3 of Forms I-9 for seventy individuals, also in violation of 8 U.S.C. § 1324a(a)(1)(B)."
...
"On February 26, 2024, the parties filed by facsimile and email a Joint Motion to Dismiss Complaint. In the joint filing, the parties moved the Court to dismiss the case without prejudice and explained that they had reached a “full agreement” in this matter."
...
"The Court notes that the parties did not file a copy of their settlement agreement. It is within the Court’s discretion to order them to do so. See 28 C.F.R. § 68.14(a)(2). After considering the nature of these proceedings and the record before the Court, including that both parties are represented by counsel and have been actively participating in this matter, the Court will not require the parties to file their settlement agreement and now rules on their pending motion."

Translation: We the people will never find out the details of the settlement agreement because (secret money? special favors? both?).

Not a scientific poll, but not exactly reassuring:

https://www.glassdoor.com/Reviews/U-S-Got-People-Reviews-E1320586.htm

"1.0 *
Sep 10, 2022
Garbage
Anonymous employee
Former employee, less than 1 year
...

Pros

There are no pros working for this company.

Cons

This company does not care about its employees."

https://www.glassdoor.com/Reviews/U-S-Got-People-Reviews-E1320586_P3.htm?filter.iso3Language=eng

"1.0 *
Sep 2, 2020
NO good
Recruiter
Former employee, more than 1 year
...

Pros

Location is nice . Close to pearl and downtown

Cons

Bad Business, untrustworthy people and shady business practices."

And what's up with "U.S. Got People"? Who came up with that name? How about "The Be To Of And A Corporation, LLC?". See: Most common words in English - Wikipedia

Federal Staffing Resources LLC doing business as Epic Government Annapolis Maryland (HT001524D9003);

(Formerly FSR as above. Still looking. There's just so much "epic government failure" on the internet that it interferes with searches. Maybe that was the idea for the name change. Hmmm. Where's my tinfoil hat when I need it?)

KBR Wyle Services LLC Fulton Maryland (HT001524D9004);

KBR to Acquire Government Services Company, Wyle

"KBR to Acquire Government Services Company, Wyle

...

HOUSTON, Texas - May 23, 2016 - KBR, Inc. (NYSE: KBR) announced today it has entered into a definitive agreement to acquire Wyle, Inc., a leading provider of specialized engineering, and professional, scientific and technical services primarily to the U.S. federal government."

Whistleblower exposes $7 billion no-bid Defense Department contract

"Last decade, when American was embroiled in the Iraq War, a high-ranking U.S. Army Corps of Engineers put her career on the line to stand up to some of the most powerful men in America. She believed that a major corporation had been benefiting from a collection of well-connected contracts that were costing taxpayers tens of millions of dollars in waste, fraud and abuse.

Although she was warned against it by supervisors, she blew the whistle on national TV in front of a Senate committee. "My name is Bunnatine H. Greenhouse. I have agreed to voluntarily appear at this hearing," she addressed the committee.

Bunny Greenhouse was an unlikely whistleblower. In 2005, Greenhouse was the highest-ranked civilian at the U.S. Army Corps of Engineers.

"When I took my oath of office it said that you will conduct the business of contracting impartially … and with preferential treatment toward none. I saw preferential treatment toward KBR," she told "Whistleblower" host Alex Ferrer in "Bunny's War: The Case Against the U.S. Army Corps of Engineers."

KBR was Kellogg Brown and Root — back then, a wholly-owned subsidiary of the oil services firm Halliburton. In the weeks prior to the invasion, Greenhouse learned that KBR was being considered for a massive no-bid contract known as Restore Iraqi Oil, or RIO.

"What was the size of this contract?" Ferrer asked.

"Seven billion dollars," she replied.

...

For Greenhouse, biting her tongue was never an option. "I can unequivocally state that the abuse related to contracts awarded to KBR represents the most blatant and improper contract abuse I have witnessed during the course of my professional career," she told the Senate committee.

Loyal Source Government Services LLC Orlando Florida (HT001524D9005);

Whistleblower Says Border Patrol Didn’t Properly Vet Medical Contractor Before 8-Year-Old’s Death

"Whistleblower Says Border Patrol Didn’t Properly Vet Medical Contractor Before 8-Year-Old’s Death
...
Nov 30, 2023,02:56pm EST

"A senior Customs and Border Protection official wrote a letter to Congress Thursday where he alleged that CBP failed to adequately monitor its medical service contractor before an 8-year-old died in U.S. custody in May...

In the letter, an attorney for Troy Hendrickson, a 15-year veteran at the CBP, said he had raised concerns about the agency’s medical contractor, Loyal Source Government Services, which was responsible for providing medical services and received a $25 million-per-month contract from the CBP, according to the Washington Post.

Hendrickson alleged the company was understaffed by 40%, employees lacked proper licenses and clearances and the company made billing errors that he said led to millions of dollars in overpayments and other problems."

Luke & Associates Inc. Rockledge Florida (HT001524D9006);

https://www.floridatoday.com/story/...issioner-wins-7-5-billion-contract/806337001/

"Rockledge company, headed by county commissioner, wins $7.5 billion contract

(Obligatory grinning picture)

Brevard County Commissioner Jim Barfield and president and CEO of the Rockledge-based Luke & Associates.

ROCKLEDGE — Luke & Associates Inc., the company headed by Brevard County Commissioner Jim Barfield, has won a $7.5 billion contract from the Defense Health Agency to provide medical staff services to the U.S. military.

Since Luke & Associates started — its name honors Luke the apostle/physician in the Bible — the company has hired more 3,400 health care professionals and treated thousands of patients at more than 80 military installations worldwide."

Oh Jes--- Chr---, this politician thinks he's an associate of the Apostle Luke? Really?

No wonder he gets contracts from the United States Air Force Under Jesus:

united states air force academy religion scandal at DuckDuckGo
Air Force Academy chaplain says she was fired for speaking out on religious climate
Air Force Academy Instructor Outrageously Asks Cadet If He’s Accepted Jesus Christ; Then Implores Cadet Not To Run To Mikey Weinstein!
Military Religious Freedom Foundation Homepage

Matrix Providers Inc. Denver Colorado (HT001524D9007);

(Still looking. Way too many references online to the movies of that name. Once again, this gums up search engines, especially if the company has utilized any kind of Search Engine Optimization (SEO) [I finally found my tinfoil hat]. At least the CEO is a former military physician who doesn't appear to have obvious Pentagon crony connections, unlike others I could mention.)

Optumserve Health Services Inc. La Crosse Wisconsin (HT001524D9008);

(some words on the following page and comments below it are Not Safe For Work):

Reddit Link: r/VeteransBenefits/comments/16jli8h/optum_serve_caught_redhanded_filing_false/ (can't link to Reddit here I guess...link gets replaced with huge "Media" image)

"I made another VERA virtual appt for 9/14 and requested same rep who helped me on 9/13. I spoke with the same rep from previous day and told him about the phone calls. He looked in my file on VBMS and said that O.S. had filed an exam report on afternoon of 9/13 to make it look like an exam had been done and was only waiting for additional paperwork to be included. I informed him nothing had been done as of the time of my phone calls on 9/13. VERA rep said I can write a Vendor Complaint against LHI/Optum Serve and upload to my file. He said the more vets that file complaints is the more squeaky wheels there are in the system. He also said they are already starting to draw a lot more attention. I will also be sending this complaint to my congressman."

Whistleblower Releases Audio, Files Complaint: Cites Medical Billing Plot at Optum | The Examiner News

"The revelation involves grave concerns cited by a whistleblower about an alleged local Optum Tri-State strategy to manipulate patient diagnoses and secure more revenue by bilking the federal government through value-based incentive compensation via the Centers for Medicare & Medicaid Services, or CMS."

Formerly LHI (Logistics Health Incorporated):

Loading...

"Today, LHI is the federal health services business of both Optum and UnitedHealth Group (NYSE: UNH). It brings together the vast resources and clinical insights of UnitedHealthcare's unique health services, along with the innovation, technology and scalability of Optum."

Any physician who reads the words "United Health Care Group" will understand why I am shuddering right now. One of these days I'll retell the true story of the infamous Two Ball Denial that happened to my ex-USAF FP ex-wife, starring United Health Care...

Spectrum Healthcare Resources Inc. St. Louis Missouri (HT001524D9009);

Spectrum’s Attorneys Entitled to Higher Protest Fees Recovery

"Spectrum’s Attorneys Entitled to Higher Protest Fees Recovery

Spectrum Healthcare’s recovery should exceed cap
FEMA didn’t oppose cost of living adjustment calculation

Attorneys for Spectrum Healthcare Resources Inc. should receive fees that exceed the statutory limit of $150 per hour for their work on a FEMA medical services contract protest, the GAO said in a decision released Wednesday.

Spectrum demonstrated that its attorneys’ fees award should range between $289 and $291 per hour, totaling $29,111, the Government Accountability Office said.

The $150 hourly rate is stipulated by the Competition in Contracting Act, but recovery may be higher if there’s a cost of living increase or a “special factor” such as limited availability of qualified attorneys justifies an increase, the GAO said."

Wish I could make that much money per hour.

Vesa Health & Technology Inc. San Antonio (Texas (HT001524D9010)

Platinum Business Corporation

"Platinum Business Corporation (PBC), of Laurel, Maryland, protests the award of a contract to Vesa Health & Technology, Inc., of San Antonio, Texas, under request for proposals (RFP) No. HSCG23-17-R-P1C000, issued by the Department of Homeland Security, United States Coast Guard, for multidisciplinary personal healthcare services. PBC asserts that the agency improperly waived material solicitation requirements when evaluating the awardee's price proposal.

We deny the protest.
We deny the protest.

DOCUMENT FOR PUBLIC RELEASE
The decision issued on the date below was subject to a GAO Protective Order. This redacted version has been approved for public release.

Decision

Matter of: Platinum Business Corporation

File: B-415584

Date: January 18, 2018

Ah, the spring-fresh smell of government decisions funneling your taxpayer dollars behind closed doors to private, for-profit corporations in a completely transparent and unbiased manner! I need some of that on my dryer sheets! (Emphasis on "sheet", Sherlock.)

Contract Award: The Arora Group Inc. Gaithersburg Maryland (HT001524D9000); Decypher Health Services LLC San Antonio Texas (HT001524D9001); Dilligas Corp. doing business as U.S. Got People San Antonio Texas (HT001524D9002); Federal Staffing Resources LLC doing business as Epic Government Annapolis Maryland (HT001524D9003); KBR Wyle Services LLC Fulton Maryland (HT001524D9004); Loyal Source Government Services LLC Orlando Florida (HT001524D9005); Luke & Associates Inc. Rockledge Florida (HT001524D9006); Matrix Providers Inc. Denver Colorado (HT001524D9007); Optumserve Health Services Inc. La Crosse Wisconsin (HT001524D9008); Spectrum Healthcare Resources Inc. St. Louis Missouri (HT001524D9009); and Vesa Health & Technology Inc. San Antonio (Texas (HT001524D9010), will share a multiple award) - $43,000,000,000 - Defense Daily

"...will share a multiple award) – $43,000,000,000"

...which I am now 100% sure will be administered without any fraud, waste, or abuse whatsoever.

 

[militaryPHYS]

Wow, it is incredible how much time you must have spent on that. Kudos

 

[DrMetal]

We don't have a staffing issue. Walk around any local MTF or branch clinic: note the dearth of patients (especially on a Friday). Note the staff sitting around and not doing much. (I give only exceptions to Peds/OB, they seem busy still).

We have a patient volume issue.

 

[MedicalCorpse]

We have a patient volume issue.

Does anyone have any idea what caused that? Anyone? Bueller?

BLUF (Bottom Line Up Front): What we really have is a bunch of politicians who want to give for-profit civilian contractors billions of taxpayer dollars for their own jircle cerk benefit. The fact that the contractors are both incompetent to provide the services they are promising and are expected to siphon off most of the money for themselves is irrelevant. As long as the DHA functionaries get post-government jobs and our political leaders get kickbacks in the form of donations and other benefits, the endless cycle of Military-Industrial Complex graft grinds its way into the future. In the best case scenario, the worst possible human caregivers are paid the lowest amount of money to care for our troops, their families, and (maybe) a few retirees face to coughing face.

In reality, their plan is to upgrade everyone to Tricare Super Platinum, which involves downloading an app you can use to interact with your friendly TricAIr LLM avatar to diagnose your illness.

Great news: the AI is now authorized to send your prescription to the nearest pharmacy, which can deliver the medications to your door for a small price, with no need for a slow, poorly trained human in the loop at all!

Even better news: self-serve U.S. Aaaaah!-branded appendectomy kits are on sale, with full audio and video guidance at no extra charge! Double your money back if you die! Can't beat that deal with a piece of those things with leaves we used to have not so long ago!

 

[deleted551990]

We don't have a staffing issue. Walk around any local MTF or branch clinic: note the dearth of patients (especially on a Friday). Note the staff sitting around and not doing much. (I give only exceptions to Peds/OB, they seem busy still).

We have a patient volume issue.

Check the er waiting room. Usually where I find them

 

[militaryPHYS]

If your department is short on staffing I would have a list of those positions at the ready because that money will be funneling down in the near future. Those who are ready to hire and can show the need will get the positions.

 

[militaryPHYS]

We don't have a staffing issue. Walk around any local MTF or branch clinic: note the dearth of patients (especially on a Friday). Note the staff sitting around and not doing much. (I give only exceptions to Peds/OB, they seem busy still).

We have a patient volume issue.

Building back. Our enrollment targets are increasing regularly. I’m thinking in 5 years we will be back to early 2000 levels as the civilian staffing for primary care increases.

 

[Mace1370]

We don't have a staffing issue. Walk around any local MTF or branch clinic: note the dearth of patients (especially on a Friday). Note the staff sitting around and not doing much. (I give only exceptions to Peds/OB, they seem busy still).

We have a patient volume issue.

This isn't true at all. My department is severely understaffed and has been since Covid (prior to Covid we were only somewhat understaffed). Despite being so understaffed, we have had multiple contractors quit over the last year or two and DHA refuses to refund those positions. We are told there is no money for new hires, period. The staffing shortage has resulted in massive delays in patient care, compromised the quality of residency education, and resulted in a safety stand-down for the entire department a few years ago.

Due to the dire nature of the situation and a congressional inquiry we were authorized a couple of emergency positions. HR refuses to offer market rate for these positions, so they are all essentially dead in the water. We have gone through multiple rounds of interviews, candidate selection, and salary negotiations only to have the selected candidate dip at the last minute because their original employer offered them $10k more.

I'll believe DHA has increased spending money on staffing when I see it. So far I have seen no evidence of that.

 

[militaryPHYS]

This isn't true at all. My department is severely understaffed and has been since Covid (prior to Covid we were only somewhat understaffed). Despite being so understaffed, we have had multiple contractors quit over the last year or two and DHA refuses to refund those positions. We are told there is no money for new hires, period. The staffing shortage has resulted in massive delays in patient care, compromised the quality of residency education, and resulted in a safety stand-down for the entire department a few years ago.

Due to the dire nature of the situation and a congressional inquiry we were authorized a couple of emergency positions. HR refuses to offer market rate for these positions, so they are all essentially dead in the water. We have gone through multiple rounds of interviews, candidate selection, and salary negotiations only to have the selected candidate dip at the last minute because their original employer offered them $10k more.

I'll believe DHA has increased spending money on staffing when I see it. So far I have seen no evidence of that.

This is valid and I have also seen it locally. Most MTF’s are feeling the same I would bet.

Pretty sure this is reason the $43B was awarded. DHA slimmed, cut as much as possible and now needs to rebuild with civilian staff at competitive salaries to keep MTF’s running regardless of military billets be because they are unreliable.

None of this money has hit the networks yet as far as I know. Will take months/years

 

[ProwlerturnGas]

I was looking at a contractor position last year. Would have worked well for me. The rep quoted the salary and I laughed. I didn’t mean to laugh but it was so outrageous and under-market that it reflexively came out.

 

[Correlate Clinically]

There is a pre-existing DHA enterprise contract mechanism to hire "healthcare workers", including physicians. I forget the name, but I have never seen it used and only seriously discussed for low level, non-patient care positions. I have heard it was kind of a cluster to deal with. Maybe they are doubling down on something like that program.

CTRs are better than nothing. The business model is absolutely crazy. DHA often actually pays the staffing companies at or above market rate for the position. The company skims off a massive percentage, then turns around and hires whoever is willing to work for half as much as the private group down the street. How this is financially better than GS or AD stumps me.

There are always a few good physician contractors who stick around. Often prior service or just people who have a particular situation that makes the job somehow a good fit for them. More often than not the position goes vacant or, well, you get what you get. Since the services control manning and seen hell bent on gutting all their respective medical corps, maybe contractors are DHA's only way to try to recapture bodies.

Are enterprise contracts like this still FTCA covered like a personal services contract?

 

[Apollyon]

Are enterprise contracts like this still FTCA covered like a personal services contract?

I would guess no, because I work for a company that contracts to the VAMC, so all my files are directly from the VA, but I have to have my own malpractice.

 

[Mace1370]

This is valid and I have also seen it locally. Most MTF’s are feeling the same I would bet.

Pretty sure this is reason the $43B was awarded. DHA slimmed, cut as much as possible and now needs to rebuild with civilian staff at competitive salaries to keep MTF’s running regardless of military billets be because they are unreliable.

None of this money has hit the networks yet as far as I know. Will take months/years

I hope the money comes eventually. I'm a little skeptical because some these positions have been largely open for about 10 years. I'm at Walter Reed and DHA refuses to offer more than 90-100k/year for a PA. There are numerous open civilian positions in the area for 130+/year. Over the past 10 years the positions have only been held by spouses of active duty who just wanted to work near their significant other or people with major red flags (like active opioid addiction). Even once the money arrives I don't really see DHA raising the salary cap. Things are limping along as is, so why actually hire more people?

 

[militaryPHYS]

I hope the money comes eventually. I'm a little skeptical because some these positions have been largely open for about 10 years. I'm at Walter Reed and DHA refuses to offer more than 90-100k/year for a PA. There are numerous open civilian positions in the area for 130+/year. Over the past 10 years the positions have only been held by spouses of active duty who just wanted to work near their significant other or people with major red flags (like active opioid addiction). Even once the money arrives I don't really see DHA raising the salary cap. Things are limping along as is, so why actually hire more people?

Because they consolidated, cut and deferred so much to get us here today. Now they have to start allocating money to build and improve because they are responsible for the care of DOD forces and other beneficiaries.

The new contract is so much because it is specifically designed to be competitive across different cost of living regions.

A Revolution in Military Medical Staffing is Afoot and Private Sector Firms are Playing a Big Part - MedCity News

No revolutionary naval vessels, fighter planes, or weapon systems were involved. Rather, this one was about staffing military healthcare facilities. Make no mistake, though: It’s also revolutionary.

medcitynews.com

But I’m probably hoping way too much.

 

[pgg]

Because they consolidated, cut and deferred so much to get us here today. Now they have to start allocating money to build and improve because they are responsible for the care of DOD forces and other beneficiaries.

The new contract is so much because it is specifically designed to be competitive across different cost of living regions.

A Revolution in Military Medical Staffing is Afoot and Private Sector Firms are Playing a Big Part - MedCity News

No revolutionary naval vessels, fighter planes, or weapon systems were involved. Rather, this one was about staffing military healthcare facilities. Make no mistake, though: It’s also revolutionary.

medcitynews.com

But I’m probably hoping way too much.

That's a pretty enthusiastic article.

Editor’s note: The author’s company was one of the healthcare medical staffing agencies awarded contracts.

Oof


I worry there's a very large chicken-egg problem. They let the system atrophy so much, it now lacks both staff and patients.

They can't ramp up the patient volume and case complexity without more staff, and manning up with capable people is going to be hard while there's nothing for them to do.

And that's assuming they can even pull retirees back in / away from the VA at all. The pathology isn't in the active duty and AD-dependent groups. Will they try to start strongarming retirees with various flavors of Tricare back to MTFs? (Small scale efforts to do this haven't gone well.)

The root cause of the military health system's problem is mainly lack of patients dating back to decisions made in the 90s and earlier. We spent 30 years chasing patients away. Staff cuts and skill atrophy for those who remained followed as a consequence.

It's good there's commitment to hiring staff. It's a positive step. Where are the patients going to come from?

We closed the CT surgery program at NMCP primarily because market analysis showed there weren't enough MTF-care-eligible hearts in the catchment area to gainfully employ a program, even assuming 100% capture.

 

[militaryPHYS]

For instance, at my current location there used to be 100k ish patients enrollled to the MTF. Currently there is about 65k ish from the chasing away.

Slowly all AD will come back, then family members and retirees.

They have a good idea of max amount we could eventually have enrolled based on local population so civilian staffing models can be built off of that as patients return.

Intent is likely never to bring back cases like hearts or transplants which are expensive programs to maintain and volume would be relatively low. Plus most places already have great MOU’s established.

 

[DrMetal]

And that's assuming they can even pull retirees back in / away from the VA at all. The pathology isn't in the active duty and AD-dependent groups. Will they try to start strongarming retirees with various flavors of Tricare back to MTFs? (Small scale efforts to do this haven't gone well.)

Absolutely correct.

If the left end of the spectrum is a low-acuity, glorified outpatient/urgent care model of medicine. and the right end is a fully functioning medical center doing complex care . . . we are definitely more towards the left.

And quite frankly, it would make more sense to continue going left. Defer everyone to the civilian network and shut it all down. No one would fault us for it, it's the Dept of Defense, not the Dept of Health Care.

Need a trauma surgeon for the next war? Look for her at your local civilian university. You won't find an experienced one on active duty.

 

[armytrainingsir]

Now retired from the reserves, knowing what I know, no way would I voluntarily go back into a DoD facility unless for a very specific issue and personality knowing the doc taking care of it.

And that’s just sad, but the military killed milmed, so don’t get mad at me for agreeing that milmed is a dead man walking.

 

[Correlate Clinically]

Now retired from the reserves, knowing what I know, no way would I voluntarily go back into a DoD facility unless for a very specific issue and personality knowing the doc taking care of it.

And that’s just sad, but the military killed milmed, so don’t get mad at me for agreeing that milmed is a dead man walking.

Depending on the day, it's pretty depressing.

We can do healthcare well and we have done it well in the past; that past is getting further and further away. DoD/DHA is shooting itself repeatedly in the foot and just keeps going.

 

[pawprint]

You can’t defer people to the civilian network if no civilian doctors accept Tricare due to its abysmal reimbursement. We seem to overlook that tiny detail that’s critical for the civilian deferred care to work.

 

[armytrainingsir]

You can’t defer people to the civilian network if no civilian doctors accept Tricare due to its abysmal reimbursement. We seem to overlook that tiny detail that’s critical for the civilian deferred care to work.

True, but I have yet to see a hospital system (in the SE) and its legion of employed physicians not take tricare. And I would imagine the bad PR would be incredible if one tried to stop.

 

[Chonal Atresia]

For instance, at my current location there used to be 100k ish patients enrollled to the MTF. Currently there is about 65k ish from the chasing away.

Slowly all AD will come back, then family members and retirees.

They have a good idea of max amount we could eventually have enrolled based on local population so civilian staffing models can be built off of that as patients return.

Intent is likely never to bring back cases like hearts or transplants which are expensive programs to maintain and volume would be relatively low. Plus most places already have great MOU’s established.

Always the cheerleader.....IMO this is a pipe dream and will never happen. Milmed is dying a slow death.

 

[pawprint]

True, but I have yet to see a hospital system (in the SE) and its legion of employed physicians not take tricare. And I would imagine the bad PR would be incredible if one tried to stop.

I work at a military clinic at a city in the SE that struggles sending referrals out into the network because of the low Tricare acceptance rate. There is 1 GI doctor in town that takes it, which makes it effectively impossible to get my patients scheduled with him. Same goes for ENT and Derm. We have zero neurologists that take Tricare. That was a joy to deal with when one of my sailors had a seizure and I had to coordinate follow up care in another state.

 

[militaryPHYS]

Poor reimbursement and lack of network clinics that will see tricare patients wasn’t accounted for in the initial pause, downsize, defer plan. It is a HUGE obvious issue that is now causing a big shift in plans of action.

More money to hire, optimize hospitals that remain, bring back patients to MilMed system. That’s where things seem to be right now. We are at a low from the decisions made by prior leadership and generations but the shift in priority is palpable and DHA is putting money out there to build back better.

 

[RE-Tired]

Change change change; Military med always changing but never really getting better; Was in 20 years (Army) and 10 more civ at (left 2019) same hospital I retired from with time in-between in private practice. My simple conclusion was health care does not exist for the soldiers or the healthier care workers. It exists so medical management (MC, NC, MSC) have the ability to have careers and advance in them. Twice yes twice duiring my time we changed admin (same hospital) from the 4 leaders ((Commander (used to be MC) and 3 below the Commander ( 1 each MC, NC, MSC)). I think the last time under this "silo method" there were 10 or so positions of admin created between the top 3 and all departments. Our dept (lab) was under the former Chief of Pharmacy along with pharmacy and radiology. I have a very high respect for the knowledge pharmacists have but this person did not have a CLUE how the lab worked. So we spent more or our time having another hoop to pass thru to get what we needed. This action impaired the how the lab worked.
And yes a Doctor (MC) in charge knows more about the lab and if they are smart understands that we lab rats understand how to run our shop.
I can't add up how many meetings and time all the admin people had us spend meeting their "needs" when we could be doing patient service. And yes the meetings ALWAYS were considered more important than anything else including direct patient care .
And everyone remember at many meetings there is usually one person who likes to say something about every topic even if it was not in their field.
I never said anything unless I was asked. No one wants to hear a "lab rat's" opinion on how to reduce wait time in the ER. ER wait time was a constant topic for all of my 30 years. Sorry starting to digress.

 

[RE-Tired]

I want to just add one more thing RE: DHA. DHA was starting when I left as a Civilian, 3 of my former colleagues who wanted to stay in the Military until retirement (all very good HPSP military residency trained Docs) left. Why: because pathologists not being a deployable asset are considered worthless for promotion unless they want to be admin. All 3 (one at VA) are doing great and for them this was the best thing. But the Army lost 3 very good doctors. So I agree with most posters I don't think the new money will help. The whole admin system needs to change- will never happen. Admin exists for their careers.

 

[militaryPHYS]

The whole admin system needs to change- will never happen. Admin exists for their careers.

Who else is going to do it? If we hire civilians and then change the way MC can promote, sure…more time for each of us to spend in patient care. That isn’t the system we live in.

Thanks for your service. That sounds like one heck of career. I am curious on why you stuck around so long if your post is how you feel about the system that consumed 30 years of your life.

 

[Correlate Clinically]

Funding, if it is real, will help.

Funding won't matter if the plan is to replace all the AD with CTRs, while not paying enough to actually hire anyone. The current system massively overpays for physician contractors from the DHA side while the actual contractor is typically underpaid, with predictable consequences for recruiting and hiring.

I'm skeptical that they can actually man a health care system with the current DoD/DHA contracting model. Especially not without exorbitant cost. I may be wrong.

The services are also effectively sabotaging DHA (not that DHA isn't full of fault on it's own) by continuing to cut AD medical manpower. DHA doesn't "own" those positions and can't replace them. I have often wondered who they think is going to fill positions in wartime. Maybe they are counting on a draft.

General officers and senior DHA civilians can talk about recapture, quality care, and about how we're going to change course. Until they figure out how to actually put doctors and ancillary staff in the MTFs to treat someone, it is worthless. To date they have done a poor job on that front.

 

[pgg]

Who else is going to do it? If we hire civilians

If we're not going to do the correct thing (move to a mostly reserve medical corps and fold all MTFs into the VA), then the second best thing would be to relieve all medical corps flag officers and yes, hire civilians to run the hospitals and the military healthcare system.

A large portion of the problems in military medicine can be laid directly at the feet of the active duty hospital commanders and the flags they report to. It's not even really their fault - I'm not making character judgments here - it's just that the system is designed badly. It's laughably ridiculous to put people in charge of a hospital for TWO YEARS and then move them to another job. Especially considering that their preparation and training for that job was ... TWO YEARS as the XO serving another TWO YEAR wonder commander. And perhaps TWO YEARS prior to that of being a director somewhere - a job they got because 98% of the other people eligible to do that job were quick enough to hide in a stairwell when the XO was walking the halls looking for someone to Step Up and fill an empty director seat.

Look at every civilian hospital in the country. The people in charge are career administrators are in their late 50s or 60s, having spent the last 3+ decades of their lives working in healthcare administration. A handful are physicians who made the switch mid/early career. We joke about the value of MBAs, but they've all got them, and there's some value to it. Most importantly, they have decades of experience, and they've won the competition vs similar people to get those top jobs. And I mean real competition in real markets with at least some consequences for failure - not the military "competition" that selects nine people for hospital command out of the ten XOs who were interested/eligible.

Now I've got my gripes about healthcare administrators in the civilian world ... oh man do I have a lot of gripes ... but one thing they CAN do is stay enough out of the way of the clinicians that they can run functional, efficient (+/-), busy hospitals full of patients, pathology, and good care.


I've told this story before, but I'll repeat it because it's short and it perfectly encapsulates the structural problems we have with medical corps leadership. When I was an O4 at a small Navy hospital, I was the DSS. (I didn't have even day 1 of any kind of management training, much less a MBA, but I was the guy. My "competition" for selection for that job was an O5 nurse whose resume included being an O4 nurse and an O3 nurse and an O2 nurse and even an O1 nurse.) This was right after the small hospital study came out, and a number of places, including ours, were getting rightsized by closing some inpatient and surgical services and semi-dumping them on the community. I say semi-dumping because the plan was to send our surgeons to the local civilian hospitals to take care of some of those patients under an external resource sharing agreement (ERSA). The surgeons, mind you, not the nurses or the techs or the anesthesiologists or anyone else.

So as DSS, there I was accompanying our CO (an O6 nonphysician) and XO (an O6 nonphysician) as we visited the local hospital and met with their board.

The best analogy I can come up with was Thanksgiving where a couple of kids are allowed to leave the kids' table and go to the adults' table just long enough to ask for some more mashed potatoes.

The imbalance in knowledge, expertise, understanding, was just palpable and quite uncomfortable. My CO and XO were awesome people and I genuinely liked working for them. They were smart and they worked hard and they cared about our hospital and our staff and our patients. (I, as well.) The civilian hospital administrators were gracious and welcoming - they wanted our patients for the sweet, sweet facility fees they'd bring, and I think they wanted to do their part to help out the military and the community.

Again, none of the people involved were bad or lazy or dumb. On the military side, we were just hopelessly unqualified and outclassed. It wasn't imposter syndrome. We were just actual genuine imposters.


Now, raise that dynamic to the Nth power as you climb up the ranks of DHA (and BUMED before them). They've got no business doing what they're doing. They're not bad people, but none of us should be surprised that they've been ****ing it it up nonstop for the last 30 years. Because they're (1) unqualified and (2) 100% beholden to the line which has a different set of needs and definition of "good enough" than we do.

and then change the way MC can promote, sure…more time for each of us to spend in patient care. That isn’t the system we live in.

It's a hard problem. We haven't been progressively failing at it for the last 30+ years because we're not trying and not acting in good faith.

The 1980s model isn't coming back. The solution is to fundamentally change the way the system is set up. I don't believe that will happen, for various political reasons. I do believe the systemic atrophy will continue and I feel for you guys still inside grinding out the days as best you can.

 

[RE-Tired]

Who else is going to do it? If we hire civilians and then change the way MC can promote, sure…more time for each of us to spend in patient care. That isn’t the system we live in.

Thanks for your service. That sounds like one heck of career. I am curious on why you stuck around so long if your post is how you feel about the system that consumed 30 years of your life.

"I am curious on why you stuck around so long if your post is how you feel about the system that consumed 30 years of your life".

That is an excellent question. Difficult to answer in a paragraph but will try with succinct frases.
Intern and Resident at TAMC, with GMO in between finished res, 1990. TAMC was a great training hospital all services represented; I loved it and got great training; when I did my civ fellowship was on par with others on a knowledge basis. Last assignment was Army Med Center, and was there when at 12 years my mil. obligation was completed. Was very happy, loved the hospital and the people there. Did not even try the job market and decided to do the 8 years till Ret. Tricare came, ie. retirees we hate you get the **** out of our mil health care system. Our workload dropped by 40% with a greater loss of interesting pathology. Was not as good but was committed to retirement. Was passed over for O6 (our MOS at that time prom. was less than 50% for O6) but some of being passed over was my fault. Retired and went into private practice - lots more money but less family time. Opportunity to return as CIV and work with many people I knew well. Us CIV drs were treated well- much less BS and leave could not be denied because of uncompleted computer tng. Pay was less but money was never my top goal. Retired second time and DHS implemented after I left. Two years after I left there was only one pathologist (the chief) which is as you know is ore like (0.5) because admin and meetings are the most important thing.

I don't post much militaryPHYS but I read all the MIL ones and I feel like you are a lone voice in the wilderness advocating for the MHS. And deep down I hope you are correct and the MHS is brought back to some of its former glory, but the downslide has been on longterm and will be difficult to stop much less bring back to anything like it once was. And honestly after 4 years I don't know people that are still in the system so it could be better than what is represented here. I hope so.
I praise your efforts.

 

[narcusprince]

Having served as an attending physician both in the military and in civilian practice, I’ve had the opportunity to see the major differences firsthand. One thing stands out above all: the professionalism within the military medical field.

In the military, patient care was always delivered with the best intentions, regardless of staffing levels. Whether we were fully staffed or running short, the entire team consistently worked hard to deliver the highest quality of care. Complaints were rare, and there was a collective focus on the mission.

Another key advantage of military service is the mentorship. If you wanted to advance in your career, there were always mentors available to guide you up the ranks. The system was structured to foster professional development and growth.

On the civilian side, the financial benefits are undeniable—you will almost certainly make more money. However, the work ethic can be inconsistent. I’ve encountered vastly different levels of commitment from individuals, which can make for a less cohesive team environment.

In summary, while both environments have their pros and cons, I’ve found that the camaraderie and professionalism in the military are unmatched, even if the financial rewards are greater in private practice.

 

[militaryPHYS]

Funding, if it is real, will help.

Funding won't matter if the plan is to replace all the AD with CTRs, while not paying enough to actually hire anyone. The current system massively overpays for physician contractors from the DHA side while the actual contractor is typically underpaid, with predictable consequences for recruiting and hiring.

I'm skeptical that they can actually man a health care system with the current DoD/DHA contracting model. Especially not without exorbitant cost. I may be wrong.

The services are also effectively sabotaging DHA (not that DHA isn't full of fault on it's own) by continuing to cut AD medical manpower. DHA doesn't "own" those positions and can't replace them. I have often wondered who they think is going to fill positions in wartime. Maybe they are counting on a draft.

General officers and senior DHA civilians can talk about recapture, quality care, and about how we're going to change course. Until they figure out how to actually put doctors and ancillary staff in the MTFs to treat someone, it is worthless. To date they have done a poor job on that front.

Agree on these points. The DOD services hamstrung DHA from the start. Unfortunately the victims of this are everyone…the physicians because they are pulled to the line with no avenue to maintain their clinical skills, the patients because of inconsistent staffing to run an efficient system, and then the services themselves are impacted because their medical assets eventually won’t know how to practice medicine effectively.

DHA is over here like…”fine, I’ll just spend 43 billion and hire civilians to fill the gaps the services have created”.

"I am curious on why you stuck around so long if your post is how you feel about the system that consumed 30 years of your life".

That is an excellent question. Difficult to answer in a paragraph but will try with succinct frases.
Intern and Resident at TAMC, with GMO in between finished res, 1990. TAMC was a great training hospital all services represented; I loved it and got great training; when I did my civ fellowship was on par with others on a knowledge basis. Last assignment was Army Med Center, and was there when at 12 years my mil. obligation was completed. Was very happy, loved the hospital and the people there. Did not even try the job market and decided to do the 8 years till Ret. Tricare came, ie. retirees we hate you get the **** out of our mil health care system. Our workload dropped by 40% with a greater loss of interesting pathology. Was not as good but was committed to retirement. Was passed over for O6 (our MOS at that time prom. was less than 50% for O6) but some of being passed over was my fault. Retired and went into private practice - lots more money but less family time. Opportunity to return as CIV and work with many people I knew well. Us CIV drs were treated well- much less BS and leave could not be denied because of uncompleted computer tng. Pay was less but money was never my top goal. Retired second time and DHS implemented after I left. Two years after I left there was only one pathologist (the chief) which is as you know is ore like (0.5) because admin and meetings are the most important thing.

I don't post much militaryPHYS but I read all the MIL ones and I feel like you are a lone voice in the wilderness advocating for the MHS. And deep down I hope you are correct and the MHS is brought back to some of its former glory, but the downslide has been on longterm and will be difficult to stop much less bring back to anything like it once was. And honestly after 4 years I don't know people that are still in the system so it could be better than what is represented here. I hope so.
I praise your efforts.

I appreciate the thorough response.

I do advocate for it but only for the very right person. I am very against recruiting in any form in which numbers mean more than quality applicants. I do have time left to pay back so it’s easy for me to just stay positive because it is the system I’m stuck with. However, I do plan to stay past my commitment and make it to 20. But I also do see positive steps forward in certain areas. A ton of work to do but failure is not an option. It will never be an option because we have wars to fight and strategic goals across the world. Somebody has to stay in and support the warfighters but I also have zero judgement for people who get out. Continued service has to work for you and your family, otherwise misery ensues.

 

[MedicalCorpse]

Because they consolidated, cut and deferred so much to get us here today. Now they have to start allocating money to build and improve because they are responsible for the care of DOD forces and other beneficiaries.

The new contract is so much because it is specifically designed to be competitive across different cost of living regions.

Does anyone have any idea what percent is going to be skimmed off the top by these corporations as part of their fiduciary responsibility to their shareholders (or officers, if not a publicly traded company) to maximize profit by any means necessary?

We all know the answer to this rhetorical question.

A Revolution in Military Medical Staffing is Afoot and Private Sector Firms are Playing a Big Part - MedCity News

No revolutionary naval vessels, fighter planes, or weapon systems were involved. Rather, this one was about staffing military healthcare facilities. Make no mistake, though: It’s also revolutionary.

medcitynews.com

In the interest of fairness, and to optimize the refreshing splash of hope in our souls, here are the upbeat press releases and/or web site announcements of all of the rest of the contractors EXCEPT Matrix Providers as they joyously relate their good fortune in being guaranteed to make payroll for the next ten years from this one contract:

Decypher Health Services

https://www.decypher.com/defense-health-agency-medical-q-coded-services-mqs/

(They haven't updated their web site yet to reflect the new contract. They may or may not be currently spending Tim the web developer's salary in Vegas instead to celebrate their good fortune.)

Epic Government (incumbent, also known as Federal Staffing Resources)

Epic Government Secures Spot on DHA’s MQS2-NG IDIQ Contract

KBR

KBR Health and Human Performance Expertise Recognized with Multiple-Award Contract Worth $43 Billion

Loyal Source Government Services

They also have not updated their official web site. However...

Loyal Source Government Services on LinkedIn: Excited for this Opportunity!

(Behind LinkedIn paywall/joinwall, but fear not!)

Loyal Source Government Services’ Post
...
"Excited for this Opportunity!"
View organization page for Loyal Source Government Services, graphic
Loyal Source Government Services

40,097 followers
4mo

"Loyal Source is proud to be one of the awardees of the $43B Defense Health Agency (DHA) Medical Q-Coded Support and Services-Next Generation (MQS2-NG) Unrestricted IDIQ Contract. Awardees have been named to this important 10-year multiple-award IDIQ in support of this enterprise strategic sourcing program that implements a performance-based, strategic sourcing acquisition strategy with respect to entering into contracts for the services of health care professional staff."

Luke & Associates (incumbent)

LUKE Named to 10-Year $43B Defense Health Agency IDIQ for the Medical Q-Coded Support and Services-Next Generation Program

Matrix Providers (incumbent)

(see above)

Optumserve Health Services

Optum Serve recent news and upcoming events

Spectrum Healthcare Resources

Spectrum Healthcare Resources awarded new 10-year contract to deliver health care for active duty and retired military personnel and families

The Arora Group (incumbent)

Arora Wins Spot on 10-Year $43 Billion DHA MQS2-NG Contract - The Arora Group, Inc.

U.S. Got People aka Dilligas Corp

Billy, the high school student who wrote their web site, is currently grounded by his parents (including no internet access) for texting while driving. He is sure to update this URL soon: Home - MY USGP

Vesa Health & Technology (incumbent)

Again, their official page at Vesa Health & Technology | Medical Staffing, IT Consulting is outdated (latest "breaking" news is from 2018), but the happy gouge has been proclaimed here:

https://www.fbodaily.com/archive/2024/05-May/04-May-2024/FBO-07049303.htm

C'mon, let all that optimism gushing from corporate officers raking in truckloads of cash from U.S. taxpayers wash over you all like a healing rain. Now, doesn't that feel better? You can banish from your minds the sour cynicism of Medicalcorpse and his dour predictions of fraud, waste, abuse, and eventual failure.

Instead, revel in the positive vibes of civilian contractors making bank for the next ten years off of this IDIQ (Indefinite-Delivery, Indefinite-Quantity) contract while military surgeons continue to be asked to save money for the line to buy more shiny things by using fewer sutures during surgery (true story, not made up, as some may recall), leaving the rest of the physicians on active and reserve duty to be nickeled and dimed to death over dwindling "buckets of money" which should be petty cash to a U.S. government who can afford to throw BILLIONS of dollars to civilian contractors, not to mention foreign governments.

But I’m probably hoping way too much.

Do you really think so?

All of this looking on the bright side of life reminds me of the famous quote from Admiral Hyman Rickover about optimism.

But I have trouble communicating, so just ignore me.

 

[TheEarDoc]

True, but I have yet to see a hospital system (in the SE) and its legion of employed physicians not take tricare. And I would imagine the bad PR would be incredible if one tried to stop.

My guess is they treat it he same as many private facilities treat Medicaid. So many slots dedicated to Medicaid/TriCare patients per day and have a different wait list for TriCare vs say BCBS

 

[TheEarDoc]

Funding, if it is real, will help.

Funding won't matter if the plan is to replace all the AD with CTRs, while not paying enough to actually hire anyone. The current system massively overpays for physician contractors from the DHA side while the actual contractor is typically underpaid, with predictable consequences for recruiting and hiring.

I'm skeptical that they can actually man a health care system with the current DoD/DHA contracting model. Especially not without exorbitant cost. I may be wrong.

The services are also effectively sabotaging DHA (not that DHA isn't full of fault on it's own) by continuing to cut AD medical manpower. DHA doesn't "own" those positions and can't replace them. I have often wondered who they think is going to fill positions in wartime. Maybe they are counting on a draft.

General officers and senior DHA civilians can talk about recapture, quality care, and about how we're going to change course. Until they figure out how to actually put doctors and ancillary staff in the MTFs to treat someone, it is worthless. To date they have done a poor job on that front.

You hit the nail on the head. No one seems to be thinking about what is coming down the road. Major conflict where there is no actual safe space in the battle space. I don't feel they have enough active duty/Reserve/Guard medical providers for any of the branches to meet even another Afghanistan or Iraq type of scenario and that is not losing many medical folks to enemy attack. Large scale combat? How are we replacing KIA or severely wounded medical providers? They going to just draft every resident in the civilian world? Force DHA providers into active service? VA providers?

 

[TheEarDoc]

If we're not going to do the correct thing (move to a mostly reserve medical corps and fold all MTFs into the VA)

The VA couldn't handle the load. We can't handle the load of patients we have now. I see a mass push of VA patients into the private sector via care in the community which to me just results in the veteran having more hoops to jump through on their end to get care, longer wait times vs. VA care, poorer outcomes, and all at about 3 times the price point. We can't get any staff or positions replaced let alone get new positions created. I wouldn't be a PCP in the VA for what they pay and put up with......

 

[pgg]

The VA couldn't handle the load. We can't handle the load of patients we have now. I see a mass push of VA patients into the private sector via care in the community which to me just results in the veteran having more hoops to jump through on their end to get care, longer wait times vs. VA care, poorer outcomes, and all at about 3 times the price point. We can't get any staff or positions replaced let alone get new positions created. I wouldn't be a PCP in the VA for what they pay and put up with......

I mean the MTFs should become part of the VA, expanding the VA. The MTF facilities, staff (which is largely civilian already!), GME programs, everything - out from under the thumb of the line, which doesn't need, want, or fund a comprehensive healthcare system.

The $43B would better spent manning up those facilities in the VA system, than throwing good money after bad in the MTFs. (I don't have any faith that this initiative will bring patients and pathology back to the MTF system.)

We have two systems with problems, the VA and the MTFs. Both suffer from the government inefficiency curse but only one is actively dying and progressively getting worse at its mission.

Who knows, maybe once we see the light and (1) cut the active duty medical corps to the bone and (2) expand the VA, some of the former AD people will want to work for the VA.

 

[Chonal Atresia]

I mean the MTFs should become part of the VA, expanding the VA. The MTF facilities, staff (which is largely civilian already!), GME programs, everything - out from under the thumb of the line, which doesn't need, want, or fund a comprehensive healthcare system.

The $43B would better spent manning up those facilities in the VA system, than throwing good money after bad in the MTFs. (I don't have any faith that this initiative will bring patients and pathology back to the MTF system.)

We have two systems with problems, the VA and the MTFs. Both suffer from the government inefficiency curse but only one is actively dying and progressively getting worse at its mission.

Who knows, maybe once we see the light and (1) cut the active duty medical corps to the bone and (2) expand the VA, some of the former AD people will want to work for the VA.

None of this matters because neither the VA or DHS pays their doctors worth a s$&@. Our local VA has been without ENT over 10 years. Why would anyone accept $200k/yr when you can cross the street and make $800k by working just slightly harder but with adequate staff? Answer, 10 years of an open position.

They farm it all out to me and I charge a level 4 new visit for 10 minutes of clinic time (if that). I would guess that well over half of referrals are a complete waste. So much waste with the government and throwing $43B more means $43B in debt with nothing to show for it.

Can’t believe some people think a single-payer government run health system is still the answer. Both systemsare train wrecks.

 

[pgg]

None of this matters because neither the VA or DHS pays their doctors worth a s$&@. Our local VA has been without ENT over 10 years. Why would anyone accept $200k/yr when you can cross the street and make $800k by working just slightly harder but with adequate staff? Answer, 10 years of an open position.

They farm it all out to me and I charge a level 4 new visit for 10 minutes of clinic time (if that). I would guess that well over half of referrals are a complete waste. So much waste with the government and throwing $43B more means $43B in debt with nothing to show for it.

Can’t believe some people think a single-payer government run health system is still the answer. Both systemsare train wrecks.

If they're going to throw $43 billion at something, it'd be better spent in the VA than the MTFs. There's no reason why the VA can't pay their doctors more, hire adequate staff, and demand more productivity.

The reason the military can't do the same is because the line controls the spending. There's an enduring fiction that military physicians are officers first and doctors second. It's been a struggle since forever to pay them more than line officers. The line doesn't want a comprehensive healthcare system and they sure don't want to pay for it and they absolutely resent its "overpaid" doctor-officer widgets.

We have two systems now: an undersized, underfunded, underproductive VA - and a MHS in continual decline.

Option 1 - do nothing

Option 2 - this impending $43B boondoggle of contractor fraud/waste/abuse that @MedicalCorpse described so nicely

Option 3 - put those resources into the VA and turn 90%+ of the active duty medical and nurse corps into reservists who can work at busy hospitals with high volumes and get paid well 11 1/2 months out of the year

Option 4 - something else

I'm just saying 3 is a better plan than 1 or 2. I'm all ears for an option 4 though.

 

[militaryPHYS]

It’s not dead yet! ☠️

 

[DrMetal]

It’s not dead yet! ☠️

It should be, let's be honest. Put 'Old Yeller' down.

 

[RE-Tired]

PGG replied "The reason the military can't do the same is because the line controls the spending. There's an enduring fiction that military physicians are officers first and doctors second."

This is not fiction, this is what the medical command believed 40 years ago. Let me illustrate with an anecdote.
When I was a TI at TAMC in 1984 on the med service, I was counselled by the Dep. Chief of Clinical Services (06-prev med MD), because my hair was too long. He asked me what my gig line was. I did not know what a gig line was. Because of course my belt was out of line. He proceeded to lecture me for 10 min that all of my patients (95% of them were not AD) looked at me as a soldier first and a doctor second. I listened and literally thought the man was insane. But as it turned out over the years slowly but surely his lecture became very true.

Anecdote 2: About a year later as a GMO I saw the commanding general of the post at my clinic for a minor ailment. He was so nice and thanked me for seeing him as he was an add on at the end of the day. I felt great. I guess my gig line was perfect. At that time I think the line at least thought we are doctors first. It is my former AMEDD command that loved to think they are real soldiers.

 

[pgg]

PGG replied "The reason the military can't do the same is because the line controls the spending. There's an enduring fiction that military physicians are officers first and doctors second."

This is not fiction, this is what the medical command believed 40 years ago.

Oh, they still believe it. It's still a fiction though. 🙂

Let me illustrate with an anecdote.
When I was a TI at TAMC in 1984 on the med service, I was counselled by the Dep. Chief of Clinical Services (06-prev med MD), because my hair was too long. He asked me what my gig line was. I did not know what a gig line was. Because of course my belt was out of line. He proceeded to lecture me for 10 min that all of my patients (95% of them were not AD) looked at me as a soldier first and a doctor second. I listened and literally thought the man was insane. But as it turned out over the years slowly but surely his lecture became very true.

Leadership absolutely plays the fantasy game about officership first. It's real to them - after all, most of them got those little silver eagles on the collar by shirking medical responsibilities and being officers full time. The good ones pay just enough attention to it to function within the system, but keep their doctor souls intact. For the rest of us, and the patients especially, being a doctor was first, second, and third.

Anecdote 2: About a year later as a GMO I saw the commanding general of the post at my clinic for a minor ailment. He was so nice and thanked me for seeing him as he was an add on at the end of the day. I felt great. I guess my gig line was perfect. At that time I think the line at least thought we are doctors first. It is my former AMEDD command that loved to think they are real soldiers.

It's funny, my Marine CO when I was a GMO was all about me being a doctor. He said he had a couple dozen officers but just two doctors.

It was the goofballs at Field Med Service School (orientation for intern grads assigned to the Marine group or division as GMOs) who pushed the officer-first BS so hard.


Higher up in the flag line community, the medical widgets are perceived as just fine. They look at deploying units that are sufficiently manned with medical support, and they look at historically awesome battlefield casualty survival rates, and sometimes they even notice that dependents are delivering babies and getting adequate care, and they call the system good enough.

I am frankly astonished that this $43B materialized out of somewhere. I hope it helps, I really do. I just can't help but believe we're trying to prop up a model that was doomed and obsolete with the first big cuts made way back when the Berlin Wall came down.

 

[HighPriest]

PGG replied "The reason the military can't do the same is because the line controls the spending. There's an enduring fiction that military physicians are officers first and doctors second."

This is not fiction, this is what the medical command believed 40 years ago. Let me illustrate with an anecdote.
When I was a TI at TAMC in 1984 on the med service, I was counselled by the Dep. Chief of Clinical Services (06-prev med MD), because my hair was too long. He asked me what my gig line was. I did not know what a gig line was. Because of course my belt was out of line. He proceeded to lecture me for 10 min that all of my patients (95% of them were not AD) looked at me as a soldier first and a doctor second. I listened and literally thought the man was insane. But as it turned out over the years slowly but surely his lecture became very true.

Anecdote 2: About a year later as a GMO I saw the commanding general of the post at my clinic for a minor ailment. He was so nice and thanked me for seeing him as he was an add on at the end of the day. I felt great. I guess my gig line was perfect. At that time I think the line at least thought we are doctors first. It is my former AMEDD command that loved to think they are real soldiers.

I’ve said it before, but: I was in the OR at 0600 on call with a pediatric patient sleeping on the table, doing surgery on this patient, when the hospital nurse commander came in to the OR in a bunny suit and angrily demanded to know why I had no showed my UA that morning (I was a half hour late). This would have been my 9th/13 UA that calendar year. I told her it was because I was operating on this kid (indicating the sleeping kid a foot in front of me). She told me I needed to scrub out and go pee in a cup. I told her I wouldn’t do that, but I would be happy to do it after I’m done with the active surgery I was doing. She didn’t like that, but fortunately the anesthetist I was working with and the circulating nurse all chimed in that it wasn’t safe for me to just leave.

So, yeah, soldier first.

But I think pgg is saying that practically not many actual medical officers feel or act that way. Unless they’ve drown in the kool aid. But there is definitely strife created between those two mindsets.

 

[HighPriest]

It’s funny though, none of them seem to feel that way when they come in for medical care. suddenly they want you to be a doctor full time.

It’s like the yokels making our anesthesiologists monitor how much sevo they’re giving so that they can track the individual providers effect on global warming.

Great. So when you need your gallbladder out, are you ok limiting what your anesthesiologist can give you? Or is this only a thing when you’re not the patient?

 

[DrMetal]

the hospital nurse commander came in to the OR in a bunny suit

Great visual. Did she belong in a bunny suit, or was she a typical miliary nurse with a 'thyroid' problem?

 

[HighPriest]

Great visual. Did she belong in a bunny suit, or was she a typical miliary nurse with a 'thyroid' problem?

She probably didn’t work in actual clinical healthcare long enough to “fill the barn”.