Report: Quality of Care Suffers at Smaller Military Hospitals

Tuesday, 02 Sep 2014 12:06 PM

By Jennifer G. Hickey

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The inefficiencies and poor quality of care at some veterans hospitals is well documented, but a new report by The New York Times has found the care provided to active service members at smaller military hospitals may be placing patients at risk.

"Inexperienced doctors often assume outsize responsibilities because military policies encourage more experienced and ambitious clinicians to become administrators. Continuity, so crucial to medical care, is lost as hospital commanders and doctors, as well as patients, constantly rotate from post to post. The wars in Iraq and Afghanistan have taken an especially heavy toll: With many military doctors and nurses overseas, hospitals have been forced to shunt patients to civilian care, leaving empty beds and out-of-practice medical staffs," the Times reports.

The paper conducted a number of interviews with patients, health experts, and outside analysts. The paper noted that it is difficult to accurately assess performance of the hospitals within the system because the Pentagon "either does not collect or does not rigorously analyze" crucial data.

An earlier Times investigation uncovered Pentagon statistics showing that compared to civilian hospitals, military hospitals had higher than expected rates of harm and complications when it came to maternity care and surgery.

More than 50,000 babies are born at military hospitals each year, but were twice as likely to be injured during delivery as babies born at civilian hospitals, the Times reported.

"You are constantly losing momentum, constantly losing traction, and that relates directly to patient safety and quality of care," one former hospital commander told the Times on condition of anonymity. "What civilian health organization rotates their CEO every two years? There is no continuity, no institutional memory."

Just as is the case in the civilian sector, defense healthcare costs have greatly increased in recent years.

Between 2000 and 2012, funding for military healthcare increased by 130 percent, over and above the effects of overall inflation in the economy. In 2000, funding for healthcare accounted for about 6 percent of the Pentagon's base budget; by 2012, that share had reached nearly 10 percent, according to Congressional Budget Office (CBO) estimates.

On May 28, Secretary of Defense Chuck Hagel announced the Pentagon would embark on a 90-day review of the military health system with a focus on access to healthcare, safety of care, and quality of care.

"Following the review, the secretary will receive recommendations on areas for improvement with a specific focus on those areas where we are not meeting a nationally defined standard or a DoD policy directed standard," Pentagon Press Secretary Rear Adm. John Kirby said in a statement.

A final report was scheduled to be provided to Hagel by Aug. 29.

In October 2013, the Pentagon established the Defense Health Agency in an attempt to standardized healthcare in the Defense Department by establishing common business processes and clinical practices for the Army, Navy, and Air Force.

"There are some very important and wonderful things coming out of this new approach to enterprise management of the Military Health System," Dr. Jonathan Woodson, the assistant secretary of defense for health affairs, said in a recent interview.

"The establishment of the [DHA] was probably one of the most important transformative changes in the Military Health System in five decades, and it was due," Woodson added.

Increased spending, however, does not always equate to improved care. A June report by the Institute of Medicine found that the Defense Department spent $789.1 million on post-traumatic stress disorder (PTSD) treatment from 2010 through 2012, and the Veterans Administration spent $8.5 billion. But neither agency could assess whether the treatment was effective because of a lack of data collection and analysis, according to a report by NextGov.


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